• Emergency readmission data for CCGs to be published from March
  • NHS Digital announcement follows concerns about rising number of readmissions
  • Interim measures to be used while longer term plan for richer data set is developed

Emergency readmission data for NHS commissioners will be published from March amid concerns about rising numbers of patients returning to hospital within 30 days of discharge.

The proposals were set out in new NHS Digital guidance published this month. They represent a fresh attempt to capture data for a notoriously complex part of patient activity, after system leaders pulled the plug on collections in 2013 amid data quality concerns.

The report said the NHS needs “a more consistent form of measurement” and set out plans to add 30 day readmission data to the clinical commissioning group outcomes indicators set from March.

It also cited Healthwatch England’s review, published in November, which showed the numbers of recently admitted patients returning to emergency departments was rising, as reported by HSJ.

Healthwatch has long campaigned for better data on readmissions, arguing readmission caused patients huge amounts of distress and plans to cut rates could only be grounded with robust data.

The NHS Digital guidance also set out plans for a review into how to improve the data set in the longer term – for example, whether the reasons for readmission could be included in the future.

Nuffield Trust deputy director of research Sarah Scobie said the innate complexities in measuring readmissions meant the “phased approach being taken by NHS Digital was sensible”.

She told HSJ: “There are so many different reasons for readmissions, and it may be, for example, that a patient is readmitted to a different hospital to where they were first treated. So, publishing CCG and system level data as proposed by NHSD this time rather than just focusing on provider level data, is a better method.

“Hopefully it will give the NHS a better understanding of why patients are readmitted, a figure which has been rising, and help address the preventable ones for conditions such as pneumonia and pressure sores.”

Ms Scobie said the new metric would not be a data burden because it was developed from already collected data.

Healthwatch’s research found there were 484,609 emergency readmissions in 2017-18 – 22 per cent more than five years ago, based on a sample of 70 of England’s 125 hospitals (See box: Emergency readmissions are rocketing – but why?).

The patient lobby group also said it “found that people with the most complex or acute needs are often the worst affected, including older people and people receiving end of life care”.

“The lack of official data published by the NHS has made it difficult to build a comprehensive picture of who is being affected and why they are coming back in to hospital,” a statement said.

Healthwatch chair Sir Robert Francis added: “Whilst not all emergency readmissions can or should be prevented, they can cause significant distress for patients and families and so it’s vital that the NHS avoids them where possible.

“[This] announcement by NHS Digital, therefore, marks an important step, arming hospitals and community services with the data they need to identify and address the issue.”

Emergency readmissions are rocketing – but why?

Healthwatch England obtained data from 70 hospital trusts from 2013-14 to 2017-18. It found:

  • Emergency readmissions rose from 397,952 to 484,609 over five years, a 22 per cent increase.
  • The number of emergency readmissions within 24 hours of being discharged rose 33 per cent from 53,538 to 71,398 over the same period.
  • The number of readmissions within 48 hours rose 31 per cent from 82,674 to 107,960.
  • Readmissions within 48 hours account for more than one in five – 22 per cent – of the total.

The report said: “Most troubling is that the sector still can’t report on how many emergency readmissions were unavoidable and which ones could be prevented, or use this insight to learn.

“[NHS England has] given repeat assurances that it is developing better data to understand why readmissions to hospital within 30 days of discharge are rising.

“In March, the Department of Health and Social Care confirmed it is working with NHS England to agree a single definition for emergency readmissions, which will enable this to progress. However, as yet there is still no agreed definition and the data remains unavailable.”

Source: Emergency readmissions - what’s changed one year on? Healthwatch England policy briefing November 2018