The National Audit Office documents only failure in its ‘Reducing Emergency Admissions’ report

On 1 March 2018, the National Audit Office published a damning report on successive failed initiatives to reduce emergency admissions at NHS hospitals in England. The National Audit Office scrutinises public spending and holds Parliament to account and improve public services. Apparently the Department of Health  wants elective and emergency admissions to be reduced to 1.5% (whatever that means). The NHS England mandate is however extremely weak in the admissions arena. – ‘…to achieve a measurable reduction in emergency admissions by 2020’.

Cost is a big issue here and reducing mortality and patient pain and suffering makes no appearance in the 54 page report. The current annual cost of emergency hospital admissions is £13.7 billion. This cost has remained static over recent years. Between 2015/16 and 2016/17 emergency admissions increased by 2.1 %. So all attempts over recent years to reduce emergency admissions have failed.

The elephant in the room here is the oft quoted 2009 McKinsey & Co theory that 40% of patients admitted to hospital should not be there. The theory continues with the notion that Out of Hospital/community care/intermediate services could ‘replace’ these hospital admissions. NHS England states that currently 24% of emergency admissions could be avoided.

79% of the growth in emergency admissions from 2013/14 to 2016/17 was by people who did not stay overnight in hospital. Reducing beds (bed use) is clearly a key factor as staying overnight in hospital is expensive. The emergency admissions’ increase is mostly of older people.

It’s pretty clear that attempts to reduce the impact of emergency admissions have failed. These reduction programmes include the urgent and emergency care programme, the new care models, the Better Care Fund, RightCare and Getting It Right First Time.  Re-admittance rates rose by 22.8% between 2012/13 and 2016/17.

In October 2017 the Department of Health admitted that £10 billion spent on community care ‘could have been better used’ and that ‘programmes to focus on community care had stalled’.

The Department of Health, NHS England and NHS Improvement all admit that they have no idea why there are local variations in hospital emergency admissions. NHS England is not happy with emergency admission data, and the lack of linked data across healthcare and social care.

On page 10 of the report we find ‘…the challenge of managing emergency admissions is far from being under control’.

There are enormous amounts of data analysis on performance, beds and intermediate care.

The number of days that beds are used by people admitted as emergency admissions has increased from 32.4 million in 2013/14 to 33.59 million in 2016/17 – an increase of 3.6%. The majority of bed days (96% in 2016/17) are used by people who stay for two days or more after being admitted as an emergency admission.

The recommendations in the report are stunning and include:

  • Establish an evidence base
  • Disseminate learning on new care models effectively
  • Link primary, community health and social care data
  • Figure out why there are local variations in emergency admissions
  • Figure out how community services will support reductions in emergency admissions
  • Introduce an Emergency Data Care Set to improve data on daycase emergency care
  • Publish data on re-admissions.

View the NAO report 


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One Comment

  1. Umesh Prabhu says:

    Thanks Eric for a wonderful summary. Success is when we all work together for a common purpose. Sadly NHS is a very insular organisation and not willing to listen as same old leaders move around and come in different shapes and different organisation and they keep on moving from one place to another.

    Transformation means, you keep the good old and bring new vision, new thinking and new leaders.

    What we need is locally in each and every town a group of good people which must include Commissioners, Councillors, patients representation, hospital staff and GPs and Primary care staff (not just doctors) and design a different service, This must be piloted first and Devolution Manchester is ideally place for such experiment.

    We make sure patients have easy access. So that they do not go to AE but seen in the community or near AE by GPs. Any walking in patients must be seen by GPs who are good at taking risk as they are very experienced in this in their day-to day practice. We must also use good skill mix to triage patients as many of them can be seen by other staff like social worker, Pharmacists, Nurses, Physio and so on.

    This way we can reduced hospital admissions, busy AE and unnecessary waiting in AE and doctors in AE can see really sick patients.

    Of course with 2000 GP shortage, 10,000 doctors shortage and 30,000 nurses shortage, we must address this work force crisis and NHS needs urgent short, medium and long-term plan and we need cross party MPs or Health select committee to work with some of us to come up with short medium and long-term plan. This needs to be done urgently so that we can transform NHS and social care and make sure both are safe, good quality care and patients get the best treatment as close to their house as possible but for major surgery they have to travel few miles.

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