Abstract
The challenge to the sustainability of the NHS is unlikely to fade. With an increasingly elderly population, and accompanying multiple morbidity, the pressures to deliver a high-quality, high-value service will outlast the current efficiency drive. Any five-year forward view requires to be mindful of demographic changes beyond the next five years. Do the answers lie in expensive high-tech solutions or low-cost simple interventions?
Research can help guide future policy but research is a time-consuming enterprise and rarely offers up a quick answer. Policy makers favour rapid evaluations that often don’t stand methodological scrutiny and are designed to best serve political timelines. The balance between producing evidence quickly and ensuring it is rigorous is a difficult one. The best research available may not be the most ideal research, but it can be a starting point for a serious debate on questions that are hard to study. Let’s take residential care homes for instance. We know already that health professionals have concerns about the quality of care in such homes in the UK. Elderly people may be neglected by health services in comparison with elderly people living in their own homes.
With this in mind, Anthony Wolff et al. focus on dehydration, exploring the association between hypernatraemia and residence in care homes. 1 Data are scarce, and this month’s study based in one NHS Trust in London is the most robust evidence we have on this controversial topic. Worryingly but perhaps unsurprisingly, Wolff et al. find that patients admitted to hospitals from care homes have a 10-fold higher prevalence of hypernatraemia than those admitted from their own homes. Further still, these patients also have double the risk of in-hospital mortality.
The authors argue that a follow-up intervention study is required, involving education and active encouragement of water intake in care homes. The benefits from such an intervention, both for patients’ well-being and healthcare costs, might be considerable. In our 4G-Internet-of-Things-World we strive for expensive high-tech solutions to even the most minor clinical problems. The welfare of patients is generally better served by investing in simple preventative measures.