Fifth of emergency admissions avoidable, says NAO

One in five emergency admissions to hospitals in England could be avoided through improvements to primary care, ambulance services and hospital management of patients, a financial watchdog has said.

Emergency: ambulances need community alternatives to taking patients to A&E

A report by the National Audit Office found there were 5.3m emergency admissions to hospital in 2012/13, costing £12.5bn.

The rate of emergency admissions has risen 47% over the last 15 years, the report said.

Emergency admissions accounted for 67% of all ‘bed-days’ in the NHS in England in 2012/13. Wide variations in rates of emergency admission exist between CCGs, from 38 to 208 per 1,000 patients.

The NAO report, Emergency admissions to hospital: managing the demand said: ‘We estimate that at least one fifth of emergency admissions could be managed effectively in the community.’

The cites the lack of alternatives to A&E for ambulances to take patients to, pressure from the four-hour A&E waiting target, a rise in day-case surgery and perverse incentives to admit created by the Payment by Results tariff as key factors behind the sharp rise in emergency admissions.

Variable access to urgent primary care is another primary issue highlighted in the report.

Variations in GP referral rates for emergency admissions are another factor – the report found that referral rates vary from 0 to 95 per 1,000 patients around the country.

The NAO warned that the DH and NHS England must draw up plans to align incentives for providers.

‘Payment mechanisms should reflect the fact that different providers need to work together to manage the flow of patients through the system and make sure patients get the best treatment,’ the report said. ‘All parts of the health system need to be encouraged to reduce emergency admissions.’

The report says the DH must assess what barriers exist to seven-day working in hospitals and remove them, that successful local schemes to cut emergency admissions are shared and that patients’ information and records are shared more effectively.

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