Insight report: High intensity users of A&E departments

Dr Foster | January 2019 | Insight report: High intensity users of A&E departments

Analysis conducted by Dr Foster  examining data from A&E departments across England in the year to May 2018 shows that 10 patients attended A&E 2,000 times between them in one year while 31,492 people attended A&E more than 10 times a year. Findings indicate that 0.4 per cent of all patients, made more than half a million visits to A&E, equivalent to 4 per cent of all A&E attendances. The data suggests that the analysis suggests a relatively small cohort of people are receiving a significant allocation of NHS resources compared to the average population. This is increasing the pressure on the NHS and contributing to the rising cost of healthcare (Dr Foster

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Dr Foster Insight report: High intensity users of A&E departments 

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Dr Foster High Intensity Users Report  

Dr Foster High Intensity users methodology 

A&E visits by young people with mental health problems have almost doubled in five years

There has been a steep rise in the number of young people aged 18 or under arriving at A&E departments in England with psychiatric conditions, according to new figures released this week | via YoungMinds

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The Department of Health and Social Care has revealed that, in 2017-18, there were 27,487 attendances in A&E by young people aged 18 or under with a recorded diagnosis of a psychiatric condition. This figure has almost doubled since 2012-13, when there were 13,800 equivalent attendances, and almost tripled since 2010.

The findings coincide with a survey by mental health charity YoungMinds, which revealed that 61 per cent of parents said the care their child received in crisis was “bad” or “unacceptable.” In the survey of 1,531 parents whose children have experienced a mental health crisis:

  • 75% agreed that “it would have been helpful for my child to have a safe place to go to while they were in crisis within our local community”.
  • 65% agreed that “It would have been helpful for me or my child to have access to a mental health crisis telephone hotline”.
  • 86% agreed that “it would have been helpful for my child to have access to support before they reached crisis point.”

Full detail: A&E attendances by young people with psychiatric conditions almost doubled in five years – new figures | YoungMinds

Reducing emergency admissions

This Public Accounts Committee report states that the Government must improve preventive care outside hospitals , warning that hospitals, GPs, community services and social care need to work together more effectively | House of Commons Committee of Public Accounts

The Public Accounts Committee has published Reducing emergency admissions.  The Committee finds it lamentable that nearly 1.5 million people could have avoided emergency admissions in 2016–17 if hospitals, GPs, community services and social care had worked together more effectively.  They say it is frustrating that NHS England and partners are making some progress in reducing the impact of emergency admissions for patients and hospitals when they do happen, but no impact on reducing the numbers of admissions that could have been avoided.

The report make a number of recommendations, including:

  • NHS England should identify gaps in capacity in primary and community health care and set out how it intends to fill those gaps. 
  • NHS England’s and NHS Improvement’s regional teams should assess the capacity that hospitals need in terms of beds, staff and funding to deal with emergency admissions throughout the year.
  • The Department should encourage better sharing of best practice on how the voluntary sector supports health and social care efforts to reduce emergency admissions and understand the reliance the system has on the sector.
  • NHS England and NHS Improvement should improve data they collect and that hospitals record so that by the end of 2018 care can be tracked and publicly reported.

  • Read the report summary
  • Read the report conclusions and recommendations
  • Read the full report: Reducing emergency admissions

How is the NHS performing?

This report aims to take stock of what has happened within the NHS over the past quarter. 

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The report finds that more patients are facing long waits for hospital treatment, with those experiencing the longest waits often most in need of treatment. With demand for services continuing to rise, the authors suggest it is very unlikely that meeting waiting time targets will become more achievable.

The report also finds that:

  • nearly two-thirds (63 per cent) of finance directors felt that patient care has worsened in their local area in the past year. Just 4 per cent said it had improved
  • more than half (52 per cent) of trust finance directors said they expected their organisation to end 2017/18 in deficit. A third (32 per cent) were fairly or very concerned about meeting financial targets agreed with national NHS bodies
  • demand for services continues to soar – admissions from A&E jumped by 6.8 per cent in January 2018 compared to January 2017, reaching 389,649
  • more positively, progress on reducing delayed discharges from hospitals has continued to improve, with 145,3180 total days delayed in December 2017, the lowest total since September 2015.

Full report: How is the NHS performing? March 2018 quarterly monitoring report

See also:

Waiting times in A&E departments

Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.

The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.

At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.

Full article: What’s going on with A&E waiting times?

Urgent and emergency care: best practice

This CQC report offers practical examples of how leading emergency departments are meeting the challenges of managing capacity and demand, and managing risks to patient safety .

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This report from the Care Quality Commission details the good practice identified following the Commission’s work with consultants, clinical leads, senior nursing staff and managers from leading emergency departments in 17 NHS acute trusts.

This resource identifies:

  • strategies staff use to meet the challenge of increased demand and manage risks to patient safety
  • positive actions to address potential safety risks and to manage increased demand better
  • how working with others can manage patient flow and ensure patients get the care they need
  • that rising demand pressures in emergency departments are an issue for the whole hospital and local health economy.

Full report: Sharing best practice from clinical leaders in emergency departments

NHS trusts predicting worse deficit than originally anticipated

Quarterly performance of the NHS provider sector | NHS Improvement

The quarterly performance of the NHS provider sector for the second quarter (July to September) of the 2017-18 financial year reveals that NHS trusts and foundation trusts are collectively predicting a full-year deficit of around £623 million – £127 million worse than planned.

The data from NHS Improvement also showed that despite the NHS treating more patients than even before, more people were seen within four hours in A&E and within 18 weeks for planned care.

Between July to September of this year, 90.2% of emergency patients were seen within four hours – meeting the national ambition of 90% by September while 3.43 million patients were seen within 18 weeks, compared with 3.36 million during the same period last year.

Cost improvement programmes had delivered £1.25 million of improvements in the first six months of the year and hospitals had delivered a £119 million reduction in temporary staffing for the first six months of the financial year, compared to the same period last year.

Full detail at NHS Improvement