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

Emergency readmissions to hospital

The Nuffield Trust and the Health Foundation have published Emergency readmissions: trends in emergency readmissions to hospital in England.  This report, part of the QualityWatch research programme, looks at hospital data detailing patient diagnoses and the reasons behind emergency hospital readmissions between 2010/11 and 2016/17. It aims to highlight where improved quality of care in hospital or the community might have prevented readmission.  The analysis tracks a 19% rise in patients being readmitted to hospital in an emergency within 30 days of discharge between 2010/11 and 2016/17. Within this, the author identifies a 41.3% rise in emergency readmissions for conditions they classify as “potentially preventable”.

Emergency hospital admissions in England: which may be avoidable and how?

The Health Foundation | May 2018 | Emergency hospital admissions in England: which may be avoidable and how?

The Health Foundation has published new research that looks at trends in emergency admissions over the past decade and reviews some of the interventions aimed at reducing them. 

The first part of the briefing covers emergency admissions since 2006, explores the reasons behind more patients being admitted in the last  12 years and what are the implications for elective care? The second half of the briefing looks at what can be done to address emergency admissions, questions if  improving the availability and quality of social care reduce these, and whether integrated care may also decrease the number of admissions.

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Key findings

  • One in three patients admitted to hospital in England as an emergency in 2015/16 had five or more health conditions, such as heart disease, stroke, type 2 diabetes, dehydration, hip fracture or dementia. This is up from one in ten in 2006/07.
  • The number of patients admitted urgently to hospital has increased by 42% over the past decade – that’s an average of 3.2% per annum. This far outstrips the total number of people who attend A&E departments, which is up by only 13%.
  • Patients arriving at A&E are sicker than ever before, and more likely to need admission. This has grown for patients with multiple health conditions, as well as for older patients aged 85 or over, up by 58.9%.
  • Hospitals are treating patients more quickly, with overnight stays for those with five or more conditions lasting 10.8 nights in 2015/16 compared with 15.8 days a decade previously. The number of these patients admitted to hospital but discharged on the same day have increased by 373% over the same period.

The briefing also identifies opportunities to reduce emergency admissions including:

  • Approximately 14% of all emergency admissions are for ‘ambulatory sensitive’ conditions – conditions such as asthma where timely and effective primary care could reduce the likelihood of admission.
  • If older patients saw their regular GP two more times out of every ten consultations, this would be associated with a 6% decrease in admissions for ambulatory sensitive conditions.
  • Around 26.5% of all unplanned A&E attendances in England (5.77 million per year) were preceded by the patient being unable to obtain a GP appointment that was convenient to them, however few of these A&E attendances will have resulted in an admission.

The full report can be downloaded here or read online from The Health Foundation

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

UK has 6th highest rate of obesity – OECD

Health at a Glance 2017: OECD Indicators | Organisation for Economic Cooperation and Development | OnMedica

A report from the Organisation for Economic Cooperation and Development (OECD) has found that the UK has the sixth highest rate of adult obesity. The report looks at health indicators across its 100 member countries.

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It shows that almost 27% of the adult population of the UK is obese, compared with the OECD average of 19.4%. The UK has a smoking prevalence of 16.1%, which is below the OECD average of 18.4%.

However average alcohol consumption per UK adult is higher than the OECD average, with consumption averaging at 9.5 litres per adult. Although this is down from 10.4 litres in 2000, it is still above the OECD average, added to which harmful drinking among teens remains problematic. Nearly a third (30.5%) of 15-year-olds have been drunk at least twice in their life, compared with the OECD average of 22%.

Many quality of care indicators are close to or just below the OECD average, but avoidable hospital admissions are high, says the report.

Full document: Health at a glance 2017 – OECD indicators.

Adult and older adult mental health services 2012-2016

Adult and older adult mental health services 2012-2016: An analysis of Mental Health NHS Benchmarking Network data for England and Wales | Centre for Mental Health

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Image source: http://www.centreformentalhealth.org.uk

The number of acute inpatient beds for adults with mental health problems in England and Wales fell by 15% between 2012/13 and 2015/16 while specialist community mental health services also reduced by about 6%, according to a new briefing published today by Centre for Mental Health.

The briefing, Adult and older adult mental health services 2012-2016, analyses data collected by the NHS Benchmarking Network since 2012/13 up to the publication of the Five Year Forward View for Mental Health.

The briefing finds that while psychiatric acute inpatient beds for adults fell by 15% between 2012 and 2016, and staffing levels fell by 20%, the number of people admitted and the time they stayed in hospital did not change. This means that bed occupancy levels have risen to an average of 94%.

During the same time, community mental health service provision fell slightly: the number of people on community team caseloads reduced by 6%, staffing levels fell by 4% and contacts reduced by 7%. By contrast access to psychological therapies rose rapidly, reaching some 900,000 people a year by 2015/16.

Full report:  Adult and older adult mental health services 2012-2016 

 

Shifting the balance of care

Imison C, Curry N, Holder H, et al. Shifting the balance of care: great expectations.  March 2017 | Nuffield Trust.

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Moving care out of hospitals into the community can deliver holistic, patient-centred care closer to home.  In most cases however, it is unlikely to save money, according to a  report published today by The Nuffield Trust.

The report is based on a review of 27 schemes to reduce hospital activity, which included changes to urgent and emergency care pathways; speeding up discharge; managing ‘at risk’ groups; supported care at home; and cutting down on admissions.

Most of the initiatives demonstrated the potential to improve patient experience, and in some cases, outcomes. The evidence on cost savings was much less clear cut, partly because good economic evaluations have often not been carried out.

Several schemes did seem to be cost-effective in the right circumstances, but where schemes had been evaluated, most were cost neutral or were more expensive.

Download the full report here 

Report summary available here