Health Solutions

A common marker of success for health systems is their ability to control rates of emergency admission.  Indeed, there are few health policy issues that have received greater attention than how best to meet the demands on hospital A&E departments and manage the associated unscheduled admissions to hospital.

Last week the National Audit Office added to the clamour of concerns about our emergency care services in a report identifying serious failings in the way emergency admissions are being managed.   It found that in 2012-13 there were 5.3 million emergency admissions to NHS hospitals in England (47 per cent overall increase since 1977-98); costing the NHS around £12.5 billion. Some 3.7 million of these were from A&E Departments (116 per cent increase), 0.7 million were from outpatients (17 per cent increase) and 0.8 million were from GP referrals (34 per cent decrease).  A tenth of these were readmissions which the hospital, in theory, doesn’t get paid for. 

The NAO suggests that many emergency admissions are avoidable and that many patients are staying in hospital longer than clinically necessary. The report identifies large variations in performance at every stage of the patient pathway, suggesting scope for improved outcomes; and a need for short term interventions to manage winter pressures and longer term interventions to create a more accessible, integrated, urgent and emergency care system.  It concludes that until the systemic issues are addressed, value for money in managing emergency admissions will not be achieved.  So now we have the diagnosis and a suggested treatment regime, unfortunately, past experience suggests that it will be some time before we see any meaningful improvement. 

Most of the NAO recommendations that are within the gift of hospitals to address are already being implemented, albeit with varying degrees of success. For example many hospitals are in the process of introducing or indeed have implemented new staffing