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24.10.12

70% of trusts losing money on A&E despite increased efficiency

A&E departments are dealing with more and more patients, yet 7 out of 10 are losing money, a new study suggests.

In response to a rise in A&E admissions, hospitals have increased their efficiency in diagnosing and treating patients within accident and emergency departments. Yet with NHS trusts receiving an average of £79-123 for every A&E patient, and costs per patient averaging £69-129, there is small room for profit, and the majority of hospitals are incurring losses.

The study by the Foundation Trust Network (FTN) highlights that PCTs are given little incentive to accept joint responsibility for avoiding emergency admissions, while hospitals are being paid less despite rises in efficiency.

The FTN study concluded that risks and responsibility for avoiding admissions should be shared more fairly between acute trusts and primary community care, trusts with primary or urgent care centres within their A&E departments should provide faster treatments for minor and major problems and injuries and trusts using senior clinicians in a rapid assessment team provide faster assessments for the majority of acute patients.

Additionally, the near 50% overnight admissions rates of elderly (75+) patients attendances could be reduced by providing increased nursing, occupational and physio services in A&E before being discharged and increasing out-of-hours primary and community services could reduce A&E admissions, particular stemming from mental health and addiction admissions.

Chris Hopson, chief executive of the FTN, said: “We should be very proud of the job that our A&E departments do…they are dealing with large numbers of patients and actively striving to do better by reorganising the way that the A&E department works.

“However, the amount that NHS trusts are paid for doing this work is being trimmed by a policy designed to keep people out of hospital beds.”

He called for a “whole system approach” to help keep patients out of A&E and criticised the fines for rising numbers of patients to A&E.

The report is at: www.foundationtrustnetwork.org/resource-library/ftn-benchmarking-elderly-care-services-briefing-2012/elderly-care-ftn-benchmarking-briefing-march-2012.pdf

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Comments

Tom Hughes   31/10/2012 at 10:40

I am an Emergency Medicine consultant and recently stopped a nursing home patient with a dislocated hip going to the ward. We relocated his hip in the ED and sent the patient home. This was the right thing to do for the patient, but in doing so I lost my hospital a few thousand pounds and gained a 4 hour breach. This is a perverse incentive, and there are many others which reward admission and re-attendance rather than sorting out the patient in a one-stop-shop. Until Emergency Department remuneration is linked with value-added activity, we are not going to make progress with this. The current data are so poor we do not know what we are doing in Emergency Departments, and this is a significant barrier to improvement by commissioning.

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