NHS yet to gain control of emergency admissions

In a report, Reducing emergency admissions, the auditors said the NHS had done well to manage the impact on hospitals in the face of rising admissions. And, though it recognised that progress has been made, the report added that the NHS had not gained control of the management of emergency admissions. Much of the effort to reduce pressure on hospitals is through providing more day case emergency care, but with inconsistencies in how hospitals record these cases NHS England cannot determine the impact of the measure.

Between 2013/14 and 2016/17 the cost of emergency admissions rose from an estimated £13.4bn to £13.7bn – a 2.2% increase – while emergency admissions increased by 7%, it said.

In 2016/17 there were 5.8 million emergency admissions, of which 24% were considered avoidable by NHS England, the report said. Over the last four years there was a 12% rise in emergency admissions in people over 65. Demographic changes accounted for only half of this increase in older people, it said, and NHS England was carrying out further work to understand the other causes.

While the pace of the rise in emergency admissions slowed a little in 2016/17, the NAO said there was little evidence this was brought about by initiatives such as the Better Care Fund and the urgent and emergency care programme.

Significant challenges remained in efforts to manage emergency admissions. These were due to:

• Bed closures that have increased the pressures on acute hospitals
• An increase in emergency admissions of an estimated 22.8% between 2012/13 and 2016/17. The NAO said that though there were questions over the reliability and consistency of the data, the rate of growth raised questions about decisions to discharge and the support provided to people in the community
• A lack of community capacity to help prevent emergency admissions. The report also said there was a lack of a clear plan to better use community healthcare spending to reduce emergency admissions
• Inaccurate data - NHS England emergency admissions data was not always good enough
• Significant variations in emergency admissions that are not fully understood by the Department of Health and Social Care and NHS England.

The NAO recommended the Department and NHS England should gather evidence on measures that reduce emergency admissions. Primary, community, hospital and social care data should be linked to inform decision-making, it added.

NAO head Amyas Morse (pictured) said: ‘It is a problem for all of us that A&Es remain overloaded and a constant point of stress for patients and the NHS. A lot of effort is being made by NHS England. At the centre of this is increased day case treatment but the decision to stop methodical measurement of emergency readmissions a few years ago makes it difficult to understand whether day case interventions achieve enduring results.’

Saffron Cordery, deputy chief executive of NHS Providers, said trusts had been cost-effective in managing the rise in emergency admissions. However, she continued: ‘We agree there is a need for better data to understand properly the rise in readmissions 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 in out-of-hospital care to deal with growing demand for treatment, has had a knock on impact on trends in admission.’