Integration could slash admissions bill by £500m, says watchdog

Slashing emergency admissions in high-cost areas to national average rates could save the NHS in England more than £500m by 2015, according to a financial watchdog.

This is equivalent to 2.5% of the total £20bn efficiency saving required by the government’s quality innovation, productivity and prevention (QIPP) scheme.

But the report by the Audit Commission, Joining up health and social care warns that the savings could be impossible unless health and social care services integrate more.

The report said rates of admissions vary widely by PCT and are often well outside predicted rates: ‘Performance ranges from one PCT having one-and-a-half times as many admissions as expected, to one that has just under two-thirds of the admissions expected.’

But if areas with high rates of unplanned admissions – after taking account of the make-up of their populations – matched the national average, costs could be cut significantly.

‘If all those areas that have higher than expected emergency admissions of patients aged 65 and over had the expected number of admissions, we estimate that PCTs would have saved about £132m in 2009/10,’ the report said.

It argued that financial constraints on NHS and social care budgets mean the two sectors must work together to achieve value for money.

But the report warned that the lack of funding may drive some local authorities and health organisations to ‘retreat from joint working’, a move that could lead to ‘cost-shunting and greater costs in the future as well as worse outcomes for people’.

The report suggests that measures of emergency admissions can be used to track effectiveness of partnerships between health and social care.

‘NHS and social care partnerships can use a few high-level indicators to show how well the NHS and social care interface works. These indicators are by no means definitive or exhaustive,’ it said.

The indicators are:

  • Emergency admissions for people aged 65 and over.
  • Emergency bed days for people aged 65 and over.
  • Admissions to residential and nursing care.
  • Admissions to residential and nursing care direct from hospital.
  • Numbers of people dying at home.

The report added: ‘Locally, many partnerships track progress by using a much wider range of information, including, crucially, the views of people who use services.’

The report also highlighted a series of joint working initiatives across the country.

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