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Poor service integration driving up avoidable hospital admissions

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Nearly 1.5 million people could have avoided emergency admissions in 2016-17 if hospitals, GPs, community services and social care had worked together properly, according to a committee of MPs.

The Commons public accounts committee said that around a quarter of emergency admissions to hospital could and should have been avoided.

“The NHS had not made the necessary investment to fund this kind of preventative work”

PAC report

The MPs identified a number of problems, from badly funded preventative care outside hospitals to a failure by NHS England to work with the voluntary sector.

Almost a quarter – 24% – of emergency cases could have been avoided if people had more effective community health care and case management to prevent them getting so unwell, they said.

In a new report, published today, the MPs noted that the proportion of avoidable admissions had been rising faster than the overall rate of emergency admissions since 2013-14.

“However, the NHS had not made the necessary investment to fund this kind of preventative work and the need to make short term savings means local areas have been overlooking investment in preventative services,” said the report titled Reducing emergency admissions.

The problem was exacerbated by insufficient investment in social care, it said. “Social services also help prevent people needing an emergency admission, and we find the combination of rising demand for social services and limited local authority finances particularly worrying,” said the report.

“It is disappointing that there is no central understanding of the work of the voluntary sector”

PAC report

The report stated that the voluntary sector had an important role to play in supporting health and social care teams in the community. But it said “NHS England has not systematically engaged with the voluntary sector to fully understand the importance of its support in reducing emergency admissions”.

In their evidence to the committee, NHS witnesses had pointed to the voluntary sector’s role in ambulance services but these were only “piecemeal” examples, the report said.

“It is disappointing that there is no central understanding of the work of the voluntary sector in helping to reduce emergency admissions or how reliant trusts may be on voluntary sector support, both paid and unpaid,” it stated.

The report also identified poor understanding of what works best to reduce emergency admissions. It noted that NHS England was using the urgent and emergency care programme, new care models and the Better Care Fund.

“However, neither NHS England nor NHS Improvement know what is most effective at reducing emergency admissions,” said the report.

“NHS England does not seem to understand which particular interventions are working or why. This lack of understanding hampers improvement and prevents the cash strapped NHS from targeting taxpayers’ money on the things that work best,” it said.

“NHS England and NHS Improvement must take a lead here and move swiftly”

Meg Hillier

The committee flagged up the fact that, while 79% of the growth in emergency readmissions was caused by people who did not stay overnight, there was inconsistent data management. Some were recorded as admissions and some as outpatients, it said.

“Without good data, NHS England cannot assess if readmission rates are at harmful levels,” warned the MPs in their report.

They also highlighted concern about rising bed occupancy rates affecting hospitals’ ability to cope with emergency readmissions.

The MPs urged the regional teams at NHS England and NHS Improvement to assess the capacity that hospitals for beds, staff and funding to cope with emergency admissions throughout the year.

Committee chair Meg Hillier said the report exposed the government’s failure to adequately fund and coordinate preventative health care and social care.

“The benefits of work to reduce the impact of emergency admissions will inevitably be limited until hospitals, GPs, community services and social care work better together to drive down the level of avoidable admissions,” she said.

“Adult social care needs to be put on an equal footing to the health service”

Izzy Seccombe

Ms Hillier, Labour and Co-operative Party MP for Hackney South and Shoreditch, urged NHS leaders to take more care to understand what was happening.

“NHS England and NHS Improvement must take a lead here and move swiftly to better understand the stresses across the health and social care sectors and their implications,” she said.

“A priority must be to properly identify the impact of measures intended to reduce emergency admissions and explain how this information will be used to target scarce resources effectively,” she added.

NHS England welcomed the thrust of the report while rejecting “several factual flaws”. Contrary to the report’s findings, it said a “patient being discharged from hospital today does not have a higher likelihood of being readmitted than a similar patient a decade ago”.

It also said that the chance of being admitted to hospital as an emergency from accident and emergency was down 12% over five years.

Saffron Cordery

Saffron Cordery

Saffron Cordery

A spokeswoman said: “Despite containing several factual flaws, the report makes several important points, including the need for properly resourced and integrated social care and community support, which all need to be addressed if the proposed 10 year long term plan for the NHS is to succeed.”

The body NHS Providers welcomed the report, saying it echoed its own findings, which were recently published.

“Our recent report showed how repeated promises to bring more patient care closer to home by prioritising NHS community services have fallen flat,” said Saffron Cordery, NHS Providers deputy chief executive.

“Thanks to advances in care and treatment it is now possible to look after people at home who, 10 or 20 years ago would have needed to stay in hospital,” said Ms Cordery.

“Yet our survey of NHS trust leaders showed support on the ground for community services has failed to match the rhetoric, leaving many providers marginalised, underfunded and short staffed,” she said.

Izzi Seccombe

Izzi Seccombe

Izzi Seccombe

Meanwhile, in its response, the Local Government Association highlighted that the funding gap facing adult social care was set to exceed £2bn by 2020.

“Adult social care is essential to reducing pressures on the NHS and since July 2017 transfer of care delays due to social care have fallen by about 30,” said Izzi Seccombe, chair of the LGA’s community wellbeing board.

“This should incentivise government to fully fund our social care system,” she said. “Adult social care needs to be put on an equal footing to the health service if delayed transfers of care are to be reduced further.”

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