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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’.

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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.