tag:theconversation.com,2011:/fr/topics/hospital-admissions-6707/articlesHospital admissions – The Conversation2024-02-01T19:04:50Ztag:theconversation.com,2011:article/2221482024-02-01T19:04:50Z2024-02-01T19:04:50ZE-scooters are linked with injuries and hospital visits – but we can’t say they are riskier than bikes yet<figure><img src="https://images.theconversation.com/files/572055/original/file-20240130-19-6isy51.jpg?ixlib=rb-1.1.0&rect=20%2C40%2C6689%2C4426&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/girl-in-pink-dress-riding-kick-scooter-on-road-during-daytime-7f6dk5M2XMs">JavyGo/Unsplash</a></span></figcaption></figure><p>E-scooters are a popular new feature of urban mobility, offering an <a href="https://www.sciencedirect.com/science/article/pii/S1361920922001560">eco-friendly</a> solution with <a href="https://www.nature.com/articles/s41560-022-01135-1">zero exhaust emissions</a> and agility in city spaces. They make an attractive option for <a href="https://www.sciencedirect.com/science/article/pii/S0965856420306522">“last-mile” commuting</a> — bridging the gap between public transport and final destinations. </p>
<p><a href="https://theconversation.com/five-years-on-brisbanes-e-scooters-and-e-bikes-are-winning-over-tourists-and-residents-as-they-open-up-the-city-212464">Tourists</a> like them, too, as <a href="https://theconversation.com/wallets-on-wheels-city-visitors-who-use-e-scooters-more-spend-more-161886">a convenient way to explore new cities</a>.</p>
<p>Launched in Singapore in 2016, the global electric scooter market is valued at more than <a href="https://www.grandviewresearch.com/industry-analysis/electric-scooters-market">US$33.18 billion</a> (A$49 billion) and is growing each year by around 10%.</p>
<p>More than 600 cities globally have embraced e-scooter sharing programs, yet reactions to these micro-mobility vehicles vary, making them a <a href="https://x.com/cyclecollective/status/1519180314853011456?s=20">contentious</a> urban planning issue. </p>
<p>Cities such as <a href="https://www.levyelectric.com/resources/cities-that-have-banned-electric-scooters%3A-a-comprehensive-list">San Francisco and Madrid</a> initially banned e-scooters, citing safety and public space concerns, but later introduced regulations for their use. <a href="https://x.com/guardian/status/1593352770521899010?s=20">Paris</a> conducted a <a href="https://x.com/AFP/status/1642725442556932096?s=20">referendum</a>, resulting in an e-scooter ban. </p>
<p>In Australia, the response has been more welcoming, though regulations differ across states and territories. What do we know about how safe e-scooters are? And what can we learn from other cities?</p>
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Read more:
<a href="https://theconversation.com/e-scooters-are-becoming-wildly-popular-but-we-have-to-factor-in-the-weather-190917">E-scooters are becoming wildly popular – but we have to factor in the weather</a>
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<h2>More e-scooters means more injuries</h2>
<p>The growing popularity of e-scooters worldwide, including in Australian cities, has been mirrored by a significant rise in related <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ans.18814">injuries and hospital admissions</a>. </p>
<p>Most of <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2795144">these incidents</a> involve males in their late 20s or early 30s, commonly sustaining head, face and limb injuries. There is consistently low helmet use in those injured. Also, about 30% of people who go to hospital with e-scooter injuries have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204371/">elevated blood alcohol levels</a>. Crashes involving <a href="https://www.nature.com/articles/s41598-022-25448-z">riders under the influence of alcohol</a> are associated with more severe head and face injuries.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ans.18814">A study</a> examining data from the Royal Melbourne Hospital reported 256 e-scooter-related injuries in the year to January 2023 – including nine pedestrians – with a total hospitalisation cost of A$1.9 million. </p>
<p>In <a href="https://www.racq.com.au/latest-news/news/2023/12/ns191223-data-shows-e-scooter-riders-still-not-taking-safety-seriously">Queensland</a>, e-scooter-related presentations to hospitals rose from 279 in 2019 to 877 in 2022. By September of 2023, this figure had already reached 801 (full-year figures weren’t available yet). Similar trends are seen in almost every city that has introduced e-scooters. </p>
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<a href="https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571795/original/file-20240129-15-jxxvsl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Data source: Royal Automobile Club of Queensland.</span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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Read more:
<a href="https://theconversation.com/thinking-of-swerving-high-fuel-prices-with-an-e-scooter-or-e-bike-5-crucial-questions-answered-179563">Thinking of swerving high fuel prices with an e-scooter or e-bike? 5 crucial questions answered</a>
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<h2>But are e-scooters riskier than other transport?</h2>
<p>All modes of transport come with inherent safety risks. While <a href="https://onlinelibrary.wiley.com/doi/10.1111/ans.18538">trauma patient records in Western Australia</a> show an almost 200% annual increase between 2017 and 2022 in e-scooter related admissions, these figures still remain well below those for cyclist injuries.</p>
<p>We need to understand the <em>relative risk</em> of e-scooters – a newcomer to the mobility market – and compare it to other established forms of transport. A proper assessment also considers <em>exposure</em> – the total number of trips and the distance covered.</p>
<p>A <a href="https://www-sciencedirect-com.wwwproxy1.library.unsw.edu.au/science/article/pii/S0033350622000646?ref=cra_js_challenge&fr=RR-1">study</a> in the United Kingdom, incorporating exposure factors using data from an e-scooter rideshare operator and hospital admissions combined, indicates that although hospital presentations increased during the e-scooter trial period, the injury rate was comparable to that of bicycles.</p>
<p>But it might be a different story when it comes to the severity of injuries. Some studies suggest a higher incidence of <a href="https://injuryprevention.bmj.com/content/29/2/121.abstract">severe trauma among e-scooter users</a> compared to cyclists. One <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2806716">study</a> of more than 5,000 patients treated at a major trauma centre in Paris found that, while the mortality rate from e-scooter crashes wasn’t higher than that of bicycles or motorbikes, the risk of severe traumatic brain injuries was slightly higher than bicycles (26% compared to 22%).</p>
<p>There is <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2795144">evidence</a> e-scooter riders tend to engage in significantly more risky behaviour than cyclists. Compared to injured bicyclists, those injured while riding e-scooters: </p>
<ul>
<li>tend to be younger </li>
<li>are more frequently found to be intoxicated </li>
