Trends in emergency admissions in England 2004 – 2009: is greater efficiency breeding inefficiency?

Blog post

Published: 07/05/2010

Rates of emergency admissions to hospital have been rising for many years, and if they continue it could prompt major financial problems for the NHS, particularly heading into a period of constrained funding.
Although there is no shortage of opinions and ideas about what underlies this trend, relatively little is actually known about detailed patterns and causes.  
Here at the Nuffield Trust, we have used nationally available routine administrative data to look at the rise in emergency admissions over the past few years.
Our analysis showed that the number of emergency admissions in England rose by 11.8 per cent between 2004/05 to 2008/09 – resulting in around 1.35 million extra admissions.  
Our report goes on to explore trends in the types of patients, their conditions and nature of the hospitals admitting them.
Our approach allows us to test out many of the ‘usual suspects’ for the causes of the rise.  For example, it has been suggested that the rise is due to England’s ageing population.  We know that emergency admission is much more likely for older people – a person of 80 is 10 times more likely to have an emergency admission than someone in their 20s, 30s or 40s.  
We also know that improved health care and living standards have contributed to us living longer, meaning there are increasing numbers of older people in England.  
Despite this, we found that when you apply age standardised emergency admission rates from 2004/05 to the population structure in 2008/09, at most it would only increase admissions by 4.7 per cent.   That means that the ageing population of England accounts for less than half the rise in admissions, even without adjusting admission rates on the basis that older people are becoming healthier.   
So what is causing the majority of the rise?  
We don’t think there is a simple all-embracing explanation, but one thing that stands out is the increase in the number of short-stay emergency admissions, which we suspect has – in part – been caused by a lowering of the clinical threshold for emergency admissions. 
This could be for reasons such as clinical decisions becoming more conservative, lack of faith in primary care services to monitor patients, or simply that the patient goes to A&E rather than their GP.  
We think this trend could be reversed by creating better out-of-hospital care and preventive care to enable expensive hospital beds to be closed and patients to be treated in the most appropriate and cost-effective setting.   You can see a more detailed set of actions in our report.
Without such change, future rises in emergency admissions – with all the avoidable human and financial cost they represent – appear guaranteed.

Suggested citation

Blunt I (2010) ‘Trends in emergency admissions in England 2004 – 2009: is greater efficiency breeding inefficiency?’. Nuffield Trust comment, 7 May 2010.