Improve Healthcare By Reducing Unnecessary Emergency Admissions

30 pc reduction in admissions could mean people don’t spend unnecessary time in hospital and save over £400m a year for other services.

Improving health services by cutting unnecessary emergency admissions could help the NHS save over £400 million a year, Health Secretary Patricia Hewitt said today.

She published new figures from the NHS Institute for Innovation and Improvement to illustrate how the NHS could improve its services for people, reduce the interruptions of unnecessary emergency admissions on people’s lives and improve value for money. She also published best practice examples from the NHS to highlight what can be done.

The NHS spends around £1.3bn a year on admissions for patients with 18 common ailments – known as ‘ambulatory care sensitive’ conditions – such as asthma, angina and chronic obstructive pulmonary disease. These unplanned admissions are extremely worrying for the people concerned and their families and disrupt their lives.

The most frequent admissions – those patients who repeatedly call on emergency care services and are often admitted to hospital three times or more during a year – are often for one of these 18 conditions.

Such emergencies account for a large proportion of total hospital admissions, and this varies enormously from area to area. In some regions, it is less than 10 per cent of hospital costs and in others it rises to nearly 25 per cent.

Ms Hewitt said that better management of these patients’ conditions in a community setting could improve their lives, reduce emergency hospital admissions and reduce costs – especially for those Primary Care Trusts (PCTs) where unplanned emergency admissions account for a larger than average proportion.

She said: “Some people with long term conditions experience their lives as going from one emergency hospital admission to another. {mospagebreak}

“Whilst it’s important to know the hospital is always there, it’s a much better, more stable life for people if they can be treated in the community without the need for so many emergencies.

“Everything we can do to diminish this will improve people’s lives. Having so many unplanned admissions can also make it harder to develop day-to-day services in the hospital and increase costs. More efficient community treatment and better assessment processes can avoid the need for hospitalisation.”

She said there was a lot more that some parts of the NHS could do to improve productivity and efficiency. “If we could cut these unplanned emergency admissions by 30 per cent, patients would have improved lives, hospitals would be able to plan their services better and the NHS could achieve savings of over £400m a year.

“The potential savings from those PCTs that have many more emergency admissions than the average is almost £2.5m per PCT.”

The 18 common conditions where community treatment can reduce costs include chronic obstructive pulmonary disease (over 106,000 admissions costing £253m a year), angina (almost 80,000 admissions costing more £134m), asthma (over 61,000 admissions costing £64m) and the skin complaint cellulitis (over 45,000 admissions costing £87m).

Recommendations from the NHS Institute for Innovation and Improvement outline areas on which the NHS should focus to reduce emergency care costs, including:

– identifying which conditions account for a disproportionate level of hospital admissions – the number of patients with a length of stay of between 0 and 2 days varies between 40 and 60 per cent between PCTs;

 – implementing local systems to feedback to GPs which of their patients fall into this category;

– providers of care should move from an ‘admit to decide’ system – where patients are admitted without a second thought to alternative methods of treatment – to one that facilitates ‘decide to admit’ – where more consideration is given to other methods of care; and

– commissioners of care should use NHS reforms like practice based commissioning and other care pathways, such as community nurses preventing the likelihood of unplanned emergency admissions.

Patricia Hewitt added: “Trusts with a high proportion of unplanned emergency care admissions and a high proportion with a length of stay of less than two days have the potential to reduce this with better assessment processes and improved primary care management of patients.

“The NHS is in receipt of record funding. Better patient care has been the result, with waiting lists at record lows, more doctors and nurses than ever before, a world-class A&E service and huge reductions in death from the big killer diseases. But we have a duty to the taxpayer as well as the patient to ensure we get more value for this extra money.

“Reforms like practice based commissioning, where GPs and other primary care professionals are more involved in commissioning care for patients in the community, can help reduce costs and the burden on emergency services as well as providing more accessible care for patients.”

In Dudley, west Midlands, PCTS have developed new care-closer-to-home pathways for patients, by redesigning clinical roles. Clinician to clinician communication has been improved so that patients have a seamless transfer through their whole episode of care, with services developed to prevent unnecessary hospital admission.

Stan Doman, 68, from Lodge Farm Estate in Dudley, suffers from a number of conditions including emphysema and angina. For the last twelve months, he’s been cared for by nurse consultant Cath Molineux.

Stan said: “Cath is always on hand if I have any questions. Over the last six years I’ve been in and out of hospital around five times a year but last year I only went in once. Being at home actually makes me feel better – in hospital you have less freedom to decide what you eat and when you have a bath. At home I can please myself.”

Cath Molineux, said: “Not all patients need to keep going into hospital, and by visiting them at home we can monitor their condition and anticipate any problems they may have. By working in partnership with social care colleagues we can ensure our patients get the best care possible. This way we help reduce overcrowding in our hospital – helping them to focus on providing care for patients who really need it.”