<li>exhibit a lower rate of helmet use </li>
<li>and are more commonly involved in accidents at night or on weekends.</li>
</ul>
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Read more:
<a href="https://theconversation.com/whos-liable-if-youre-injured-or-killed-riding-an-e-scooter-187436">Who's liable if you're injured or killed riding an e-scooter?</a>
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<h2>We can make them safer</h2>
<p>Mitigating safety risks of e-scooters requires consistent <a href="https://www.sciencedirect.com/science/article/pii/S2210670722006175">regulation</a>, stricter enforcement of rules, and <a href="https://theconversation.com/if-e-scooter-riders-are-breaking-the-law-its-mostly-because-they-dont-know-what-it-says-219453">user education</a> about safe scootering. This includes restrictions on usage times, rider age restrictions, mobile phone and headphone use, riding under the influence of drugs or alcohol, speed limits, helmet use and carrying passengers.</p>
<p>The cooperation of e-scooter companies is crucial in enhancing safety. They could curb risky behaviours and enforce the rules. This could be done with simple devices to make scooters automatically stick within speed limits, <a href="https://www.tiktok.com/@abcnewsaus/video/7322301343421451527">sobriety tests before operation</a> or detecting and preventing <a href="https://www.theguardian.com/australia-news/2023/aug/11/melbourne-e-scooters-will-shout-at-riders-in-no-go-areas-deputy-mayor-says">tandem riding</a>. More advanced options could include technology to require helmet use for scooter activation.</p>
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<a href="https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="bank of e-scooters on city footpath" src="https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572057/original/file-20240130-24-4cw8wc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Better infrastructure could make e-scooters safer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/melbourne-australia-november-20-2022-shared-2281810191">Shutterstock</a></span>
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<h2>Safety in numbers</h2>
<p>Data on the total number of rides and coverage, as well as recording of accidents, is needed. Access to this detailed information would offer a clearer understanding of the actual accident and injury risks associated with e-scooters than the news headlines.</p>
<p>And let’s not overlook the “<a href="https://injuryprevention.bmj.com/content/21/4/271.short">safety in numbers</a>” effect. In the world of urban mobility, e-scooters are currently “the small fish in a big pond”. As the demand for e-scooters grows, they may find their place in our city planning and infrastructure design. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0014292123002210">Across Europe</a> cities with limited cycling infrastructure have seen the largest increase in e-scooter accidents. Cities with lots of bike lanes showed no significant effect. </p>
<p>The path to safer e-scootering might lie in the development of more friendly infrastructure. As the ridership grows, safety investments should follow, and that can make the future of e-scootering less risky for everyone.</p><img src="https://counter.theconversation.com/content/222148/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Milad Haghani receives funding from the Australian Research Council (Grant No. DE210100440).</span></em></p><p class="fine-print"><em><span>Clara Zwack does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The growing popularity of e-scooters has seen a surge in related injuries. They may not be more common than cycling injuries – but they may be more serious.Milad Haghani, Senior Lecturer of Urban Mobility, Public Safety & Disaster Risk, UNSW SydneyClara Zwack, Lecturer in Physiotherapy, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092572023-07-20T09:02:31Z2023-07-20T09:02:31ZPandemic healthcare disruptions led to more preventable hospital admissions – new research<figure><img src="https://images.theconversation.com/files/536558/original/file-20230710-15-wlbok3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pensive-senior-man-sitting-on-hospital-2314256183">Drazen Zigic/Shutterstock</a></span></figcaption></figure><p>It’s well known that the COVID pandemic created <a href="https://theconversation.com/five-ways-the-pandemic-has-affected-routine-medical-care-184712">unprecedented disruption</a> in how healthcare was provided and delivered globally. With the emergency phase of the pandemic now behind us, it’s important to understand if and how these disruptions affected people’s health.</p>
<p>In a <a href="https://www.bmj.com/content/382/bmj-2023-075133">new study</a> published in the BMJ, my colleagues and I have shown that people who were disrupted in accessing healthcare in England were more likely to be hospitalised for preventable conditions.</p>
<p>In England, non-emergency treatment, surgeries and diagnostic tests were postponed or cancelled. Appointments <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(21)00279-X/fulltext">were moved online</a>. Some treatment options were changed <a href="https://theconversation.com/coronavirus-has-forced-us-to-embrace-digital-healthcare-it-could-transform-how-we-look-after-patients-138557">to allow for their safe delivery</a> (for example, <a href="https://emj.bmj.com/content/39/8/575">monitoring blood oxygen levels</a> at home allowed people to be discharged earlier). Many of these changes were necessary to build capacity for treating COVID patients. </p>
<p>Meanwhile, staff <a href="https://theconversation.com/burned-out-heroes-why-bedside-nurses-should-not-have-to-be-martyrs-to-be-valued-184505">burnout</a> and <a href="https://theconversation.com/covid-19-2020-was-horrendous-for-health-workers-early-2021-was-even-worse-159503">illness</a> due to COVID or long COVID reduced the number of available healthcare workers.</p>
<p>Patients were also deterred from seeking healthcare, either for fear of being exposed to the virus or altruistic behaviour in not wanting to be a burden at a time of crisis. </p>
<p>While much of this was described at the time, there has been no empirical evidence that we know of to demonstrate the health effects of this disruption. We simply did not know how bad, if at all, this disruption would be. </p>
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Read more:
<a href="https://theconversation.com/coronavirus-has-forced-us-to-embrace-digital-healthcare-it-could-transform-how-we-look-after-patients-138557">Coronavirus has forced us to embrace digital healthcare – it could transform how we look after patients</a>
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<h2>Reviewing the data</h2>
<p>To investigate this, we used data on 29,276 people from seven large studies in England between March 1 2020 and August 25 2022. Each study sent several surveys to their participants during the pandemic to hear about their experiences, including in accessing healthcare.</p>
<p>People who participated in these surveys were then linked to their medical records by something called the <a href="https://ukllc.ac.uk/">UK Longitudinal Linkage Collaboration</a>. This provided us with a powerful way to see whether people who reported any disrupted healthcare were more or less likely to be hospitalised. </p>
