‘Health MOTs’ planned for people aged 65 and over arriving at A&E in England

People aged 65 and over arriving at A&E in England who appear frail will soon receive a “health MOT at the front door”, the head of the NHS will pledge.

A&E units must start giving everyone that age a battery of tests to see if they are frail or have any other underlying condition and then arrange whatever care they may need.

NHS England hopes the initiative will reduce the number of older people being admitted to hospital, and cut overcrowding, “trolley waits” and “corridor care”.

Amanda Pritchard, the organisation’s chief executive, will tell an audience of health service heads on Wednesday they must ensure by next April that all A&E units start offering detailed assessments of older people’s health. However, the service will only operate for 10 hours a day.

“Health MOTs at the front door of A&Es for older people could be a lifeline for many. From blood pressure tests to a review of their falls history, these checks mean patients can be assessed quickly and directed to the right support for their needs,” Pritchard will say.

“While some people do need to be admitted, it isn’t always the most suitable place for older patients’ needs, and they can also rapidly lose mobility while in hospital.”

The initiative is an effort by the NHS to change the way care is given to relieve the pressure on hospitals and adapt to the increasing demands of an ageing population.

Assessing frailty is important because falls and the resulting injuries, such as broken bones, are one of the most common reasons for many older people to spend time in hospital.

“Half of hospital inpatients aged over 65 are affected by frailty, and the growing number of people with frailty will have a significant impact on future health and care services,” said Sir Julian Hartley, the chief executive of NHS Providers.

Despite some hospital and community services providing innovative care for such people, “too many frail people who need well-planned, joined-up care still aren’t getting the support they need”, Hartley added.

The checks will also involve tests of older patients’ heart health, mobility, risk of malnutrition and of any history of breathing problems. Anyone deemed at risk of a fall will be referred to the hospital’s falls service while those with other needs will receive care from specialist teams, such as those looking after people with dementia.

More than a million people over 75 are admitted to hospital every year in England and about one in five are severely frail. Doctors are worried that older patients undergo “deconditioning” while they are an inpatient and lose muscle mass, which can heighten their risk of falling and being readmitted to hospital soon afterwards.

Some hospitals are already giving older patients the “MOTs” that will become standard by next spring.

For example, the acute frailty assessment unit at the Princess Royal hospital in Orpington, Kent, now gives a frailty score to more than nine out of 10 patients it admits aged 65 or over. That has helped the hospital get more patients home early and has doubled the proportion of those discharged home within a week.

A clinical nurse specialist based in its A&E identifies frail older people while the frailty team works closely with the London ambulance service, community health services and local GPs.

However, A&E doctors cautioned that the checks could obscure what they believe are the real reasons so many people end up in A&E and often have to wait a long time to be treated.

“Focusing on interventions such as this distracts from the root causes of long waits in emergency departments. These include a lack of staffed beds, and difficulties discharging patients because social care and community-based services are in such difficulty,” said Dr Ian Higginson, the vice-president of the Royal College of Emergency Medicine.

“Unless these fundamental problems are addressed, we will continue to see long waits in our EDs [emergency departments], with patients continuing to come to harm as a result.” There was no evidence that frail patients contributed to A&E overcrowding, he added.


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