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Emergency admissions must reduce 'measurably' by 2020, NHS told

NHS England has been told to make ‘measurable’ reductions in emergency admissions over the course of the next two years, following a review by the National Audit Office.

Emergency admissions increased by 9.3% since 2013/14, with avoidable cases making up nearly one quarter of admissions last year, the NAO found.

The report, which comes as the hugely unpopular and bureaucratic Avoiding Unplanned Admissions DES was scrapped from the GP contract only last year, said that NHS emergency admissions were far from under control and mandated NHS England to reduce the admission rates by 2020.

But the report warned that efforts to reduce emergency admissions could 'create additional demand' for general practices and local social services.

It said: 'The NHS... 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.'

Despite the rise in admissions, the NAO said NHS providers had done well to reduce the financial impact by reducing length of stay and increasing daycase treatments.

But, in light of increasing rates of readmissions, it said it could not know if the approach was working 'until it understands whether reported increases in readmissions are a sign that some people admitted as an emergency are being discharged too soon'.

In order to improve decision making, as well as understanding among policy-makers, the NAO said NHS Digital should link up hospital activity data with primary, community and social care data.

BMA council chair Dr Chaand Nagpaul, who negotiated for the scrapping of the unplanned admissions DES from the GP contract, said the reasons behind the rise in admissions were two-fold.

He said: ‘Increases in emergency admissions are partly as a result of an ageing population with people living longer with a range of complex medical needs, but also because of cuts to social care budgets and a lack of capacity in community services.'

He argued that 'without the necessary investment in staff and services the NHS will continue to struggle'.

The avoiding unplanned admissions DES was first introduced with the 2014/15 GP contract but came under critique for heavy workloads and bureaucracy.

It was renewed for 2015/16, despite experts indicating there was no evidence of its effect and despite the number of unplanned admissions rising in 2014/15.

The scrapping of the DES saw £157m moved into the GP global sum in for this financial year, but made GP practices contractually bound to carry out frailty checks in elderly patients instead.


Readers' comments (12)

  • I trust this is aimed at our Consultant friends. They admit the patients to their wards, not us. If one quarter are unnecessary then NHSE needs to be educating our learned colleagues to stop bringing them in if not required medically.
    Not sure how GPs can stop hospitals admitting people.

    Maybe if we weren't pressured to keep people alive at all costs in their old age with multiple morbidities then all would be wel. Less pension pay outs, less resource strain. It's a win-win for Govt.
    I still think old age is a reasonable and allowable cause of death and it really is the likely outcome of a long and hopefully healthy life.

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  • Maybe we can pay GPs for reducing admissions - that is likely to go down really well!

    More realistically - everyone on the front line can see a link between difficult recruitment and increasing hospital admissions. Deliver your 5000 extra GPs, then add a few thousand more to cover the difference in work hours from a workforce that is moving from partners (longer hours) to salried/ locum GPs (shorter hours), then you might see progress in this area.

    What we can say with confidence is 'schemes' like pointless care plans are just not going to work. There is no way to achieve this on the cheap. Do it properly. For once.

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  • The NAO can ask but will they get extremely unlikely in the current climate.There is a workforce crisis brought on by the austerity agenda, push one place give another.They can't have it both ways.Add on to this a profession under siege every systematic failure one of them get hung out to dry I for one will not alter my admitting when my career can be ended by the parasitic legal system.

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  • Just as well the NAO ‘told’ and ‘mandated’ that people become less ill! That should sort it!

    Perhaps their ancestors worked for king Canute.

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  • Another useless quango delivering missives from up on high. Why don't we just scrap the national audit office and reinvest this money in general practice where it will be put to good use?

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  • National Audit Office.
    Just who is this 'expert' collective? All related to King Canute presumably?

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  • Sorry @Big and Small
    Couldnt see your post when I did mine, but agree of course!

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  • Useless quango trying to justify its existence. We see what happens if any doctors makes any mistake, most people are just being more risk averse and careful. I dont blame them.

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  • Just Your Average Joe

    Chicken - Egg

    Increased costs from unnecessary admissions, no funding for social care and primary to keep them at home.

    Move money to primary care, hire staff and resource social services to support elderly at home, and move care home spaces for those unable to remain at home, and out of hospital.

    Have outreach teams to keep elderly supported at home, without GP taking on the unfunded extra work - as we have neither time, manpower or resources to take on more home visits.

    Stop the merry go round admit, failed discharge and back in again.

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  • medicine tastes awful

    Emergency admissions must reduce 'measurably' by 2020

    R U KIDDING ME!!!!!!!!!!!!!!!!!!!!!!!!!

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