<p>We focused on so-called “avoidable hospitalisations”. These are conditions that could have potentially been prevented with adequate access to healthcare (for example, gastric ulcers, angina and asthma).</p>
<p>We found that 35% of people had experienced some form of disruption in accessing healthcare during the first year of the pandemic. Some 26% of people had trouble accessing appointments (for example, visiting their GP or an outpatient department). And 18% were disrupted in receiving procedures (for example, postponed or cancelled surgery, changes to treatments offered or delays in accessing cancer treatment).</p>
<p>People who had faced any level of disruption were 80% more likely to be admitted to hospital for a potentially preventable condition up to the end of the study period. The effects were consistent when looking at short-term issues (such as gastric ulcers, dental problems and cellulitis) and chronic conditions (such as asthma, angina and high blood pressure).</p>
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<img alt="A number of patients and staff in a healthcare setting wearing masks." src="https://images.theconversation.com/files/536570/original/file-20230710-25-6w6bzg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536570/original/file-20230710-25-6w6bzg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536570/original/file-20230710-25-6w6bzg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536570/original/file-20230710-25-6w6bzg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536570/original/file-20230710-25-6w6bzg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536570/original/file-20230710-25-6w6bzg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536570/original/file-20230710-25-6w6bzg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Routine healthcare changed significantly at the height of the pandemic.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-senior-patient-going-hospital-examination-1804803289">DC Studio/Shutterstock</a></span>
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<p>When we looked at which type of disruptions mattered most, our analyses suggested disruption to procedures was particularly significant. Disruptions in accessing appointments were also important. </p>
<p>Not everything was bad. Disrupted access to medications was uncommon (occurring for 6% of people) and we didn’t find meaningful associations between these experiences and hospital admissions. </p>
<p>Our study did have some limitations. Measuring the effects of healthcare disruption is hard. Linking specific moments of disruption to hospital admissions is impossible. Not all hospital admissions will have been due to disruptions in accessing care – some will have occurred anyway. </p>
<p>It’s also plausible that the full effects of disruption may not have occurred yet – it could take years to understand the total impact. For example, delays in cancer diagnosis due to postponed screening programmes might lead to poorer survival rates five years later if cancers are caught at later stages where they’re harder to treat.</p>
<h2>What can we learn?</h2>
<p>What we need to be doing now is learning about what worked and what didn’t in managing the COVID pandemic to help us prepare for the next pandemic. Our study suggests the importance of maintaining continued care, particularly in delivering treatments and procedures.</p>
<p>It’s of course easier to move GP appointments online than surgeries or treatments that need to be delivered in person. But focusing on preventing disruptions in delivering treatments is important in preparing for future pandemics.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-ways-the-pandemic-has-affected-routine-medical-care-184712">Five ways the pandemic has affected routine medical care</a>
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</em>
</p>
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<p>Our study also raises important questions about the need to clear backlogs of treatments, diagnostic tests, procedures and appointments. The NHS waiting lists <a href="https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/rtt-waiting-times-march-2023/">are at record levels</a> and we cannot continue to let them grow.</p>
<p>A challenging economy coupled with chronic under-investment in staff and infrastructure is going to make tackling these waiting lists and the longer-term effects of COVID disruption difficult. Ultimately, we need to increase <a href="https://theconversation.com/the-nhs-workforce-plan-is-a-good-start-but-a-lot-of-detail-is-missing-208886">investment in the NHS</a> to counter the legacy of COVID disruptions to healthcare.</p><img src="https://counter.theconversation.com/content/209257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work was funded by the Medical Research Council, NHS Research Scotland, the Scottish Government Chief Scientist Office, Health Data Research UK and the National Institute for Health and Care Research. </span></em></p>About 35% of people in England faced some form of disruption to healthcare access during the pandemic.Mark Green, Reader in Health Geography, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1750992022-01-21T11:49:57Z2022-01-21T11:49:57ZFour surprising ways climate change is affecting people’s health in England and Wales<figure><img src="https://images.theconversation.com/files/441285/original/file-20220118-15-1n7axyd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6016%2C4016&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/burning-hot-sunset-on-uk-motorway-1455388946">Jevanto Productions/Shutterstock</a></span></figcaption></figure><p>When you take age out of the equation, temperature-related deaths are on the decline in England and Wales. That’s according to the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/climaterelatedmortalityandhospitaladmissionsenglandandwales/2001to2020">latest figures</a> from the Office for National Statistics (ONS). But more people are going to hospital, compared with 20 years ago.</p>
<p>It turns out, that’s not the only surprise in this new report. Here’s how else climate change is affecting health in Britain.</p>
<h2>1. Deaths during heatwaves are increasing</h2>
<p>By reporting the number of climate-related deaths per 100,000 people for each age cohort, the study effectively hid the influence of age, making factors like temperature easier to compare over time. </p>
<p>Looking at the <a href="https://www.gov.uk/government/statistics/excess-mortality-in-english-regions">excess mortality rate</a> instead tells us how deaths linked to a certain cause – such as heart disease or road traffic accidents – have increased compared with the average death rate over the last five years. Using this measure reveals that <a href="https://www.gov.uk/government/publications/phe-heatwave-mortality-monitoring/heatwave-mortality-monitoring-report-2020">excess deaths</a> of all causes have increased in Britain during heatwaves since 2001, especially among people over 65. </p>
<figure class="align-center ">
