The impact of structural changes to community nursing services on the rate of emergency hospital use of older people: a longitudinal ecological study of based on 140 primary care trusts in England

Research output: Contribution to journalArticlepeer-review


  • Steven Wyatt
  • Robin Miller
  • Peter Spilsbury
  • Mohammed Amin Mohammed

Colleges, School and Institutes


In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.

The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.

The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.

Research limitations/implications
PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.

Practical implications
The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.

As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.


Original languageEnglish
JournalJournal of Integrated Care
Publication statusPublished - 20 Jan 2021


  • older people, health and social care, integrated care, community nursing, emergency admission

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