Emergency readmissions up 29% since 1999

7 Jun 07
Cost-consciousness in the English NHS has led to a 29% rise in emergency readmission rates for all age groups, Public Finance has been told. Ministers pledged to examine the figures.

08 June 2007

Cost-consciousness in the English NHS has led to a 29% rise in emergency readmission rates for all age groups, Public Finance has been told. Ministers pledged to examine the figures.

Official figures, summarised in PF last week, show that emergency readmission rates increased between 1998/99 and 2005/06 by 31% for over 75-year-olds, 22% for 16-75 year-olds and 10% for under 16s. The overall increase was 29%, with half a million patients being readmitted to hospital A&E departments within 28 days of being discharged in 2005/06.

Emergency readmission rates are used as an indicator of quality of care and appropriate discharge. Anne Williams, president of the Association of Directors of Adult Social Services, told PF that although the increasing complexity of some diseases might be a factor, there was no doubt that the introduction of payment by results had led hospitals to discharge people earlier – sometimes inappropriately.

'The NHS is under huge pressure to reduce waiting lists, increase the speed at which people are treated and therefore to increase their throughput and usage of their facilities,' she said. 'Once you've got someone in, there is a big financial incentive to get them out.'

Last year a PF investigation found that bed-blocking rates were soaring in one in ten local authorities by as much as 158%. At the time, directors of social services warned that the cause was hospitals assessing patients as 'fit for discharge' too early. Williams said the new figures corroborated that claim.

'If the hospital says they are ready, we have to act straight away… But we haven't got the necessary care places to cope.'

Gordon Lishman, director-general of Age Concern, said: 'No-one wants to stay in hospital longer than they have to. But it is imperative that the pressure to speed up an older person's discharge is backed up by services in their community.'

The NHS Information Centre has categorised 27 local authority areas as experiencing both 'significantly above average' readmission rates and 'significant deterioration' on the previous year; 42 trusts have been judged likewise, including eight of the 18 most 'financially challenged' ones.

Care minister Ivan Lewis was challenged on the figures for over 75-year-olds by the joint parliamentary committee on human rights on June 4. MPs said they were concerned that the 2004 Delayed Discharge Act – under which a council can be fined if a patient deemed ready for discharge is still in hospital after 48 hours – was driving the increase.

Lewis said: 'Nobody should be discharged from hospital without appropriate arrangements being put in place for their care. If we find this is an unintended consequence of policy we ought to do something to address it.'

Nigel Edwards, policy director at the NHS Confederation, said that better data collection could have contributed to the rate increase but admitted that 'a more aggressive approach' was most likely the prime cause.

PFjun2007

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