<img alt="A digital thermometer displays 38°C in front of a row of terraced houses." src="https://images.theconversation.com/files/441106/original/file-20220117-23-95jx20.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4900%2C3264&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441106/original/file-20220117-23-95jx20.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441106/original/file-20220117-23-95jx20.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441106/original/file-20220117-23-95jx20.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441106/original/file-20220117-23-95jx20.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441106/original/file-20220117-23-95jx20.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441106/original/file-20220117-23-95jx20.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Temperatures broke 38.7°C in July 2019 in England.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/digital-thermometer-london-showing-temperatures-during-2010154742">DRG Photography/Shutterstock</a></span>
</figcaption>
</figure>
<p>Despite this, the weighted death rate is lower today than two decades ago, perhaps because of better <a href="https://www.oecdbetterlifeindex.org/countries/united-kingdom/#:%7E:text=The%20United%20Kingdom%20ranks%20above,work%2Dlife%20balance%20and%20housing.">living conditions</a> and an <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020">increase in life expectancy</a> more generally. </p>
<h2>2. Respiratory deaths up on hot and cold days</h2>
<p>Deaths from respiratory diseases have increased on cold days as well as warm ones since 2001 according to the ONS report. </p>
<p>One reason for this may be that these weather conditions are often associated with higher levels of air pollution. The wood-burning stoves some homes use during colder weather are now a bigger source of <a href="https://www.theguardian.com/environment/2021/feb/16/home-wood-burning-biggest-cause-particle-pollution-fires">fine particulate pollution</a> (38%) than road traffic in the UK.</p>
<p><a href="https://www.metoffice.gov.uk/weather/learn-about/weather/how-weather-works/high-and-low-pressure/blocks#:%7E:text=Blocks%20are%20areas%20of%20high,eastward%20progression%20of%20pressure%20systems.">Settled periods</a> in the atmosphere often give rise to clear skies and lots of sunshine which can cause <a href="https://acp.copernicus.org/preprints/acp-2021-297/acp-2021-297.pdf">heatwaves</a>. The air pressure systems causing this also allow pollution to accumulate overhead as the air <a href="https://uk-air.defra.gov.uk/library/assets/documents/reports/aqeg/fullreport.pdf">remains trapped</a> – exacerbating respiratory illnesses. </p>
<h2>3. Drowning is a leading cause of death on hot days</h2>
<p>More people died from drowning on hot days than of heat stroke annually between 2001 and 2020. There were around 22 extra <a href="https://www.itv.com/news/2021-07-23/warnings-issued-after-at-least-20-water-deaths-amid-uk-heatwave">drowning deaths during hot weather</a> in summer 2020 compared with 2001 in England and Wales. And despite a fall in the overall number of people dying <a href="https://www.nationalwatersafety.org.uk/media/1005/uk-drowning-prevention-strategy.pdf">annually from drowning since 2001</a>, there has been an uptick since 2019.</p>
<p>Many of these cases may involve people who bathed in rivers or the sea to escape the heat. Jumping into cold water when your body is hot can cause it to <a href="https://www.local.gov.uk/about/news/heatwave-bathers-warned-drowning-risk-following-recent-deaths">go into shock</a>, and drowning is a <a href="https://www.nationalwatersafety.org.uk/media/1005/uk-drowning-prevention-strategy.pdf">leading cause of accidental death</a> in the UK. More people died as a result of recreational swimming in the last 20 years than flooding. </p>
<p>The increasing popularity of wild swimming may be responsible,
and should prompt better information on rivers and beaches to alert people <a href="https://www.nationalwatersafety.org.uk/news/posts/2021/may/public-urged-to-respect-the-water-as-new-statistics-show-drowning-deaths-increased-last-year-with-more-dying-inland-than-around-the-coast">to the risks</a>. </p>
<figure class="align-center ">
<img alt="Two people bathe in a river out of focus." src="https://images.theconversation.com/files/441287/original/file-20220118-19-1dhiikm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441287/original/file-20220118-19-1dhiikm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441287/original/file-20220118-19-1dhiikm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441287/original/file-20220118-19-1dhiikm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441287/original/file-20220118-19-1dhiikm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441287/original/file-20220118-19-1dhiikm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441287/original/file-20220118-19-1dhiikm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wild swimming can be pleasant in hot weather – so long as bathers are careful.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wild-swimming-children-out-focus-nature-1743939233">Lois GoBe/Shutterstock</a></span>
</figcaption>
</figure>
<h2>4. Warm weather is raising hospital admissions</h2>
<p>The number of hospital patients admitted during cold weather has fallen over the last 20 years as winters in the UK have become milder. This is despite winter months being known as the busiest for hospitals. In comparison, the number of people admitted with a condition related to high temperatures, such as heat stroke in warm weather has increased by 12,086 a year on average for the past decade. </p>
<p>There were 2,325 more patients admitted for mental health treatment in the warmest four months of the year (June, July, August and September) in 2018 compared with when the records began in 2010 in England as well. Heatwaves tend to <a href="https://theconversation.com/heatwaves-dont-just-give-you-sunburn-they-can-harm-your-mental-health-too-121203">make mental illness worse</a>, as our bodies produce more of the stress hormone cortisol in extreme heat. But this finding alone is not enough to indicate a trend of increasing hospitalisations for mental health treatment since 2010.</p>
<p><a href="https://www.nhs.uk/conditions/dehydration/">Dehydration</a> was a leading cause of hospital admissions up to 2018 and around 800 more people were admitted to hospital due to dehydration on average in England in 2018 compared with a decade earlier in 2010. However, the report does not indicate an increasing trend since 2010.</p>
<p>Climate change will become a bigger influence on human health in <a href="https://theconversation.com/one-in-three-heat-deaths-since-1991-linked-to-climate-change-heres-how-else-warming-affects-our-health-161761">all regions of the world</a> in the future. This report suggests that the health consequences of Britain’s climate warming have been relatively mild so far. But that is not a cause for complacency.</p>
<hr>
<figure class="align-right ">
<img alt="Imagine weekly climate newsletter" src="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><em>Don’t have time to read about climate change as much as you’d like?</em></strong>
