On 1 March 2018, the National Audit Office (NAO) published a damning report on successive failed initiatives to reduce emergency admissions at NHS hospitals in England. The NAO scrutinises public spending and holds Parliament to account and improve public services.
Apparently the Department of Health (DoH) wants elective and emergency admissions to be reduced to 1.5% (whatever that means). The NHS England (NHSE) 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 (OOH)/community care/intermediate services could ‘replace’ these hospital admissions.
NHSE states that currently 24% of emergency admissions could be avoided.
79% of the growth in emergency admissions form 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 NHSE and partners attempts to reduce the impact of emergency admissions has 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 DoH admitted that £10 billion spent on community care ‘could have been better used’ and that ‘programmes to focus on community care had stalled’.
The DoH, NHSE and NHS Improvement (NHSI) all admit that they have no idea why there are local variations in hospital emergency admissions. NHSE 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 form 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 can be found here