This is PCTs’ admission of failure – but everyone shares the blame
Analysis of primary care trusts’ emergency and elective admissions data, shared exclusively with HSJ by health intelligence provider CHKS, reveals that in the majority of areas, both trends are going in the wrong direction: upwards.
While success in meeting the 18 week target may explain some of the rise in elective admissions as backlogs were cleared, it does not justify ongoing increases.
It might not be a bad idea if the public at least knew how much it costs every time someone inappropriately turns up at A&E
The continuing growth of emergency admissions is even more concerning - and totally unsustainable. Even without the public sector spending cuts that are so soon going to hit home, PCTs cannot afford to keep funding ever greater numbers of acute treatments each year.
While those who come out worst in this analysis often have explanations for the increase, most are still a far cry from those areas that are actively and successfully bringing demand down. All must learn from the best practice on the ground, such as NHS Kingston’s installation of a GP in A&E, saving 30 admissions a week.
Continued failure to manage demand will not only result in nationally imposed and inevitably blunt solutions, but will provoke calls for even more extreme measures. Only last week, MPs on the health select committee were told that PCTs, which do not have the clout to negotiate with hospitals, should be “released” from the commissioning of acute care and left to concentrate on improving community services while the Department of Health doles out acute funds from the centre.
But this is not only PCTs’ fault. All parts of the system must take their share of responsibility, including the acute trusts carrying out and charging for the procedures.
And while penalising patients for inappropriate attendance at A&E would be a step too far, it might not be a bad idea if the public at least knew how much it costs every time someone inappropriately turns up at A&E, as think tank 2020health proposed last week.
It is everyone’s responsibility to make sure the NHS can live within its means.
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Anonymous | 21-Jan-2010 1:32 pm
There's no way NHS Kingston installing a GP in A&E has saved 30 admissions a week on its own. It might have saved 30 A&E attendances but to save 30 admisisons it must be backed up by PCT investment in primary care as well.
Hospitals are under real pressure for beds everywhere. They don't admit for fun, and they certainly don't admit to ratchet up their income. They admit because there is no alternative if appropriate clinical care is to be provided. The solution is to provide alternative capacity: rapid response, intermediate care, out of hours DNs and proper out of hours GP cover; and make these services accessible to the hospitals so all they have to do is pick up the phone instead of admitting. Do the same at the back door with step down care and rehab, and you have the basis for a sustainable healthcare system (this will involve telling PCTs that they will have to fund such investment).
Andrew Street has the correct prescription.
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