Introduction

This winter has been a story of profound mismatch between illness and NHS resources. More seriously unwell people needing admission have arrived at the front doors of A&E departments in England than NHS hospitals have had the staff or beds to cope with.

The results are now familiar: long, undignified and sometimes potentially unsafe waits for patients in corridors and in the back of ambulances, while other patients are having to cope with last-minute cancellations of their planned treatments to make room for the influx of emergencies. A large number of patients have not been discharged from hospitals even though they are deemed medically fit to leave, meaning they continue to occupy beds.

A great deal of effort is being put into reducing emergency admissions in England. The motivation for this is three-fold. Firstly, hospital care is the most expensive element of the health service and, in a cost-constrained system, resources must be carefully managed. Secondly, hospital admissions can expose certain patients (particularly older patients) to risk of infections. These patients can also rapidly lose the strength needed to maintain an independent life after leaving hospital. Thirdly, many patients admitted to hospital would prefer to be treated at home or in a medical facility close to home – or to avoid needing to seek urgent treatment in the first place.

Efforts to reduce emergency admissions are seen among the 44 Sustainability and Transformation Partnerships and the 50 new care models vanguards, which are being assessed on (among other things) reducing emergency bed days per 1,000 population. Releasing money from the Better Care Fund involves agreeing local plans to reduce emergency admissions. More generally, assumptions about the future growth of emergency admissions are seen throughout the central management of the health care system, including the locally agreed contracts between providers and commissioners (which specify no more than a 2.3% growth planned for 2018/19).

The efforts to reduce emergency admissions are part of a longer-term ambition to move away from health care being delivered in acute hospitals to finding alternative ways to manage patients at home or in the community. Many health systems have this ambition, with almost all of the 35 Organisation for Economic Co-operation and Development (OECD) nations seeing reductions in acute hospital beds, enabled by advances in medical technology and shortening the lengths of hospital stays. However, there are concerns over the capacity of the NHS to respond to high levels of demand, with bed occupancy rates now routinely above 90%. Meanwhile, the UK already has the third lowest bed numbers in the European Union, the second highest rate of bed occupancy and shorter than average lengths of stays.

A clear understanding of the nature and drivers of demand for emergency admissions is needed now more than ever. This briefing aims to provide an overview of trends in emergency admissions over the past decade, and a summary of the best evidence behind some of the interventions being deployed to stem what might look like to many, an inexorably rising trend.

Previous Next