Emergency admissions and delayed transfers grow despite national efforts

Nuffield Trust analysis shared with HSJ shows total A&E admissions rose from 4.15 million to 4.26 million year on year, continuing a rising trend, despite efforts by national leaders and the NHS as a whole to stem the growth (see table).

Official data published by NHS England today revealed there were 370,102 admissions via emergency departments in March, 365,116 of which were at full – or type one – emergency departments.

Nuffield Trust director of research and chief economist John Appleby told HSJ that addressing it could take years, not least because the reasons behind rising admissions were not well understood.

He said: “The decision to admit to A&E is not taken lightly [but] we don’t 100 per cent understand why [emergency admissions] are going up…It’ll be partly linked to attendances, partly to do with what is going on inside A&E departments in terms of dealing with the target, it’s partly to do with changes in medical practice.”

He added that “given the extra effort, you could see some inroads being made, but you’re probably looking at a number of years” before the trend can be changed. Firstly, the system needed to stabilise the growth at a lower rate, he said. 

Total emergency admissions 2011-12 to 2016-17

Containing and reducing emergency admissions and delayed transfers have been key objectives of a number of national policies and programmes, including the current new care models initiative and better care fund. Next steps on the five year forward view said rising pressures on emergency departments stemmed from “continued growth in levels of emergency admissions and from delayed transfers of care”. It said NHS England would “publish metrics for each STP benchmarking their emergency admission rates and bed days” in July.

HSJ analysis of sustainability and transformation plans in January revealed they envisaged cutting non-elective admissions by around 4 per cent between now and 2020-21. Recent performance shows this is a very tall order. Data obtained by HSJ shows that in 2014 commissioners nationally planned for the number of non-elective admissions to fall every year between 2014-15 and 2018-19, including a 0.7 per cent reduction in 2016-17.

Official data published today also showed the number of delayed days caused by held up transfers rose 7 per cent from 184,855 in February 2017 to 199,260 delayed days in March 2017 – the second highest number in any month on record.

Royal College of Surgeons president Clare Marx said: “Delayed transfers of care remain a major issue for hospitals. We would like to see the next government set out how they will protect bed capacity in hospitals and improve our social care system, so that patients who should not be in hospital in the first place and are given the correct alternative care in the community.

“A lack of available hospital beds, rising demand from older and sicker patients, and an under-funded social care system are all putting our health service under enormous strain. This translates directly to longer waits for treatment, cancelled operations and rationing of care.

“Until our social care system is working properly and we better protect planned bed capacity, there is little hope of NHS waiting times getting back to acceptable levels.”

Other significant figures from today’s official data releases included:

• Emergency department attendances were at historically high levels.
• The number of people starting routine elective hospital treatment rose 4.7 per cent compared with the preceding twelve month period.

NHS Providers director of policy and strategy at Saffron Cordery, said: “These figures show once again the scale of the pressures NHS trusts are up against. But they also show the NHS is dong an outstanding job in continuing to deliver care for patients – often in very difficult circumstances.

“More than two million people came to A & E – one of the highest figures on record. For the first time, emergency admissions rose above half a million. Yet performance against the four-hour target in A&E was better than in March 2016.

“The sharp rise in routine hospital treatments is another sign that the NHS is rising to the challenge – helping more patients, despite the pressures.

“It is worrying that delayed transfers of care are close to record levels, and the proportion attributable to social care continues to grow.

“It is also a serious concern that the 62 day cancer treatment target was not met in any month during 2016-17. The demands NHS trusts face are unsustainable. But they are doing all they can to provide the best possible service for patients.”