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Rising hospital admissions

BMJ 2010; 340 doi: (Published 02 February 2010) Cite this as: BMJ 2010;340:c636
  1. Stephen Gillam, general practitioner
  1. 1Institute of Public Health, Cambridge CB2 2SR
  1. sjg67{at}

    Can the tide be stemmed?

    Whoever wins the next election, years of famine are upon us. Budgetary belts are tightening in anticipation. All the more disquiet therefore attaches to a report from consultants Caspe Healthcare Knowledge Systems (CHKS; an independent provider of healthcare intelligence and quality improvement services) that, “threatens bankruptcy for the NHS.”1

    The growth in hospital admissions for elective and emergency care apparently rose by an average of 6% in England between 2007-8 and 2008-9.1 This compares with an average annual growth of 4.6% for the preceding three years, and it is mirrored by similar rises in Wales and Northern Ireland. Emergency admissions, which are inherently less susceptible to manipulation and therefore the main cause for concern, formed the bulk of these increases. Three simple questions present themselves. Firstly, are these hospital episode statistics reliable? Secondly, if so, what is driving these increases? Lastly, what can be done to reduce unnecessary use of hospital services? Unfortunately, the answers are not so straightforward.

    Hospital admission rates have long been of concern. Earlier supposed increases in emergency admissions were mainly attributable to internal transfers after admission.2 The figures have also been artificially boosted by coding differences and the conversion of …

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