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Emergency admissions are making NHS 'unaffordable'

The Nuffield Trust has released a report today which claims that reversing the ‘unsustainable’ rise in emergency hospital admissions is the single biggest issue currently facing the NHS in England. The independent health charity issued the warning following new analysis which shows that the number of emergency admissions in England rose by 11.8 per cent between 2004/05 and 2008/09, resulting in around 1.35 million extra admissions.

The report reveals that emergency admissions now make up 35% of all hospital admissions in England, at a cost of around £11bn to the annual NHS budget. The cost of treating the extra patients that have materialised since 2004/05 alone is estimated to be  £330m per year.

The rise in emergency admissions has been linked with a dramatic increase in the number of short-stay admissions – those patients that are admitted as an emergency for one day or less. In England in 2008/09, 592,724 more patients were admitted for one day or less compared to 2004/05 – a marked jump, with zero and one day admissions accounting for 49 per cent of all emergency admissions in 2008/09 compared to 42 per cent in 2004/05.

The report concludes that this has, in part, been caused by a lowering of the clinical threshold for emergency admissions. Advances in medical care and management have reduced the length of time patients stay in hospital, which in turn has freed up more available beds and allowed doctors to admit more patients. To break out of this cycle in future will mean creating better out-of hospital care and preventive care to reduce the risk to patients of admission and enable expensive hospital beds to be closed, the report warns.

“Reversing this unsustainable rise in emergency admissions must be the number one priority for the NHS in England – any reform to the health service that does not tackle this will fail,” said Nuffield Trust director, Dr Jennifer Dixon. “Our hospitals are over-heating and are on an unsustainable path in which they are treating patients at great cost to the NHS and to patients themselves.

“This cost could be avoided by preventing ill health through better care by GPs, community care services or social care, and better co-ordination of care between doctors in hospital and general practice. Avoidable emergency admissions will continue to rise unless care is more integrated and hospitals and beds are closed. Otherwise the risk is that the NHS becomes unaffordable.”