Rising emergency admissions disrupt NHS

Emergency admissions to NHS hospitals have been rising by between 7% and 13% on average during 1993-4, according to the National Association of Health Authorities and Trusts. The association, which will be raising the matter with the health secretary, says: “This is disrupting the contractual system, distorting priorities by causing a shift in resources to pay for the increase, and making it difficult for both purchasers and NHS trusts to plan for the future with confidence.”

The association believes that the rise is due to several factors, including increased pressure on hospital beds caused by more detected illness and greater availability of high tech treatment. Other factors include increased expectations among general practitioners and fundholders about the quality of care that their patients should receive in hospital; overstretching of primary care as a result of faster discharge of hospital patients, leading to higher admission rates; and greater concern among general practitioners about litigation, leading them towards the route of lowest risk.

The association's director, Philip Hunt, said: “The steady rise in admissions is evident regardless of source of patients and does not reflect any one specialty more than another. But it does send a strong signal to health authorities, general practitioners, and trusts that working together is the only way to get back on track.”

The figures were announced at a recent symposium, which heard about a detailed analysis carried out in the Aintree Trust in Liverpool. This revealed a 37.5% rise in emergency admissions between June 1992 and October 1993, the most dramatic rise being in the 15-44 age group. A separate study on mental health admissions carried out in central Manchester confirmed a considerable rise in emergency admissions, from 400 to 550 a year.

The association believes that while there is no single solution to the national problem of rising emergency admissions, several measures could help.

These include using a bed manager, so that the problem is managed by one person rather than many clinicians; greater flexibility in the use of beds, avoiding traditional demarcation lines; having more consultants in accident and emergency departments to reduce avoidable admissions; and improving discharge procedures. The association plans to set up a group of general practitioner fundholders, purchasers, and providers to look specifically at the problem.