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I've seen records suggesting there are individual patients with 100's of A&E attendances in a year who seem to be using it as a hostel/accommodation and never does a CCG actually have enough info to query the £1000's of cost they are paying for or put them in the place they need to be.
The records may suggest that but the narrative is usually a lot more complicated and changes from person to person. There are a lot of people out there whose lives are incredibly chaotic. They have a complex collection of life issues, mental health issues and physical health issues that mean their needs are quite complicated to address. They often go through a rapid cycle of getting into a bad state, coming to the attention of the police or, occasionally, adult social care, being determined in need of some kind of medical care, taken to A&E, cleaned up/patched up/dried out/detoxed, discharged because A&E have no further remit and sent home and, if they're lucky, they might manage a brief bit of stability before it all starts again.
Even if you could design and set up a "place they need to be", there really is no way of ensuring that they will stay there. There's no legal grounds for detention and disengagement is the most common point at which the multitude of interventions that are attempted will fail. The individual isn't using A&E like a hostel but at the point that it beomes necessary to pick them up from whatever situation they've managed to get into, it's the most appropriate place to take them.
Also the patient confidentiality isn't an issue. There's a lot of panels, conferences, groups and the like who have been given a clear mandate to openly discuss and share information. They regularly review these cases and plan interventions and consider what options are available to the assorted agencies that are or can be involved with patients/clients like this. The one person not on board with the whole process is the patient themselves. If you can work out how to solve that part of the equation, you'll be heralded as a saviour by vast swathes of agencies and organisations who offer support to complex and chaotic people every day.
The_Seldom_Killer-
I'm talking about contracting and information infrastructure supporting it where patient data is pseudonymised and the contracting mechanisms do not seem to allow patient pathways and interactions to be tracked over time by commissioners. Or if they are commissioners are not asking us any questions at all about frequent flyers or multiple admissions.
The rubbish we deal with is Barnet CCG saying patients registered with an Enfield GP between their referral for treatment and their admission to hospital so they don't have to pay for that admission.
dubtap
"Commissioning" is so much bullshit and patient confidentialty/Caldicott seems to obstruct patients who clearly really need help/intervention being flagged as such.
I've seen records suggesting there are individual patients with 100's of A&E attendances in a year who seem to be using it as a hostel/accommodation and never does a CCG actually have enough info to query the £1000's of cost they are paying for or put them in the place they need to be.