Key points

  • A great deal of effort is being put into reducing emergency admissions in England. While some efforts may have been successful, the number of emergency admissions has nonetheless grown by 42% over the last twelve years.
  • The impact on acute hospitals is being compounded by the increasingly complex needs of patients requiring an admission. In 2015/16, one in three emergency patients admitted for an overnight stay had five or more health conditions, up from one in ten in 2006/07. Emergency admissions have grown particularly rapidly for older patients, increasing by 58.9% since 2006/07 for people aged 85 years or older. These trends are challenging for hospitals to manage, since patients with more conditions spend longer in hospital once admitted.
  • Hospitals have attempted to manage these pressures by shortening length of stay. While the number of emergency admissions has grown by 3.2% each year on average, the total number of bed days for patients admitted as an emergency has grown only by 0.3% per year. Around a third of all emergency admissions are now zero-day stays, meaning that the patient does not need to stay overnight.
  • Reductions in length of stay have been particularly dramatic for patients with multiple health conditions. Patients with five or more conditions who were admitted overnight spent an average of 10.8 nights in hospital in 2015/16, compared with 15.8 nights in 2006/07. The number of zero-day stays for these patients has increased by 373% over the same period.
  • While these reductions in length of stay suggest there have may been improvements in productivity, these trends have not fully offset the impact of overall growth in emergency admissions: the total number of bed days devoted to patients admitted as an emergency has increased from 27.1 million days in 2006/07 to 28 million days in 2015/16.
  • These trends are making it increasingly difficult for hospitals to reliably deliver elective care. Although the overall balance between emergency and elective bed days has not changed markedly over the last decade, bed occupancy rates have increased and are now routinely above 90% in England. With such little spare capacity, hospitals are struggling to accommodate sudden and unpredictable increases in emergency admissions, meaning that elective care is cancelled or postponed.
  • For more than a decade, health policy in England has sought to reduce demand for emergency care by making improvements to other parts of the health care system. The rationale is that around 14% of all emergency admissions are for conditions that might be manageable in primary care, and good quality primary care has been linked to fewer admissions. However, it may not be possible to reduce demand for a large number of admissions even with effective out-of-hospital care. Contractions in funding for social care funding also be affecting admissions.
  • It is more important than ever to understand which approaches are effective at reducing emergency admissions and why. Unfortunately, there are comparatively few well-evidenced examples of specific interventions achieving sustained reductions in emergency admissions, in part because the NHS does not always have access to evaluations of the type needed. As a result, it is often not clear what impact changes are having, and what are the elements that could be spread.
  • Interventions must be well designed, based on a deep understanding of the underlying problems with care delivery, and evolve over time in response to learning. This will only be possible if clinicians and managers have the time, resources and skills to lead improvement work. Health and social care data sets will also need to be brought together, to help analysts understand the issues with care delivery and assess the impact of changes.