Admissions up for treatable illnesses

Simon Jones and Mike Davies

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Ambulatory care sensitive conditions are long-term health conditions that can often be managed with timely and effective treatment without hospitalisation.

They include chronic conditions which can be stabilised with effective follow-up and compliance to a programme of treatment, acute conditions that can be nipped in the bud, eg cellulitis, and conditions that can be prevented by immunisations. The NHS spent £1.6bn on hospital admissions for these last year.

The first chart shows that, despite several initiatives to reduce them, the number of these care sensitive admissions has risen about 3 per cent year on year since 1996-97. This could be explained in terms of the ageing population, with more people living with chronic disease. Or there could be great variation in standards of care for these problems.

The second chart shows the number of admissions for ambulatory care sensitive conditions by type and year. When patients arrive with such conditions this does raise questions about how well they are managed in the community. For example, the majority of acute ear, nose and throat infections should be dealt with in the community with antibiotic therapy and pain relief, but the number of infections shown seems to be extremely high.

Dental health services

One of the most dramatic changes in community care recently has been reduced access to NHS dental services. This has led to a sharp increase in the number of admissions to hospital with dental problems.

The bottom chart shows ambulatory care sensitive conditions as a percentage of all emergency admissions by primary care trust. The wide variation between PCTs might suggest that in some areas one or many parts of the outpatient service is failing or that it may just be that the various parts are not working together effectively.

Polyclinics would be an interesting development in this area: the increased access to specialists may prove decisive in cutting the number of episodes.

Early intervention by a competent physician and a strong emphasis on preventive medicine, including vaccination programmes, are the main elements in reducing hospitalisation for these conditions. Limited access to either of these, due to either poor quality management of conditions or insufficient resources, would be likely to cause hospitalisation.