Rise in emergency admissions puts NHS under financial strain

An increasing number are going in for just one day, suggesting they do not need to be there at all, experts have found.

A study from independent think-tank the Nuffield Trust warned the increase was "unsustainable" and highlighted large variations in how individual hospitals worked.

The trust calculated that there was a 12 per cent jump in the number of patients going into hospital as an emergency between 2004/05 and 2008/09, or 1.35m "extra" admissions over the period, at an annual cost of at least 330m.

It said there was a danger that the NHS would become "unaffordable" unless action was taken.

Around one in three of all hospital admissions in England are emergencies, costing the NHS around 11bn a year – one of the most expensive areas of the health service.

The study examined several reasons for the increase, including the fact people are living longer and older people are far more likely to be admitted to hospital as an emergency.

The elderly accounted for 40 per cent of the rise, although experts had thought this figure would be far higher.

A pressing problem seems to be changes in medical practice, with more patients being admitted for a stay of 24 hours or less, implying there had been a "lowering of the clinical threshold for emergency admissions".

The study found many of the extra admissions were new patients, rather than the same patient being readmitted over the year.

Previous studies suggested the four-hour A&E target had led to a rise in the number of patients admitted to hospital, as staff tried to shift people into hospital to avoid breaching the target.

Nuffield Trust director Dr Jennifer Dixon said any reform to the health service that didn't tackle emergency admissions would fail.

"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.

"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."

However The College of Emergency Medicine said it did not accept that admissions for fewer than 24 hours were unnecessary.

It said many emergency patients require access to diagnostics like blood tests and X-rays and a period of observation to ensure the decision to send them home "is informed and safe".

Symptoms like headaches, chest pain, abdominal pain or shortness of breath which could indicate "severe underlying illness" need checking by emergency doctors.

College president Dr John Heyworth said more money was needed to boost the numbers of consultants "which remain woefully inadequate".

Health Secretary Andrew Lansley said the Government was encouraging community health services, social care and home adaptations like telecare and sheltered housing to reduce emergency readmissions.