A&E attendances twice as high for people in the most deprived areas as in the least deprived

NHS Digital | September 2019 | A&E attendances twice as high for people in the most deprived areas as in the least deprived

NHS Digital figures reveal that the most deprived 10% of the population (3.1 million) are more likely to attend A & E when compared with the least deprived tenth of the population (1.5 million).



The report collates newly published data from NHS Digital’s Hospital Episode Statistics (HES) with previously published data from NHS England and NHS Improvement’s A&E Attendances and Emergency.

The HES data shows:

  • Monday is the busiest day of the week and the most popular time of arrival is between 10am and 12pm
  • The number of reattendances to A&E within 7 days was 1.9 million and accounted for 8.7% of all reported attendances
  • Patients arriving from 8am to 10am generally spent the shortest time in A&E with 16% of patients arriving between 8am and 8:59am spending one hour or less; and 90% of arrivals between 9am and 9:59am spending four hours or less
  • Looking at all arrival times, 1.5% (330,000) of all attendances in 2018/19 spent more than 12 hours in A&E, compared with 1.6% (333,000) in 2017/18. This measures the entire duration of stay in A&E.

Further details from NHS Digital

Hospital Accident and Emergency Activity 2018/19

Emergency admissions to hospital from care homes: how often and what for?

The Health Foundation | July 2019| Emergency admissions to hospital from care homes: how often and what for?

In this briefing,  The Health Foundation presents its analysis of a national linked dataset identifying permanent care home residents aged 65 and older and their hospital use in the year 2016/17. In the second part of the briefing it synthesises learning from four evaluations of the impact of initiatives to improve health and care in care homes carried out by the Improvement Analytics Unit (IAU).


The large number of these emergency admissions may be avoidable, with 41% of emergency admissions from care homes being for conditions that are potentially manageable, treatable or preventable outside of a hospital setting, or that could have been caused by poor care or neglect.

This briefing synthesise learnings from The Health Foundation’s evaluations of the initiatives in Rushcliffe, Sutton, Wakefield and Nottingham City to pull out what seem to be key lessons for implementing the framework in care homes. These key lessons are that (i) there is greater potential to reduce emergency admissions and A&E attendance in residential care homes compared with nursing homes, (ii) co-production between health care professionals and care homes is key to developing effective interventions, (iii) access to additional clinical input by named GPs and primary care services and/or multidisciplinary teams (MDTs) may be a key element in reducing emergency hospital use, and finally (iv) our studies show that it is likely to take more than a year for changes to take effect – meaning it is important not to judge success too quickly (Source: The Health Foundation)

Emergency admissions to hospital from care homes: how often and what for?


Report of the 4th Survey of Liaison Psychiatry in England (LPSE-4)

NHS England & Liaison Faculty of the Royal College of
July 2019|Report of the 4th Survey of Liaison Psychiatry in England (LPSE-4)

Liaison Psychiatry is the sub-specialty of psychiatry which addresses the mental health needs of people in general clinical settings.
In England, Liaison Psychiatry is growing as a specialty, in part because of evidence showing that well-resourced services make acute hospitals function more efficiently; shorter admissions, fewer readmissions. 


England issues a survey to the Liaison Psychiatry services in acute hospitals with Emergency Departments in England; the survey tracks Government targets which require half of all these services to be at ‘Core 24’ level by 2021. Data were returned by all 175 of the acute hospitals in England with EDs

NHS England finds that a major potential barrier to continuation of this good rate of growth is workforce; psychiatrists more than other professionals (Source:  NHS England and Liaison Psychiatry in England) (Source: NHS England)

Report of the 4th Survey of Liaison Psychiatry in England (LPSE-4) 

OnMedica Workforce issues threaten continued expansion of liaison psychiatry services


Reducing avoidable emergency admissions

This healthcare insight report details an extensive analysis of avoidable emergency admissions over a five-year period, and in doing so highlights a number of actions that can be taken towards preventing them | Dr Foster

This report looks specifically at ambulatory care sensitive conditions (ACSCs), which can be managed or prevented through effective primary and community care. ACSCs can be chronic conditions where early intervention can help prevent exacerbation; acute conditions where early intervention can prevent progression; or conditions where immunisation can prevent disease.

The report paints a startling picture of avoidable emergency admissions, finding that the admission rate increased by nine per cent over the analysis period, even after adjusting for population growth.

The report reveals which conditions patients are most likely to be admitted for in an emergency, who those patients may be, and the impact of deprivation. It takes an in-depth look at the possible savings to be made across both sustainable transformation partnerships (STPs) and clinical commissioning groups (CCGs) in England, estimating combined potential savings of £125 million.

Full report: Reducing avoidable emergency admissions. Analysis of the impact of ambulatory care sensitive conditions in England.

The role of volunteers in ambulance services

This report explores the role and value of volunteering within ambulance services in England and identifies examples of different ways in which volunteering opportunities are being developed | Kings Fund


The role of volunteers within ambulance trusts is well-established, largely focusing on two key areas of provision – community first responder schemes and non-emergency patient transport services.

However, ambulance trusts are now taking steps to develop and diversify volunteering within their services, from improving recruitment and management, to developing new activities and roles to meet changes in demand and building relationships with communities.

The report concludes by highlighting some key lessons for future development of the role of volunteering in ambulance services and identifies some important next steps to ensure a more strategic approach that realises the potential of volunteers.

Full report: Volunteering in ambulance services: developing and diversifying opportunities

See also: Saving lives, supporting communities: The role of volunteers in ambulance services

Same day emergency care

NHS Improvement| April 2019 | Same day emergency care

NHS Improvement have produced a new section on its website relating to same day emergency care along with links to relevant resources. Same day emergency care (SDEC) is one of the many ways the NHS is working to provide the right care, in the right place, at the right time for patients.

The resources are available from NHS Improvement’s website 

Effectiveness of Treatments and Diagnostic Tools and Declining Mortality in Patients With Severe Sepsis: A 12-Year Population-Based Cohort Study

Chen, K. F., Tsai, M. Y., Wu, C. C., & Han, S. T. |2019| Effectiveness of Treatments and Diagnostic Tools and Declining Mortality in Patients With Severe Sepsis: A 12-Year Population-Based Cohort Study| Journal of intensive care medicine|0885066619827270.

The Journal of Intensive Care Medicine has published the findings of a study that looks at the effectiveness of treatments and diagnosis tools on patients with severe sepsis. 


Sepsis is a major cause of morbidity and mortality worldwide. With the advance of medical care, the mortality of sepsis has decreased in the past decades. Many treatments and diagnostic tools still lack supporting evidence. We conducted a retrospective population-based cohort study with propensity score matched subcohorts based on a prospectively collected national longitudinal health insurance database in Taiwan. Severe sepsis-associated hospital admissions from 2000 to 2011 based on International Classification of Diseases, Ninth Revision, Clinical Modification codes of infections and acute organ dysfunction were identified. To compare the effectiveness of treatment and diagnostic tool, propensity scores were generated to match the comparable control groups. During the 12-year period, 33 375 patients and 50 465 hospitalizations of severe sepsis were identified. The age-standardized 28-day in-hospital mortality decreased significantly from 21% in 2008 to 15% in 2011 with increasingly implemented treatment and diagnostic tool. After propensity score matching, procalcitonin and lactate testing, transfusion of packed red blood cell, albumin, balanced crystalloid, and use of dopamine  were found to be significantly associated with lower mortality rate. However, inconsistent findings need to be further validated.

Rotherham NHS staff can request the article from the Library & Knowledge Service