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Emergency admissions continue to rise

NAO report highlights cost of emergency admissions is £13.7bn.

Published on 2nd March 2018

Emergency hospital admissions continue to increase each year and cost over £13bn in 2016-17 a report by the National Audit Office has found.

The NAO report warns that emergency admissions has risen by 9.3% between 2013-14 when figures were last recorded and 2016-17.

“In 2016-17, there were 5.8 million emergency admissions, up by 2.1% on the previous year. In 2016-17, 24% of emergency admissions were admissions that NHS England considers could be avoidable,” said the report.

The report highlights that the cost of emergency admissions in 2016-17 was £13.7 billion.

It also found:

  • 79% of the increase in emergency admissions between 2013-14 and 2016-17 was caused by people who did not stay overnight.

  • The proportion of hospital emergency bed days occupied by patients aged 65 and over in 2016-17 was 65%.

  • There was a 53% growth in emergency admissions which came from people aged 65 and over between 2013-14 and 2016-17.

“Older people make up more than half of the growth in emergency admissions between 2013-14 and 2016-17. Some of this is down to demographic change. Between 2013-14 and 2016-17, the number of people aged 65 and over grew by 6.2%. However, over the same period, emergency admissions for people aged 65 and over grew by 12%, almost twice the rate of population growth. The demographic pressure will only increase as the numbers of people aged 65 and over is projected to increase by a further 20% between 2017 and 2027,” said the report.

NHS England and partners have developed a number of national programmes that aim to reduce the impact of emergency admissions. These programmes include the urgent and emergency care programme, the new care models and the Better Care Fund. The report highlights how 32% of local areas reporting they had reduced emergency admissions by the target they set in their Better Care Fund plans for 2016-17.

The NAO highlights that the challenges in reducing emergency bed admissions include:

  • Bed closures have increased the pressures posed to acute hospitals by rising emergency admissions.

  • There has been an increase in the number of people being readmitted in an emergency shortly after an initial inpatient stay.

  • Capacity in the community to prevent emergency admissions does not currently meet demand.

  • NHS England does not yet have good enough data on emergency admissions.

“The impact on hospitals of rising emergency admissions poses a serious challenge to both the service and financial position of the NHS. Over the last four years, the NHS has done well to reduce this impact despite admitting more people as emergency admissions, largely by reducing length of stay and growing daycase treatment,” said the NAO.

“However, it cannot know if its approach is achieving enduring results until it understands whether reported increases in readmissions are a sign that some people admitted as an emergency are being discharged too soon. The NHS also still has too many avoidable admissions and too much unexplained variation. A lot of effort is being made and progress can be seen in some areas, but the challenge of managing emergency admissions is far from being under control,” the report concludes.

Margaret Willcox, President of the Association of Directors of Adult Social Services, said: “ADASS has long called for serious reform of adult social care, and this report underlines the immediate need for this. The upcoming green paper from the government must not only provide a long-term, sustainable financial footing for adult social care, but also enable us to keep people out of hospital in the first place, by keeping them well and living healthy lives in their communities.   

“There is no getting away from the fact that urgent action is needed if the care crisis in this country is ever to be addressed. Immediate funding must be made available to help hard-pressed social care teams cope with the demands on their surfaces.  

“However, governments of all persuasions have kicked this issue into the long grass over many years. It’s time to stop philosophising, and get on with delivering the long-term, sustainable strategy for social care that vulnerable adults across this country deserve – and that the green paper must deliver,” she added.

Cllr Linda Thomas, Vice Chair of the Local Government Association’s Community Wellbeing Board, said: “Councils are working closely with the NHS to avoid unnecessary admissions to hospital through better self-management of conditions, better community support and better advice and information.

“However, due to historic underfunding, the adult social care system is under significant pressure and community based services are being reduced, which is impacting on inpatient services. This reduced government funding means councils have had to spend less on key prevention work – £64 million less in the past year.

“The LGA has consistently argued that there needs to be a focus on preventing hospital admissions in the first place rather than focusing disproportionately on delayed discharges of care.

“The government needs to give urgent funding to councils to invest in prevention measures, which will help to reduce costs to the public purse.

“Social care needs to be put on an equal footing with the NHS and government needs to address immediate pressures as part of the £2.3 billion funding gap facing social care by 2020.

“A whole-system approach to health and social care – which recognises that community based support, including adult social care, helps to prevent hospital admission - is needed to ensure that people are adequately supported through their patient journey,” she concluded.

Reducing hospital admissions

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