Key points

  • Over the past 12 years, the number of emergency hospital admissions in England has increased by 42%, from 4.25 million in 2006/07 to 6.02 million in 2017/18.
  • Over 60% of patients admitted to hospital as an emergency have one or more long-term health conditions such as asthma, diabetes or mental illness.
  • Patients with long-term conditions spend under 1% of their time in contact with health professionals. The majority of their care, such as monitoring their symptoms and administering medication and treatment, comprises tasks they or their carers manage on a daily basis.
  • To find out how able patients currently feel to manage their health conditions, the Health Foundation looked at Patient Activation Measure (PAM) scores, which assess four levels of knowledge, skill and confidence in self-management, for over 9,000 adults with long-term conditions. We found that while 13% of patients reported the highest level of ability in managing their health conditions, almost a quarter reported the lowest level, and may feel overwhelmed by their conditions.
  • We found that patients who were most able to manage their health conditions had 38% fewer emergency admissions than the patients who were least able to. They also had 32% fewer attendances at A&E, were 32% less likely to attend A&E with a minor condition that could be better treated elsewhere and had 18% fewer general practice appointments.
  • Patients most able to manage a mental health condition, as well as any physical health conditions, experienced 49% fewer emergency admissions than those who were least able.
  • These findings show the NHS could reduce avoidable use of health services, including the number of emergency admissions and A&E attendances, by supporting patients to manage their health conditions better. The potential impact of this is significant.
  • If those currently least able to manage their conditions were better supported, so that they could manage their conditions as well as those most able, this could prevent 436,000 emergency admissions and 690,000 attendances at A&E, equal to 7% and 6% respectively of the total in England each year.
  • Even if the patients who are currently least able to manage their conditions could be supported to manage their health conditions only as well as those at the next level of ability, this could prevent 504,000 A&E attendances, and 333,000 emergency admissions per year. This equates to 5% of total emergency attendances, and 6% of emergency admissions in England each year.
  • In this briefing, we assess the evidence for the effectiveness of a range of approaches the NHS could use more often to support patients to manage their health conditions. These include: health coaching, self-management support through apps, social prescribing initiatives and peer support including via online communities.
  • Previous studies have emphasised the importance of supporting patients to manage their conditions to improve health, wellbeing and satisfaction. Our findings show that the ability of patients to manage their health conditions impacts every part of the health service, but we believe the biggest opportunity to reduce avoidable hospital use lies in urgent care. To reduce emergency admissions and improve care for patients, national policy makers should provide greater support to patients so that they have the ability and confidence to manage their long-term conditions.