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Rise in 'avoidable' NHS admissions

The number of emergency hospital admissions for conditions that could be avoided has risen 48% in 12 years, according to a new report.

Between April 2001 and March 2013, NHS hospitals in England received more than 56 million emergency admissions, of which one in five (10.4 million) were potentially avoidable.

Patients were admitted with conditions including dehydration, urinary tract infections, complications of diabetes, angina, chronic obstructive pulmonary disease (COPD) which is often linked to smoking, and e ar, nose and throat infections.

Research suggests better management of people's illness in the community and in GP surgeries could prevent some of these admissions.

The study, from the Nuffield Trust, found admissions for potentially avoidable conditions increased from 704,153 a year to just over a million a year. This accounts for an increase of 339,760 admissions for every year of the study.

Rates of admission were higher in older people (aged 65 and over), children under five and those in socioeconomically deprived groups.

The five conditions that accounted for more than half of admissions tended to affect older people (urinary tract infection or a kidney urinary infection called pyelonephritis, pneumonia and chronic obstructive pulmonary disease) and children (convulsions and epilepsy, and ear, nose and throat infections).

But population growth and an ageing population accounted for less than half of the overall increase in rates of potentially avoidable admissions, the report said.

Researchers argued that hospital admissions for all these causes can "indicate suboptimal care because the individual's health had deteriorated avoidably to the extent that hospitalisation was necessary".

Overall, the study found that rates of increase of admissions were broadly similar before budget constraints were introduced into the NHS in 2010/11.

But they warned: "However, small comfort can be drawn from this, as the impact of the resource constraints is very likely to be subject to a time lag.

"Indeed, it would be surprising if the first years of a real-terms freeze in NHS funding resulted in dramatic change.

"However, it is likely that the NHS and local authorities will be forced to make continued efficiency savings for many years to come."

The report also pointed out regional differences across England. All conditions resulted in much greater variability in admission than would be expected by chance alone.

With ear, nose and throat infections, 80% of regions had admission rates significantly different from the average, while 60% had admission rates that were different for angina and 67% for pneumonia.

A separate report into hip fracture by the Nuffield Trust found that emergency readmissions to hospital within 28 days of discharge rose 41.2% across the 12 years.

They went from 80.3 per 1,000 admissions in 2001/02 to 113.4 per 1,000 admissions in 2010/11.

Overall, the number of hip fracture admissions increased by 15.5%, from 46,495 in 2001/02 to 53,694 in 2010/11, mainly due to an increasingly ageing population.

The report said overall care in hip fracture has been improving, with the the proportion of patients receiving an operation within 24 or 48 hours rising.

Death rates within 30 days have also fallen by 22.9%, from 97.2 to 74.9 deaths per 1,000 admissions between 2001/02 and 2010/11.

The reports form part of a project called Qualitywatch between the Nuffield Trust, which is an independent health research organisation, and the charity the Health Foundation.

The overall finding across 150 "quality indicators" is that care in England has improved in many key areas over the past decade.

This includes "consistently low waits" for planned care, diagnostic tests, ambulance and cancer treatment compared to five or 10 years ago.

Improvements in the management of infections like MRSA and Clostridium difficile have also been marked, while patients are generally positive about their experience of the NHS.

But some areas - including prevention of emergency admissions - are a cause for concern, the project found.

Nuffield Trust chief executive Andrew McKeon said: "Given constraints in resources for the NHS and social care in the next decade, a key concern must be the extent to which the gains made in improving quality of care over the past decade may be lost.

"But despite recent high-profile failures and fears of deteriorating care standards, our research suggests that the constrained funding levels have so far not had a major impact on the overall quality of care received by patients and service users."

Health Foundation chief executive Dr Jennifer Dixon said: "It is very important that as many eyes as possible are watching the quality of health care over the next few years.

"The good news is that on most indicators examined quality appears to be at least maintained.

"But urgent care stands out as being an area to watch, in particular the quality of care outside of hospitals and timely access to it by the public. This should be a high priority for action and a test of intelligent policy-making as well as management at the front line."

Michael Scott, chair of the NHS Confederation's community health services forum, said: "We know A&E departments are under more pressure than ever before so it is absolutely vital that we take every opportunity to care for patients at home or in their communities. If we don't, we are needlessly putting additional pressure on A&Es.

"What patients tell us they want - and what common sense tells us - is more and better care in or near people's homes, so they don't need to attend A&E or be admitted to hospital in the first place.

"It is crucial that we invest in community-based services - the experts in prevention and early intervention - so that they can deliver their full potential, which is right for patients and for sustainability. Getting it right is a win-win."

A spokeswoman for the Department of Health said: "The NHS is performing well, despite more than a million patients starting treatment every month. Average waiting times are low and stable.

"We know we are facing challenging times. Our priority is to deliver better care and a more sustainable NHS.

"That is why we have set out bold and radical steps to transform the way that hospital care is delivered.

"Through more proactive primary care and better integration of health and social care, older people will be better supported in their homes and get the treatment they need in the best place for them."


From Belfast Telegraph