New research published by the Health Foundation looks at trends in emergency admissions over the past decade. It finds that 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 admitted patients having five or more conditions in 2006-7.
The number of patients admitted urgently to hospital has increased by almost half over the past decade, up 42% - that’s an average of 3.2% per annum. This exceeds growth in total number of people attending A&E departments, which is up by only 13% - just over 1% per annum.
Instead, patients arriving at A&E are sicker than ever before, and more likely to need admission. Emergency admissions have grown particularly quickly for patients with multiple health conditions, as well as for older patients aged 85 or over, up by 58.9%.
The financial implications for the NHS in England are vast, the cost of emergency admissions in 2016-17 was £17 billion, up £5.5 billion in ten years.
The UK has the third lowest number of hospital beds in the European Union (2.6 per 1,000 population in 2015), and the second highest rate of bed occupancy. By the end of 2017, the percentage of acute hospital beds in use at one time in England was 90.7%, well over the 85% benchmark recommended by the Royal Colleges of Emergency Medicine and Surgery.
While the number of emergency admissions has increased by 3.2% each year on average over the last decade, the number of beds dedicated to these patients has grown only by 0.3% per year. 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 for less than 24 hours has grown by 373% over the same period.
Higher numbers of emergency patients with more complicated needs and who stay longer in hospital once admitted are challenging to manage. With so little spare capacity available, hospitals are increasingly being forced to cancel or postpone planned treatment.
Recent figures published by NHS England show more patients are waiting longer to begin planned treatment. In March 2018, for the first time in almost a decade, nearly half a million people had been waiting longer than 18 weeks for planned care.
Dr Jennifer Dixon, Chief Executive of the Health Foundation said:
‘Hospital staff have been saying for some time that they are admitting higher numbers of much sicker patients and these new findings show they are right. Staff have worked incredibly hard under pressure to provide emergency treatment for rising numbers of older patients with multiple conditions.
‘One third of patients admitted to hospital as an emergency today will have three or four conditions such as heart disease, diabetes and high blood pressure and present to A&E with an acute episode such as a stroke. These patients require urgent and intensive treatment, often across different specialities and this is putting huge strain on hospitals’ capacity to deliver planned care.
‘Some of the increase is because the NHS is able to keep older and sicker patients alive for longer who then return to hospital. However, it could also suggest that health and care support in the community is not as good as it could be.
‘The Prime Minister recently announced both a ten-year funding settlement for the NHS and a green paper on the future of social care, which is in urgent need of revival. Longer-term investment in both the NHS and social care system is critical to meet the needs of a growing and more frail ageing population.’
The report also looks at opportunities to reduce emergency admissions, key findings include:
- 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 general practice appointment that was convenient to them, though comparatively few of these A&E attendances will have resulted in an admission.
- Approximately 14% of all emergency admissions are for ‘ambulatory sensitive’ conditions – conditions where timely and effective ambulatory care would have reduced the risk of admission. These conditions include asthma for which care delivered in GP practices or care homes can prevent deterioration, as well as conditions that are preventable by vaccination such as influenza and pneumonia.
- If older patients saw their most frequently seen GP two more times out of every 10 consultations, this would be associated with a 6% decrease in admissions for ambulatory care sensitive conditions.
- Although there is potential to reduce admissions by making improvements elsewhere in the health care system, there are few well-evidenced examples of interventions that led to sustained reductions. With the numbers of patients needing emergency treatment rising along with costs, it is more important than ever to understand why comparatively few initiatives have succeeded and what changes are needed to ensure that future interventions are effective.
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