Care Pathways

Despite major slowdown efforts, emergency admissions still hit record high

The fact that the number of emergency admissions to hospital in March this year was the highest ever recorded in a single calendar month is a cause for concern when there is substantial effort across the board to slow the growth of these admissions, the Nuffield Trust has warned.

The think tank’s worries were based on the latest health performance figures released by NHS England, which showed that in March 2017, there were over half a million emergency admissions – 3.2% more than in the same month last year. Emergency admissions over the last year are also up 2.8% on the preceding 12-month period.

And even though performance against many of the tracked measures is slowly improving, a “large number of the targets themselves are still being missed”, said the Nuffield Trust’s director of research and chief economist, Prof John Appleby. The main cancer waiting time, for example, was only met three times in the last 37 months.

Saffron Cordery, the director of policy and strategy at NHS Providers, who sits on NHE’s Editorial Board, agreed that the figures showed, once again, the “scale of the pressures NHS trusts are up against”.

But, she added, figures also proved that the NHS is doing an “outstanding job” in continuing to deliver high-quality care despite growing demand and often very difficult circumstances.

“More than two million people came to A&E – one of the highest figures on record. For the first time, emergency admissions rose above half a million. Yet performance against the four-hour target in A&E was better than in March 2016,” said Cordery.

“The sharp rise in routine hospital treatments is another sign that the NHS is rising to the challenge – helping more patients, despite the pressures.”

In its second briefing paper released ahead of the General Election, the Health Foundation backed up Cordery’s view that quality isn’t taking a battering: while waiting times for many NHS urgent and emergency services in England were at their worst in the last financial year compared to the last five, there is “so far little evidence that the quality of care for some of the big killers – like heart attack, stroke and cancer – is deteriorating”.

Nevertheless, national data on care quality lags behind data on waiting times, meaning it may be yet too early to tell whether the pressures the health system is facing are affecting the quality of care delivered.

Or, said the organisation’s senior policy fellow Tim Gardner, the so far positive data may be a reflection “of the incredible hard work of NHS staff to ensure good quality of care is maintained despite tightening resources”.

“But international comparisons also show that while there have been internationally recognised improvements in the quality of care for heart attack and stroke – for other illnesses, such as bowel and breast cancer, the NHS is still lagging behind comparable countries on patient outcomes,” he added.

“Maintaining, let alone improving, the quality of care provided is going to be very difficult in the current financial climate. Funding for the NHS in England will need to increase if these hard-won gains to the quality of patient care are to be upheld and built upon in the future.

“Waiting time targets for A&E, cancer and consultant-led treatment are a useful barometer of pressure on the NHS. But these data need to be published alongside more relevant and accessible data on how effective care is for patients.”

The Health Foundation’s first briefing paper, released earlier this week, argued that the NHS model isn’t inherently broken, but trusts will remain unable to invest in innovation and modern equipment if capital budgets continue to be raided.