Explanations and responses must be properly evaluated

Emergency admissions in Britain are continuing to rise.1 The highly publicised bed crisis this winter and a number of national meetings have underlined concern over the lack of explanations and frustration at the lack of control. In Scotland, emergency admissions increased by 45% between 1981 and 1994 (fig 1). This represented an annual increase of about 3%, rising to over 5% in 1993 and 1994,2 and probably in 1995. Even steeper increases have been reported by individual hospitals throughout Britain.1 2 In stark contrast, elective admissions have increased by only 1% a year.3 Emergency hospital admissions account for about 40% of total acute bed use in the NHS.2

Why is this rise occurring? Potential explanations need to account for its generality and persistence. Hospital admissions have actually been increasing for some four decades.1 3 Some recent inflation in the figures was caused by the use of finished consultant episodes and more complete recording. However, analysis of linked data has confirmed that the rise is genuine.2 Only 2% of the increase can be explained by population aging.1 2 Although all age groups and diagnostic categories are involved in …