<br><em><a href="https://theconversation.com/uk/newsletters/imagine-57?utm_source=TCUK&utm_medium=linkback&utm_campaign=Imagine&utm_content=DontHaveTimeTop">Get a weekly roundup in your inbox instead.</a> Every Wednesday, The Conversation’s environment editor writes Imagine, a short email that goes a little deeper into just one climate issue. <a href="https://theconversation.com/uk/newsletters/imagine-57?utm_source=TCUK&utm_medium=linkback&utm_campaign=Imagine&utm_content=DontHaveTimeBottom">Join the 10,000+ readers who’ve subscribed so far.</a></em></p>
<hr><img src="https://counter.theconversation.com/content/175099/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chloe Brimicombe receives funding from NERC through the SCENARIO DTP and the University of Reading. She is seconded to ECMWF and works as an analyst with the Hidalgo project. She is associated with the Walker Institute and Evidence for Development.</span></em></p>A new report uncovers how temperature-related deaths and hospital admissions have changed since 2001.Chloe Brimicombe, PhD Candidate in Climate Change and Health, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/770342017-08-02T07:55:25Z2017-08-02T07:55:25ZWhat England could learn from Canada on reducing child hospital admissions<figure><img src="https://images.theconversation.com/files/179662/original/file-20170725-30167-j94a99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">On the ward.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-doctor-checking-patient-fever-ward-630471359?src=a8rrhSlJmAuBymSF8bh4zw-2-1">wavebreakmedia/shutterstock</a></span></figcaption></figure><p>The number of children admitted to hospital as an emergency in England has <a href="http://adc.bmj.com/content/98/5/328">risen over the last 15 years</a>. This is not due to a deterioration in childhood health, but because of <a href="http://www.bmj.com/content/350/bmj.h2572">organisational changes</a>, such as access to <a href="http://www.cam.ac.uk/research/news/improving-access-to-gp-surgeries-could-reduce-burden-on-out-of-hours-services">out-of-hours GP services</a> and <a href="http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_6-11-2014-15-22-12">changes in the behaviour</a> of parents. </p>
<p>Obviously, we would expect children with serious conditions to be admitted to hospital and treated appropriately. But minor illnesses are often managed better by local GPs or even at emergency departments, avoiding the expense of being admitted to hospital – not to mention the disruption to children and their families. </p>
<p>But what can be done about these high rates? For our <a href="http://qualitysafety.bmj.com/content/early/2017/06/11/bmjqs-2016-006253">latest research project</a>, we wanted to learn whether children in England were being admitted to hospital more so than in other countries. So we compared the numbers of children being admitted to hospital in England with those in Canada’s largest province, Ontario. </p>
<p>England and Canada have some differences in healthcare policies and organisation, but otherwise similar cultural and social backgrounds. Each country also has a universal health care system that patients can access free at the point of care. Both have GPs that operate similar gatekeeper functions – referring to hospital when needed – and both populations have similar levels of childhood need, measured, for example, through child poverty or mortality rates.</p>
<h2>Admission rates</h2>
<p>We started by looking at how many infants, born between 2010 and 2013, went to hospital within one year of being discharged from hospital after birth. In both countries, the number of infants taken to an emergency department at least once was similar: 42% in Ontario and 36% in England. </p>
<p>So, if similar numbers of young children were taken to emergency departments, would we also expect a similar number of children admitted to hospital? We actually found the opposite. Twice as many infants were admitted to hospital as an emergency in England (20%) than in Ontario (8%). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179658/original/file-20170725-30152-12ark37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179658/original/file-20170725-30152-12ark37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179658/original/file-20170725-30152-12ark37.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179658/original/file-20170725-30152-12ark37.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179658/original/file-20170725-30152-12ark37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179658/original/file-20170725-30152-12ark37.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179658/original/file-20170725-30152-12ark37.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">GP care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pediatrician-talking-unhappy-child-hospital-536016700?src=-pdkhrKoC9jLwZuDN6yQjA-1-18">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<p>Why might this be? Are infants in England really much sicker and in need of being treated on a hospital ward? This is unlikely to be the explanation, since we made sure that we were comparing similar infants in both countries – for example, by looking at gestational age (how far along the pregnancy was) at birth. </p>
<p>What we found is an important difference in how likely infants are to be admitted, after having been seen in an emergency department. In Ontario, only 7% of emergency department visits resulted in admission. In England, it was 26%. We also looked at the percentage of admissions where children were sent home on the same day – only 6% in Ontario but 45% in England. </p>
<p>Taken together, these results suggest that the threshold for admission from emergency departments is much lower in England than in Ontario. It is likely that at least some of the infants admitted in England could have been treated appropriately in emergency departments, without the need for admission to a hospital ward. </p>
<h2>Waiting targets</h2>
<p>So why do these striking differences between England and Ontario exist? When we discussed the results with hospital doctors in both countries, they suggested that one of the driving factors is the availability of consultant paediatricians. Consultant paediatricians work in all large community hospitals’ emergency departments in Canada, but consultant paediatric emergency medicine provision in England varies regionally. In fact, it is only recommended for hospitals which see more than 16,000 children per year – around half of emergency departments in England. </p>
<p>Another likely explanation is the four hour waiting time target for emergency departments, which is stricter in <a href="http://www.qualitywatch.org.uk/indicator/ae-waiting-times#">England</a> than in <a href="http://www.health.gov.on.ca/en/pro/programs/waittimes/edrs/targets.aspx">Canada</a>. For children, watching and waiting can be important. As the four hour target approaches, doctors may be more inclined to admit a child to a ward for further observation, rather than risk sending a sick child home. </p>
<p>In England, studies have found a <a href="http://www.bmj.com/content/339/bmj.b4931">sharp peak in admissions</a> just before the four hour cut-off. At the same time, shorter waiting times are an incentive for parents to take their child to an emergency department for a minor illness, rather than wait longer to see a GP.</p>
