Care Pathways

Scale of emergency admissions poses ‘serious challenge’ to NHS services and finances

A worrying National Audit Office (NAO) report has revealed that rising numbers of emergency hospital admissions are posing ‘serious challenges’ to NHS services.

Emergency admissions cost the service £13.7bn in 2015-16 and there has been a 2% increase in the number of these cases in 2016-17.

While the report gives NHS staff credit for their efforts to reduce the number of these kinds of admissions, it questions whether efforts to quickly deal with emergency situations could be causing a surge in readmissions.

In addition, the NAO highlighted fears that around a quarter of the 5.8 million A&E admissions in 2016-17 were considered avoidable by NHS England.

The study gives a number of recommendations on the issue, mainly aimed at understanding the link between the emergency process and higher readmissions.

“The department, NHS England and NHS Improvement should establish an evidence base for what works in reducing emergency admissions and use this to inform future national programmes,” it suggests.

“The department, NHS England and NHS Improvement have not yet established a robust evidence base to show what works in reducing demand for emergency admissions.

“Many admission reduction interventions have not been tested at scale, and the department, NHS England and NHS Improvement are unable to show whether any success is both sustainable and attributable to those interventions.”

Increases in emergency admissions have been partly blamed on an ageing population, which the NAO believes could be responsible for as much as £3.4bn of NHS funds.

Providers: Lack of capacity has knock-on effect on admission trends

The report has received mixed reactions from the health sector, with NHS Providers welcoming the acknowledgement that the NHS as a whole is working hard to reduce admissions, but pointing to a lack of capacity in communities, which could be responsible for more patients returning to hospitals.

“The NAO is right to point to the health service’s success in managing the impact of increased emergency admissions on hospitals,” commented deputy chief executive Saffron Cordery.

“The NAO report shows that although admissions have increased, trusts have been cost-effective at managing the additional demand, and have coped well despite the number of beds reducing by around 6% between 2010 and 2017. On top of this, trusts have had to cope with reduced tariff payments for admissions.

“We agree there is a need for better data to understand properly the rise in re-admissions and avoidable admissions, and the drivers behind the increase in short stay admissions.

“But what is clear, as the NAO rightly points out, is a lack of capacity out of hospital care to deal with growing demand for treatment, has had a knock-on impact on trends in admission.”

The link between community and hospital care has prompted the Local Government Association (LGA) to ask for further funding for the social care system.

“Councils are working closely with the NHS to avoid unnecessary admissions to hospital through better self-management of conditions, better community support and better advice and information,” explained Cllr Linda Thomas, vice chair of the LGA’s Community Wellbeing Board.

“However, due to historic underfunding, the adult social care system is under significant pressure and community-based services are being reduced, which is impacting on inpatient services. This reduced government funding means councils have had to spend less on key prevention work – £64m less in the past year.

“The LGA has consistently argued that there needs to be a focus on preventing hospital admissions in the first place rather than focusing disproportionately on delayed discharges of care.”

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