31.10.13
Emergency admissions ‘avoidable’ with better planning – NAO
Too many emergency admissions to hospital are avoidable and preventable, according to a new report from the National Audit Office (NAO), which says the NHS needs to manage the situation far better.
More and more people are being admitted, with many staying longer than necessary. In 2012/13, over a quarter of all patients attending major A&E departments were admitted. That is an increase of 19% from 2003/04, with the rise mostly consisting of short-stays.
The NAO warned that the NHS has been too slow in developing effective alternatives to admission to hospital. It says an increasingly frail and elderly population, and changing models of care, add to the pressure.
The report identifies “large variations in performance at every stage of the patients journey’, which could be improved. There is currently limited evidence on what works to reduce unnecessary admissions and to effectively manage patients who are admitted.
A “lack of alignment” between hospitals, community and local services has also contributed to the problem. The NAO recommends both short and long-term strategies to address staffing shortages in A&E, and for the Department of Health and NHS England to address barriers to seven-day working.
Amyas Morse, head of the NAO said: “Many emergency admissions to hospital are avoidable and many patients stay in hospital longer than is necessary. This places additional financial pressure on the NHS as the costs of hospitalization are high.
“Growth in emergency admissions is a sign that the rest of the health system may not be working properly. Making sure patients are treated in the most appropriate setting and in a timely manner is essential to taking the pressure off emergency hospital admissions.”
Sir Richard Thompson, president of the RCP, welcomed the report and supported the recommendation for restructuring acute care services around the needs of patients. He said: “We also agree that more doctors from other medical specialties should be available to manage patients on the acute medical wards, and have a wider responsibility for identifying and managing patients with acute medical problems in the community.
“We particularly welcome the NAO’s specific recommendations to the Department of Health and NHS England on aligning the payment mechanisms with the flow of patients, and encouraging best practice of the kind collected for our report.”
Dr Peter Carter, chief executive & general secretary of the RCN said that increasing emergency admissions are a symptom of “an entire system under strain”.
“We know that our current health care service is not set up to deal with the challenges of an ageing population, however this is a challenge we can no longer ignore. Without more investment in community services and preventative care A&E units will continue to take on avoidable admissions from patients who simply have nowhere else to go.
“It is plain that the A&E crisis can only be solved with a system-wide approach. This will be better for the health service, and more importantly better for patients who can be cared for in the appropriate place.”
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