<p>However, these results cannot be used to say with certainty what impact there would be if more paediatric emergency consultants were available in English emergency departments, if waiting time targets were relaxed for children, or short stay observation units were used more. </p>
<p>What we do know is that hospital admissions not only increase infant <a href="https://improvement.nhs.uk/resources/healthcare-associated-infections/">exposure to infection</a> and medical errors, but can also contribute to <a href="https://oatext.com/pdf/CCRR-2-227.pdf">psychological distress</a>, disruption, or economic loss for children and their families. Hospitals in England should consider how best to reduce potentially unnecessary short-stay admissions, in order to improve quality of life for children and their families, as well as alleviating pressure on hospital resources.</p><img src="https://counter.theconversation.com/content/77034/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katie Harron receives funding from the Wellcome Trust. </span></em></p>Why do a higher proportion of children in England end up on wards after being checked into emergency departments?Katie Harron, Assistant Professor of Statistics, London School of Hygiene & Tropical MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/347042014-11-26T19:32:20Z2014-11-26T19:32:20ZVictoria votes: more hospital beds doesn’t equal better health<figure><img src="https://images.theconversation.com/files/65578/original/image-20141126-4217-y7evcp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For patients, the availability of beds is more important than the overall number. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ejorpin/7350874702/in/photostream/">Emily Orpin/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Scanning through the media coverage of the major parties’ health policies one could be forgiven for thinking that hospital beds are the key to health. </p>
<p>Sure, hospital spending dominates the health budget. But hospitals are not the most frequent point of contact with health care providers. And beds are declining in importance as a measure of what hospitals do. </p>
<p>In 2012-13, <a href="http://www.aihw.gov.au/publication-detail/?id=60129546922">more than half</a> (57%) of patients admitted to Victorian public hospitals were in and out on the same day, sometimes occupying a bed, sometimes a trolley in the emergency department, and sometimes a dialysis or chemotherapy chair.</p>
<p>Trust is an important issue in politics and keeping commitments made about the number of beds to be opened is important. But there is an art in counting beds. </p>
<p>When I worked in Queensland Health, we had to develop clear rules about how to define an “open” bed (what does it mean for a bed to be “available”?) and how to count “bed equivalents” (which include not only chairs but hospital services in the home). </p>
<p>Basically, the more horizontal a patient is, the more the media <a href="http://www.dailytelegraph.com.au/hospital-chairs-counted-as-beds/story-fn6e0s1g-1226056360790?nk=5f9321c190e5d62441d37b5095f54e49">will accept</a> a bed equivalent as a genuine bed.</p>
<p>Yet from a patient’s point of view, what matters is not the absolute number of beds but whether one is available when they need it. </p>
<p>Promises ought to be about access – waiting times, for example – and about outputs such as the number of treated patients rather than inputs such as beds. Ideally, we should be aiming to measure outcomes (was my pain relieved; did I get well) but this is not the stuff of election campaigns.</p>
<h2>More beds ≠ more beds ≠ more access</h2>
<p><a href="http://www.aihw.gov.au/publication-detail/?id=60129546922">Hospital activity</a> in Victoria increased marginally over the four years to to 2012-13 (see below). Over the four-year period, the number of patients treated increased by 3%, though it declined by 7.6% in the year 2011-12 to 2012-13. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/65581/original/image-20141126-4240-7m39ne.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/65581/original/image-20141126-4240-7m39ne.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=301&fit=crop&dpr=1 600w, https://images.theconversation.com/files/65581/original/image-20141126-4240-7m39ne.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=301&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/65581/original/image-20141126-4240-7m39ne.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=301&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/65581/original/image-20141126-4240-7m39ne.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=378&fit=crop&dpr=1 754w, https://images.theconversation.com/files/65581/original/image-20141126-4240-7m39ne.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=378&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/65581/original/image-20141126-4240-7m39ne.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=378&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hospital activity increased marginally.</span>
<span class="attribution"><span class="source">Grattan Institute</span></span>
</figcaption>
</figure>
<p>Public hospital beds increased by 4% over the four-year period.
Over the same period Victoria’s <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Mar%202014?OpenDocument">population increased</a> 11%, so per capita provision went backwards.</p>
<p>The picture for public sub-acute care – rehabilitation care, for example – is much better, with an increase of 25% in patients treated over the four years to 2012-13. Yet national growth was 37% in patients treated over this period, following a <a href="http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/nhhrc-report">major drive</a> to improve sub-acute care. Victoria is falling behind other states here and had fewer sub-acute admissions than Queensland in 2012-13. </p>
<p>Victorians also wait too long for access to hospital care. Using <a href="http://www.aihw.gov.au/publication-detail/?id=60129549064">elective surgery</a> as the example, in 2013-14 3.2% of Victorian public hospital patients waited more than a year for surgery, up from 2.8% in 2009-10. The national average was 2.4%. New South Wales improved its performance from 4.9 to 1.8% over the same period.</p>
<h2>The major party promises</h2>
<p>The Liberal government has a <a href="http://www.heraldsun.com.au/news/victoria-state-election-2014/victorian-election-2014-both-parties-vow-to-build-australias-first-cardiac-hospital-in-melbournes-southeast/story-fnocxssc-1227132140379">comprehensive policy</a> that involves a new “heart hospital” at the Monash Medical Centre, redevelopment of the <a href="https://vic.liberal.org.au/News/2014-11-07/deputy-premier-announces-75-million-pledge-for-goulburn-valley-health">Shepparton hospital</a>, and <a href="http://www.heraldsun.com.au/leader/north/state-election-2014-victoria-liberals-pledge-northern-hospital-cash-boost/story-fnglenug-1227115955293">expansion</a> at the Norther Hospital in Epping. All this is part of a <a href="https://vic.liberal.org.au/Policies/HealthierVictoria/BoostingHospitalCapacity%5D">near billion-dollar splurge</a> (A$944 million) on “boosting hospital capacity”.</p>
