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Needless admissions add to burden on Northern Ireland health system

One in six patients gets a hospital bed unnecessarily... and is kept in too long

By Adrian Rutherford

One in every six emergency admissions to hospitals in Northern Ireland is unnecessary, a shocking report reveals today.

Up to 26,000 patients were needlessly admitted in the last year, at a potential cost of £75m.

In many cases they remained on wards longer than was required, an investigation found.

The Northern Ireland Audit Office warned that emergency admissions are costly and frequently avoidable.

It comes at a time when hospitals are struggling to cope with increasing demand.

Latest figures show nearly 400,000 people - one in five of Northern Ireland's population - are on a hospital waiting list.

Yet in many cases beds are being taken up unnecessarily.

Auditor General Kieran Donnelly said: "My report shows that emergency hospital admissions are costly and frequently avoidable.

"To compound matters, once admitted, many patients can remain in a hospital bed longer than is necessary.

"With hospitals struggling to cope with increasing levels of demand for emergency care, particularly among older and chronically ill patients, ensuring that patients are treated in the most appropriate setting is crucial if the resources available for emergency care are to be used to best effect."

Today's report reveals:

  • In the 12 months to April around 16% - one in six - of all hospital emergency admissions may not have been necessary;
  • Based on the 166,000 emergency admissions last year, that equates to a staggering 26,560 wasted admissions;
  • Last year, emergency admissions to hospitals cost £467m, meaning £75m could have been needlessly lost from the health service budget;
  • The number of attendances at major emergency departments over the past eight years has shot up by 12%;
  • A series of targets aimed at reducing unplanned hospital admissions have been missed.

Emergency admissions account for 28% of all patients admitted to hospital in Northern Ireland. The number of emergency admissions has risen from 151,000 in 2008/09 to 166,000 in 2015/16 - up 10% in seven years.

Demand for emergency care has grown steadily over the past decade, driven by an ageing and growing population and increases in chronic illness.

Around one in five people who attended an emergency department in 2015/16 was then admitted to a ward.

Many emergency admissions are for Ambulatory Care Sensitive (ACS) conditions - in other words medical problems which are potentially avoidable.

Today's report states: "Research in the UK indicates that ACS conditions make up one in every five emergency admissions.

"Locally, approximately 16% of all emergency admissions to hospitals in 2015-16 were ACS conditions and thus potentially avoidable."

The report notes that in 2014/15, the cost of emergency admissions to acute hospitals was £467m - 10% of the entire health and social care budget.

Auditors found too many patients admitted as emergencies still face unnecessary delays in their discharge from hospital.

This is largely due to problems in securing appropriate care packages in their homes or the community.

The Department of Health's target in 2015/16 was that no patient with complex needs should remain in hospital for more than seven days after clinicians and other health professionals had deemed them to be ready for discharge.

However, in that year more than 1,700 such patients continued to occupy a hospital bed.

The report found that the Department of Health's focus on emergency care is securing some improvement.

There are many local initiatives to prevent avoidable emergency admissions, including risk prediction by GPs.

The trusts have also made significant efforts to improve their management of patient admissions and discharges. This has meant shorter hospital stays and falling hospital bed numbers.

Reducing acute hospital admissions for patients with one or more long term conditions has been a target for the Department of Health since the publication of the Programme for Government 2008 to 2011.

However, every major target has been missed.

Initially the target was to reduce unplanned hospital admissions for such conditions by 50% by March 2011, but this has failed.

The target was amended to 10% in the Commissioning Plan Direction for 2012 to 2014, but this also was missed.

It was scaled down again to 5% for 2015 and still not achieved, and remains at that level for 2016.

Belfast Telegraph


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