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Avoidable overnight stays cost NHS £330m a year


There has been a large and avoidable rise in the number of overnight hospital stays, which cost the NHS £330m annually, a report has said.

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The study, from independent think-tank the Nuffield Trust, said the increase was “unsustainable” and pointed to large variations between hospitals in how many patients were admitted.

It calculated there was a 12% leap between 2004/05 and 2008/09 in the number of patients going into hospital as an emergency - resulting in around 1.35 million “extra” admissions.

The number of “costly and frequently preventable” emergency admissions, mostly through A&E, rose from 4.4 million in 2004/05 to 4.9 million in 2008/09, the study said.

Around one in three of all hospital admissions in England are emergencies, costing the NHS some £11 billion a year - one of the most expensive areas of the health service.

The report said the cycle would need to broken in the future through creating better out-of-hospital care and preventing patients becoming sick in the first place.

Nuffield Trust director Dr Jennifer Dixon said: “Our hospitals are over-heating and are on an unsustainable path in which they are treating patients at great cost to the NHS and to patients themselves.”

The College of Emergency Medicine said it did not accept that admissions for fewer than 24 hours were unnecessary.

It said many emergency patients require access to diagnostics (such as blood tests and X-rays) and a period of observation to ensure the decision to discharge the patients home “is informed and safe”.

Health Secretary Andrew Lansley said: “We need a more integrated approach to NHS care. It’s better for patients and it’s also cost effective. It’s an approach which would ensure patients are not treated like drones in a production line but are given the best care at every point of their journey.”


Readers' comments (11)

  • Modernising Medical Careers? Year on year increases in numbers of people using A&E as a 24hr drop in health centre. Mass imigration from eastern europe. Growing alcohol and drug abuse. No experienced cover at nights and weekends.

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  • "We need a more integrated approach to NHS care".

    What does this mean? The 4 Hour target is about to be dropped - because of the cost agenda, more waiting time in A&E will mean less people turning up to be seen with minor ailments, but will likely have a knock on effect of reducing quality of care to those who need to be there, because there will be a loss of focus on Emergency Care.

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  • some times there are a lot of time wasters in the A&E. People get admitted for uneccessary reasons, a twist in ankle, hurt their wrist and old elderly who are not coping well because they are refusing to eat. Honestly, what they need is a nursing home not A&E, they come in and refuse dietician and even hospital food despite being encouraged so many times. So if patient refuses what can we do? As the service is free, they come in and out as they like. I support having to pay for healthcare fees! If people are too poor or stingy to pay it then There should be a cheap pay list where anybody admitted must pay xx amount of fee.

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  • I think they should be presented with a bill once they have been declared fit for discharge. If they know it'll cost 500 quid a night...I'm sure home would seem more attractive to patients and their families. We recently had one family ask us to keep their grandmother because her house was being refurbished and complained about our lack of understanding to the local paper. What evil people we are.

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  • Anonymous | 5-Jul-2010 9:22 pm that is a spot on idea I totally agree!

    Whilst I would be the first to argue for a patient if they truly needed a bed, I know that there are also a lot of timewasters and a lot of people who do need care but don't necessarily need to stay in overnight (and that is not including the army of medically fit bed blockers)!

    What is needed is sterner and more robust action on actually turfing people out, and I agree charging them for their stay if they do not clinically need to be there is a great idea!

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  • Patients like many people in the country and the majority of the western world have learned to live life in a state of I want it sorted now, they are not prepared to wait if they feel unwell for the symptoms to settle if it is a cold, or to wait for an appointment at the GP. Hence A/E is seen as a quick fix, and a 24 hour stay during which time they will get many of the investigations done that via the GP would take weeks to be organised and more importantly would take weeks to get the results, seems a small price to pay by a patient to be "SORTED" or reasurred. The key is really patients are saying they want the kind of service A/E and short hospital stay can provide rather than the prolonged back and forth care Primary care provide. The question is can the country afford that, My Gp I concider is very good but I get frustrated by the length of time it takes to sort out a problem I would love a one stop 24 hour assessment so why cant GP work towards that model of care or use the rapid access services available for may conditions more effectively. Has a current audit of why a patient used A/E for a problem been done, was it the patient that self referred or were they ADVICED to go to A/E by GP or NHS direct, if it is the last 2 then dont blame the patient aim for an improved out of hospital service!!!!!

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  • Too many people attend A/E with minor injuries and illness.As having to wait 4 hours or more does not seem to put them off i agree they should have to pay for any investigations or treatement that they could eithor have gotten from GP or buy over the counter. How many paracetamol do we give out a year?

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  • ^ and they throw their paracetamol in the bin after seeing GP!!! I know a lot of them. Thats our money too

    people in the uk are so pampered, we had a patient whos house was refubishing too and their family requested patient to stay for a few more days when she was clearly fit to leave. Obviosuly if patient cant get access to house by uk all trust policies we have to keep them in. Beds are for sick patients not for any people who feel like coming in and out

    Thats why Uk is a very very very attractive country to poor people esp in eastern europen, asian countries and african countries cos healthcare is free, u get paid for being poor, u get a flat. house, having more and more babies is not a worry because uk government will support you. What other countries in the world would do that?? Despite uk citizens being very mad at government, the uk gov always does thing in their own way. They forget whos paying tax!!

    Patients should at least have to pay a few £ to see doctors at A&E. This could also mean that we are paying less tax, keeping the money that we have worked for

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  • As acting night manager I often have the problem of uncessary overnight stays due to lack of appropriate transport with discharge taxis and private ambulances which are based a long way from the hospital. Also getting patients reassessed and discharged during the night . Due to bed closures and time limits in A/E the bed usage in the admission wards is phenominal. Our hospital covers a large rural area and there is no way may folk can get home . Plus the average age for admission is over 85. Many patients do not arrive at hospital until 7 to 9 pm as not 999 ambulance transfers when referred by GPs

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  • Some problems occur when patients stay overnight because community hospitals refuse admissions arriving after 10 pm or nursing homes close their doors at 9pm or even as early as 7 pm.

    The removal of the national one size fits all four hour target may prove to be a good thing if ,and it's a big if, the correct amount of time is given to those patients that need it, ensuring all necessary treatments are completed before discharge/admission AND patients are prioritised according to need and not time of arrival. If this is done then those people with trivial complaints might not be seen for several hours whereas those with more serious complaints will be seen sooner, this may eventually result in less 'time wasters' and thus less need for patients to be admitted for trivial reasons as outlined above. However the problem of inappropriate admissions may move from the ward to boarders residing in A&E.

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  • I believe we need more access to walk in centres and pcas centres to take the pressure off A and E, GP's and OOH. While GP's might prefer people to access them for any illness, they are not willing to expand to the point where that is possible. While they are not part of the NHS then this will continue to be a problem. They will always have leverage.
    Trying to prioritise A&E admissions and turf outs against shrinking funding issues is missing the point and trying to put a sticking plaster on a more fundamental problem.

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