<p>Labor has also promised a bed bonanza, adding a <a href="http://www.danielandrews.com.au/policy/labor-announces-major-expansion-of-casey-hospital/">Casey hospital expansion</a> and a <a href="http://www.danielandrews.com.au/policy/labor-to-build-womens-and-childrens-hospital-for-the-west/">new hospital</a> in the western suburbs for women and children. Labor has also not only matched but <a href="http://www.weeklytimesnow.com.au/news/national/vic-alp-pledge-to-build-heart-hospital/story-fnjbnvyg-1227132082593">doubled</a> the Coalition’s heart hospital promise.</p>
<p>Both parties continue to focus on inputs – more beds – rather than make promises directly related to patients’ needs. These include adopting targets to ensure disadvantaged groups can access quality care, as recommended by the National Health and Hospitals Reform Commission, and <a href="http://www.health.qld.gov.au/news-alerts/news/141123-wait-time-guarantee.asp">guaranteed maximum times for access to care</a>, as Queensland has recently promised.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/65574/original/image-20141126-4244-zos40e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/65574/original/image-20141126-4244-zos40e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/65574/original/image-20141126-4244-zos40e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/65574/original/image-20141126-4244-zos40e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/65574/original/image-20141126-4244-zos40e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/65574/original/image-20141126-4244-zos40e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/65574/original/image-20141126-4244-zos40e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some Victorians still wait too long for access to hospital care.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/bb_sara/4210519868/in/photolist-7q51S9-4FQHeu-6abPXw-5sKh6-6NNo9-rxXkG-6NNoa-99rW2E-6NNo8-6NNo7-63xsgN-4URW9Y-4VgAED-63td8g-9W29Ks-58kwRj-hkwxa6-bvvFL2-4QgnYX-cf7Fao-5NnnHd-66kjq1-7RyQpu-bs8aZr-a1inhs-dGvoR2-bEnBCe-4vFGQo-63tdcM-63tdhg-63tdoP-4tnfum-a1inos-k7nhiM-pEMaCg-6HggQX-cAJWQ7-9R1Cie-8XrBTg-3x8ghj-977S7a-8V2D32-8u1zv6-cAJWyj-8AJr5-7GEws3-cAK3JA-cAJWG3-cAK3CJ-cAK3hb">BB/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>Both parties have missed an opportunity to provide more contemporary acute-care options, such as a significant boost to hospital services in the home. Western Australia, for example, has a <a href="http://www.silverchain.org.au/wa/health-care/home-hospital/">650-bed equivalent</a> home hospital providing an “emergency care” visit within four hours, ordinary acute care and rehab care.</p>
<p>Although the hospital promises have received the most attention, both <a href="https://vic.liberal.org.au/Policies/HealthierVictoria/CommunityMentalHealth">Liberal</a> and <a href="http://www.danielandrews.com.au/wp-content/uploads/2014/11/Labors-Plan-for-Mental-Health.pdf">Labor</a> have articulated comprehensive visions for mental health. Both have promised improvements in ambulance services, with Labor pledging a shake-up in <a href="http://www.danielandrews.com.au/policy/only-labor-will-end-the-ambulance-crisis/">ambulance service management</a>. Both have promised to expand medical research. </p>
<p>Both the <a href="https://vic.liberal.org.au/Policies/HealthierVictoria">Liberal policies</a> and <a href="http://www.viclabor.com.au/wp-content/uploads/2014/05/Victorian-Labor-Platform-2014.pdf">Labor’s platform</a> address building communities and primary care but these commitments have attracted little media attention. That is unfortunate since a critical issue in health care is how the health system repositions itself to address the increased prevalence of chronic illness and people with multiple chronic diseases. </p>
<p>The system will need to be reinvented to focus on multi-disciplinary care teams, building community capacity to help patients to manage their own conditions and strengthening <a href="http://www.risen.org.au/CDSM/CDSM_Program_Wagner.asp">patient empowerment</a>. Such policies require cooperative action between the Commonwealth and state governments, which seems sadly lacking at present.</p>
<h2>The elephants stampeding into the room</h2>
<p>Regardless of who wins, there is an A$8 billion elephant, or herd of elephants, in the room. This is the amount the federal government cut from its funding to states in the <a href="http://www.vha.org.au/docs/20140514_federal-budget.pdf">last budget</a>. The cut will put enormous pressure on the Victorian budget. </p>
<p>The good news is there is still room for some improvement in hospital efficiency. Although 20 years of <a href="http://www.sciencedirect.com/science/article/pii/016885109594014Y">activity-based funding in Victoria</a> helped make Victorian hospitals the most efficient in the country, recent <a href="http://grattan.edu.au/report/controlling-costly-care-a-billion-dollar-hospital-opportunity/">Grattan work</a> shows savings could be made from tightening up on hospital efficiency through improved pricing strategies. </p>
<p>More <a href="http://grattan.edu.au/report/unlocking-skills-in-hospitals-better-jobs-more-care/">can be saved</a> by improving role allocations in hospital through greater use of health-care aids and expanding the role of nurses. Yet <a href="http://www.danielandrews.com.au/policy/labor-guarantees-nurse-to-patient-ratios-in-law/">Labor’s promise</a> to enshrine current nurse-patient ratios in legislation may make this a challenge.</p>
<p>As important as these changes are, they won’t make up the Commonwealth-imposed funding gap. Further system reform will be required. This will demand innovative thinking, careful negotiation with affected interests and engagement with the public. Getting the Commonwealth to pay its fair share will also be necessary. </p>
<p>These are the big challenges for Saturday’s winner. Announcing beds and buildings is easy, but developing new and better ways to provide health care and improve efficiency is not.</p><img src="https://counter.theconversation.com/content/34704/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett was a National Health and Hospitals Reform Commissioner. </span></em></p>Scanning through the media coverage of the major parties’ health policies one could be forgiven for thinking that hospital beds are the key to health. Sure, hospital spending dominates the health budget…Stephen Duckett, Director, Health Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/170762013-08-14T13:49:13Z2013-08-14T13:49:13ZPatients sectioned for beds, but hospitals not the best place to be<figure><img src="https://images.theconversation.com/files/29258/original/hhbwth4w-1376482880.jpg?ixlib=rb-1.1.0&rect=62%2C9%2C919%2C625&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being sectioned in a mental hospital may not mean the best care.</span> <span class="attribution"><span class="source">Truester</span></span></figcaption></figure><p>Claims that doctors are sectioning mental health patients in order to get them access to beds on psychiatric wards amount to “more than anecdotal evidence”, according to a committee of MPs who have <a href="http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news/13-08-14-mha2007cs/">just published a report</a> into the Mental Health Act. </p>
