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Near 50% rise in 'avoidable' admissions swamps NHS


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 ear, 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.”


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Readers' comments (16)

  • "With ear, nose and throat infections, 80% of regions had admission rates significantly different from the average"

    This implies that the average is just a statistical device and not a true reflection of the current situation. How can something be an 'average' if it is true for only 20% of cases? It's a pointless figure to be quoting and useless to measure against. Also, perhaps 60% or 75% actually had lower admission rates. Who knows?

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  • There is an old, old, saying "prevention is better than cure". Start in primary schools - healthy eating, NO smoking, lots of exercise, how to manage stress (never to young to learn to meditate, etc). There are so many things we can do to help our children develop into healthy adults. For adults, it's never too late to stop smoking, start eating healthier, start exercising. The govt can and should do more in terms of preventative measures. How about giving each elderly person who wants one an exercise buddy? A lot of elderly people are stuck in their homes, quite lonely, demotivated, with little money to go and meet others in similar situations. And whilst there is the rise of the silver surfer, a lot of elderly people don't have access to the internet still which is a lifeline for other people with limited access to the outside world. Since I started nurse training I have been saying the same thing - prevention, prevention, prevention.

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  • michael stone

    'potentially' and 'could prevent some' are the key words here - how much extra effort/cost to prevent what actual percentage, is the real question.

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  • I worked on an elderly care ward recently and looked after 12 patients. Out of the 12 patients 6 were as fit as they can ever be, with nothing more the doctors can do for them. Two had been there for months.
    Funding had to be sorted out, wives were too frail to look after 3 of the patients.
    The 6 patients were in the hospital as no where to go. That was only on my side, the other nurses also had patients still waiting for placements.
    We staff are getting overselves ready to have patients coming in over christmas as families cannot look after them.
    It is well known when I worked in a community hospital where patients were admitted a few days before christmas as families reported falls, (no bruising seen or any other evidence of falls).
    After christmas the patients' families would come to take them back.

    More need to help nurses in the community. GPs' need to get their act together. More places should be made available in the community for the elderly if family unable to cope or want some time off.

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  • Shows how ineffective the QOF is at improving the quality of GP care. Abolish QOF and make GPs deliver the care for which they are paid. If they fail, fine them as with other areas of the NHS. QOF just seems to be cash for ticking boxes, not actually improving outcomes.

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  • TQM with iSO or European norms are a far better fail safe method of accreditation as they involve members of staff of all disciplines and at all levels and motivate them to maintain and improve their high standards of performance and are their certification can and should be displayed for all to see.

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  • I heard a GP stand up at a conference and say that QOF was a way ofticking a box to get the performance related payments!

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  • I am not surprised admissions are up. Working in North London, out of hours and needing a social worker might take 4 hours or more to make contact, one might not be on duty when they eventually ring back, so admit. Elderly people with mobility problems , maybe living alone, ambulance service are not willing to transport and taxi is not always the best option. How can we ensure that a district nurse will check on them the next day. Most policies only work 9-5 on week days. Mental Health takes hours for the team to arrive so the patient is placed in a place of safety as with the other categories. We only have the information from the patient or relatives, no longer do GP who have knowledge of the patient visit them out of hours or advise, if they did admissions may decrease.
    If in A & E we had senior experience doctors supervising the work of their junior colleagues 24 hours a day things might change, and one cannot blame the juniors if they wrongfully admit patients to protect themselves , they cannot be knowledgably on all topics and registrars are not always readily available to assist.

    The fact that patients have to be out of the unit within 4 hours does not help the situation, if a bed is requested it looks better on statistics, when if they had waited for lab reports or relative to arrive the scenario might be different.

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  • clearly healthcare is not going back to what it was as it would require far too many resources and high costs to put it 'right'. we need to lower our expectations and seek alternatives and reckon with the fact that being elderly you will be 'left out in the cold'.

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  • Too much money is wasted on paying GPs extra to do what is just acceptable clinical care rather than striking off those who do not. Therefore it would probably save money if the NHS was run properly and not having to bankroll the private sector. The Health and Social Care Act was all about enabling the privatisation of almost any "NHS" service, this by definition costs more OR is less good quality for the same patient. The US has widespread private provision and some of the most expensive care for poorer outcomes. Most primary care services would be as well run by nurse practitioners, in fact already are, but try seeing an actual GP and they are rare as hen's teeth. So why pay so much more for more GPs if they neither provide better care nor cost less. The NHS needs to wake up to the fact that Nurse Practitioners offer significant benefits to both patient and the NHS.

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