Across England the rise in emergency admissions to hospital shows no sign of abating. Alongside it, bed days also continue to rise. The year-on-year rise in emergency admissions in the first quarter of 2006 was 7 per cent, while the corresponding rise in bed days was 5.9 per cent.

Across England the rise in emergency admissions to hospital shows no sign of abating. Alongside it, bed days also continue to rise. The year-on-year rise in emergency admissions in the first quarter of 2006 was 7 per cent, while the corresponding rise in bed days was 5.9 per cent.

Broken down by the new strategic health authority boundaries, the increase in average emergency admissions varies between 5.7 per cent in South West to 13.7 per cent in South East Coast.

There continues to be no correlation between emergency admissions and bed days at SHA level. South East Coast provides the best example of this: an increase in emergency admissions of 13.7 per cent and an increase in bed days of just 7.1.

Emergency admissions have changed over time, with a levelling between 2001 and 2002 followed by a period of sharp increases.

When we break down data by diagnosis for the top 20 causes of emergency admissions, the top causes remain non-specific chest pain and abdominal pain, increasing by 12.9 per cent and 8.1 per cent respectively.

These codes remain catch-alls for a range of conditions and their increase could simply be due to an improvement in coding or incentives allied to better healthcare resource group allocation.

Activity is unlikely to change quickly quarter by quarter, but changes in coding practice can. Aside from deliberate instances of gaming and subsequent HRG drift, these changes can be described as improvements, giving a more detailed account of increasing hospital activity.

Non-infectious gastroenteritis has risen by 17.5 per cent. The fall in coronary atherosclerosis and other heart disease is encouraging and could be seen as evidence of success in alerting people of the signs and symptoms related to heart attack. And there seems to be equivalent progress on COPD admissions, with a decrease of 3.7 per cent.

The figures also show that, in spite of increased emphasis on healthcare outside hospitals, there is still a large proportion of admissions that fall into ambulatory care-sensitive conditions - including diabetes, asthma and COPD - which should be treatable in primary care. By identifying these potential high-impact users and tackling them before emergency admissions, we should see more appropriate care pathways in primary care and reduced costs in secondary care.

Marc Farr is market development manager at Dr Foster Intelligence (phone 020-7330 0472 or visit www.drfosterintelligence.co.uk). The next Dr Foster Intelligence page is on 7 December and will cover trends in HRG spend.