<p>The committee’s report makes for worrying reading for all those involved in mental health services. Pressures on community-based mental health services mean that the number of patients detained under the act are increasing and it’s clear that not everyone should be. In her evidence to the committee, Julie Chalmers, a consultant psychiatrist, said that in some areas “being detained is the ticket to getting a bed”.</p>
<p>Patients can voluntarily be admitted to psychiatric units but pressure on beds is high. Being sectioned puts a legal obligation under the act to get access to a facility.</p>
<h2>When are people detained?</h2>
<p>The compulsory treatment of people with mental health problem raises fundamental ethical and moral questions. It is one of the few areas of medicine where it is possible to ignore the expressed rejection of treatment by a patient.</p>
<p>The Mental Health Act sets out when someone can be detained and only applied after a certain set of conditions have been met. A person can be held against their will for up to 28 days before further assessment, and in some circumstances up to six months before a decision is made to release of extend detention. </p>
<p>Patients (the act always uses this term even when people are not in hospital) must be assessed by two doctors and an approved mental health professional. The legal grounds for detention are that the person is “suffering from a mental disorder of a nature or degree” that makes such an admission justified and that the admission to hospital is in the interests of the patient’s “health or safety or with a view to the protection of others”. </p>
<p>The guidance issued to professionals carrying out these assessments is clear: compulsory powers should only be used when all other options – including a voluntary admission to hospital - have been explored. The detention of a person is clearly a very serious matter. As well the emotional distress for the patient <a href="http://www.bbc.co.uk/news/magazine-23196980">and their family</a>, it can also have wider impact across individual’s lives including risk to their employment and housing - for example paying the rent. It also puts pressure on places for those who may need it more.</p>
<p>Detention should only be used as a last resort for those most in need.</p>
<h2>Operating at capacity</h2>
<p>Figures from the Care Quality Commission, which regulates health and social care in England, show that <a href="http://www.cqc.org.uk/sites/default/files/media/documents/cqc_mentalhealth_2011_12_main_final_web.pdf">the number of detentions increased</a> by 5% to over 48,000 in 2011-12 from the year before. There is also tremendous pressure on psychiatric inpatient beds; according to the CQC, 15% of wards were operating at a capacity of over 100% - this means that when one patient is discharged another will be admitted the same day.</p>
<p>While some will be desperate, an inpatient ward is not necessarily the best place to be either.</p>
<p>In 2011, <a href="http://www.rcpsych.ac.uk/pdf/OP79_forweb.pdf">a report by</a> the Royal College of Psychiatrists described psychiatric wards as overcrowded and understaffed. Professor Dinesh Bhugra, the college’s outgoing chair, accepted that these failures meant that in-patient care – often imposed against an individual’s will was not of an acceptable standard.</p>
<p>The report showed that wards were often not a safe, let alone therapeutic environment – highlighting poor physical conditions, limited contact with staff or access to psychological therapies and a lack of constructive activity. This has <a href="http://disability-studies.leeds.ac.uk/files/library/MIND-MIND.pdf">echoes of a survey</a> carried out by mental health charity Mind in London in 2000. Its conclusions paint a picture of dirty wards, poor food, lack of stimulating activities and minimal contact with staff. </p>
<p>The following gives a flavour of its main findings: </p>
<ul>
<li><p>30% of patients found the atmosphere on the wards unsafe and frightening.</p></li>
<li><p>62% of patients said illegal drugs were easily available on the wards.</p></li>
<li><p>16% of patients said they had experienced sexual harassment on the ward, and 72% of those who had complained about this said no action was taken.</p></li>
</ul>
<p>That was, of course some years ago. But it is clear that mental health services are still struggling. As Peter Beresford wrote in an article for The Conversation, <a href="https://theconversation.com/mental-health-is-in-no-fit-state-whatever-the-politicians-say-15743">mental health services are in no fit state</a>.</p>
<p>It is generally accepted that there will be some circumstances in which a person’s mental health has deteriorated to such an extent that the only option will be a form of compulsory inpatient treatment. Only <a href="http://www.nytimes.com/2012/09/12/health/dr-thomas-szasz-psychiatrist-who-led-movement-against-his-field-dies-at-92.html?_r=0">radical libertarians such as psychiatrist Thomas Szasz</a> would oppose such a view. However, the use of any compulsory powers must be limited and there must also be guarantees that this treatment will take place in a safe, therapeutic environment with appropriate community support following discharge from hospital. </p>
<p>The Health Committee’s report outlines a vicious circle that mental health service users and campaign groups have publicised in the past: the lack of well funded community mental health services increases the pressures on inpatient services. In this pincer movement, the rights and dignity of those who need mental health services are seriously compromised. </p>
<p>In the current economic climate, the concern is that community mental services will be seen as soft targets and their budgets reduced significantly. Dorrell said mental health services were more in <a href="http://www.independent.co.uk/news/uk/politics/mentally-ill-patients-sectioned-unnecessarily-as-only-way-to-a-hospital-bed-8760166.html#">danger of local healthcare cuts</a> because commissioners thought they were easier to cut than “more politically sensitive acute services”.</p>
<p>The <a href="http://www.bbc.co.uk/news/health-23685670">select committee also said</a> that the lack of hospital beds was driving an increase in the number of Community Treatment Orders, supposed to reduce hospital admissions. The whole system is clearly not working and we need to rethink how we deal with those in acute mental health distress. </p>
<p>In particular, community based mental services need strengthening so that hospital admission – whether as a voluntary or formal patient – is only used when all other alternatives have been exhausted.</p><img src="https://counter.theconversation.com/content/17076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Cummins does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Claims that doctors are sectioning mental health patients in order to get them access to beds on psychiatric wards amount to “more than anecdotal evidence”, according to a committee of MPs who have just…Ian Cummins, Senior Lecturer in Social Work, University of SalfordLicensed as Creative Commons – attribution, no derivatives.