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The number one issue facing the NHS in England is reversing the ‘unsustainable’ rise in emergency hospital admissions, the independent health charity the Nuffield Trust warned today following new analysis it has published which reveals there has been an almost 12 per cent rise in admissions over the last five years.

The comprehensive analysis reveals the number of emergency admissions in England rose by 11.8 per cent between 2004/05 to 2008/09 – resulting in around 1.35 million extra admissions. It is estimated that treating these extra patients in emergency hospital care is costing the NHS an additional £330 million per year. The report reveals that emergency admissions now make up 35 per cent of all hospital admissions in England – at a cost of around £11billion to the annual NHS budget.

The report found significant variation between NHS hospital trusts – in some, emergency admissions reduced by up to a third over the five years, while in others they almost doubled.

A key finding from the Nuffield Trust analysis is that the rise in emergency admissions has been linked with a dramatic increase in the number of short-stay admissions – those patients that are admitted as an emergency for one day or less. In England in 2008/09, 592,724 more patients were admitted for one day or less compared to 2004/05 – a marked jump, with zero and one day admissions accounting for 49 per cent of all emergency admissions in 2008/09 compared to 42 per cent in 2004/05. Some hospital trusts have seen a much larger increase in short-stay admissions than others.

The report concludes that this has, in part, been caused by a lowering of the clinical threshold for emergency admissions. Advances in medical care and management have reduced the length of time patients stay in hospital, which in turn has freed up more available beds and allowed doctors to admit more patients. To break out of this cycle in future will mean creating better out-of hospital care and preventive care to reduce the risk to patients of admission and enable expensive hospital beds to be closed, the report warns.

Nuffield Trust Director Dr Jennifer Dixon said: ‘Reversing this unsustainable rise in emergency admissions must be the number one priority for the NHS in England – any reform to the health service that does not tackle this will fail. Our hospitals are over-heating and are on an unsustainable path in which they are treating patients at great cost to the NHS and to patients themselves. This cost could be avoided by preventing ill health through better care by GPs, community care services or social care, and better co-ordination of care between doctors in hospital and general practice. Avoidable emergency admissions will continue to rise unless care is more integrated and hospitals and beds are closed. Otherwise the risk is that the NHS becomes unaffordable.’

The report examines a number of possible reasons for the rise, including the impact of targets, the ageing population, and variations across different hospitals. Key findings from the analysis include:

• Ageing population: the report found that people aged over 85 were nearly 10 times more likely to have an emergency admission than someone in their 20s, 30s or 40s. But despite this, only 40 per cent, at most, of the extra admissions can be explained by the growing ageing population.

• Are people more unhealthy?: the rise is not down to any one particular type of illness and levels of self-reported ill health do not appear to be rising.  The report notes that the growth in admissions is mostly due to new single cases rather than individuals being admitted more often each year.

• Geographical variations: within England there is significant variation between NHS hospital trusts. In some, emergency admissions declined by up to a third, while in others they almost doubled. There is also significant variation between primary care trusts. Although admission rates are known to be higher in more deprived areas, there is no clear link between deprivation and the rise in emergency admissions.

• Central policy initiatives: such as the A&E four-hour maximum waiting time target,  the introduction of Payment by Results (PbR) and more autonomous NHS foundation trusts, have had little overall impact on rising emergency admissions. However, for some individual NHS trusts an association with the A&E target is apparent.

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Notes to Editors
1. For media enquiries please contact the Nuffield Trust press office on 020 7631 8455 or 020 7462 0555, or 07825 510527; or email: pressoffice@nuffieldtrust.org.uk.

2. The report: Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency? by Ian Blunt, Martin Bardsley and Jennifer Dixon, will be free to download from 5 July 2010 from: www.nuffieldtrust.org.uk/publications. This paper summarises the results; the methods and fuller findings are described in more detail in a fuller report (Blunt, 2010). For biographies of the authors, please visit: http://www.nuffieldtrust.org.uk/aboutus/staff_profiles/.

3. The research provides a comprehensive analysis of emergency admissions in England by using Hospital Episode Statistics to examine monthly emergency admissions over a five year period from April 2004 to March 2009. All hospitals in England have been covered, although some admissions (such as in mental health, those for which no diagnosis was recorded, or those occurring in merged NHS trusts) were excluded as appropriate to each analysis. Emergency admission is defined as any spell with admission methods via A&E, GP, bed bureau, consultant OP clinic or NHS Direct.

4. The Nuffield Trust is an independent charitable trust carrying out research and health policy analysis on health services. Our focus is on the reform of health services to improve the efficiency, effectiveness, equity and responsiveness of care. Key current work themes include new forms of care provision, commissioning, efficiency, national/international comparisons and competition policy. For more information on our work programme and to sign up to receive our regular e-newsletter, visit www.nuffieldtrust.org.uk.


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