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A&E targets drive up emergency admissions to avoid penalties

The National Audit Office says there were 5.3m emergency admissions in the last financial year - a 47% rise in 15 years - and many of these patients stayed in hospital for longer than necessary. Eivor Oborn is a Professor of Healthcare Management at Warwick Business School and has researched the NHS organisation and has worked alongside former health minister Lord Darzi.

Professor Oborn said: “Targets for A&E have served a good purpose in the past, but currently they force hospitals into unhelpful tactics of circumventing penalties by allowing more admissions than medically necessary. Instead stronger reliance on patient feedback could provide a useful indication of A&E performance, along with a range of profile measures that are not directly performance managed but used to build an overall picture of activity. A number of A&Es have coped with the target pressure by setting up a parallel ward for observation; more of this should be encouraged. This way full admission is avoided but a crisis can be averted with a more realistic timeframe for getting a community package in place.

“At the moment A&Es need to get people through within a four-hour period to achieve their target. Arranging home or community based care can take a lot of time and phone calls to sort out so it may be expedient for A&E to admit the patient first. There are also many patients who need observation rather than acute medical intervention, but given time constraints they can’t keep this category of patients in A&E.

“Once in the hospital it is increasingly difficult to discharge patients needing community services because the budgets for these have been drastically cut. On top of this there has been significant ongoing reorganisation of community-based care and the system remains lower in capacity due to the ongoing flux and change. This sits on top of the decreased willingness to accept risk of patient relapse, since this is accompanied by penalties to the hospital where as increasing the length of stay does not.

“Adequate access to GPs and community-based urgent care centres would relieve the pressure on A&E attendance as stable patients could be monitored in the community. Social and community services could have ring-fenced funding to support hospital discharge. In addition, Clinical Commissioning Groups (CCGs) and GPs more widely need to be incentivised to work more closely with hospitals and vice versa.”

To speak to Professor Oborn, call Ashley Potter, Tel: +44 (0)24 7657 3967, Mob: +44 (0)7733 013264