Background to the report

NHS England defines an emergency admission to be “when admission is unpredictable and at short notice because of clinical need”. Some emergency admissions are clinically appropriate and unavoidable. Others could be avoided by providing alternative forms of urgent care, or by providing appropriate care and support earlier to prevent a person becoming unwell enough to require an emergency admission.

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The Department of Health & Social Care sets NHS England’s mandate for arranging the provision of health services. The 2017-18 mandate includes an objective for NHS England to achieve a measurable reduction in emergency admission rates by 2020.

Content and scope of the report

The report examines progress that the Department, NHS England, NHS Improvement and other stakeholders are making in reducing the impact of emergency admissions on acute hospitals. The report takes a whole-system approach, and looks at action across acute, primary, community and social care systems rather than focusing on A&E departments alone. It builds on our 2013 report on Emergency admissions to hospital: managing the demand and our 2016 report on Discharging older patients from hospital, which also examined the pressures on the whole health and social care system.

Part One sets out trends in emergency admissions;

Part Two explains NHS England’s and partners’ response to increasing emergency admissions; and

Part Three assesses the challenges in reducing emergency admissions.

Report conclusions

The impact on hospitals of rising emergency admissions poses a serious challenge to both the service and financial position of the NHS. Over the last four years, the NHS has done well to reduce this impact despite admitting more people as emergency admissions, largely by reducing length of stay and growing daycase treatment. However, it cannot know if its approach is achieving enduring results until it understands whether reported increases in readmissions are a sign that some people admitted as an emergency are being discharged too soon.

The NHS also still has too many avoidable admissions and too much unexplained variation. A lot of effort is being made and progress can be seen in some areas, but the challenge of managing emergency admissions is far from being under control.

“It is a problem for all of us that A&Es remain overloaded and a constant point of stress for patients and the NHS. A lot of effort is being made by NHS England. At the centre of this is increased ‘daycase’ treatment but the decision to stop methodical measurement of emergency readmissions a few years ago makes it difficult to understand whether daycase interventions achieve enduring results.”

Amyas Morse, head of the National Audit Office

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Publication details

Press release

View press release (2 Mar 2018)

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