Earlier care of ambulatory care-sensitive conditions (ACSCs) such as flu, pneumonia and COPD could cut emergency hospital admissions by 8%-18%, saving the NHS in England up to £238 million a year, says a new report.
ACSCs are conditions for which effective management and treatment should limit emergency admission to hospital, yet they currently account for more than one in six emergency hospital admissions, costing the NHS in England £1.42 billion each year, says the study, from health policy think tank The King's Fund.
More than half of this cost is accounted for by influenza, pneumonia, chronic obstructive pulmonary disease (COPD), congestive heart failure, dehydration and gastroenteritis. Flu and pneumonia account for the largest proportion of admissions (13%) and expenditure (£286 million), but many of these cases are vaccine-preventable, it says.
The proportion of emergency admissions for ACSCs is larger in the under-fives and over-75s. Children are predominantly admitted for acute conditions, older people for chronic conditions, and both groups for vaccine-preventable conditions, the researchers report. Moreover, the rate of emergency admissions for ACSCs varies among local authorities from nine to 25 per 1,000 population, and the rate in the most deprived areas is more than twice that of the least deprived areas in England.
High levels of admissions for ACSCs often indicate poor coordination between the different elements of the health care system, in particular between primary and secondary care. Such an emergency admission is a sign of poor overall quality of care, even if the ACSC episode itself is well-managed, says the study.
While this problem has been known about since the 1980s, the intervening period does not seem to have produced very many breakthrough ideas, comments Nigel Edwards, senior fellow, leadership development and policy at The King's Fund.
"General improvements in care, in particular self-care, and improved access to responsive primary care can help. Some of the developments in improving chronic disease management, particularly in COPD, diabetes and heart failure, seem to offer more promise," he says.
However, rather than inventing new initiatives, a better option might be to radically simplify the "existing complex web of services and initiatives, to ensure that the basics of primary care work are supported by high-quality ambulance services, nursing homes that do their job well and good generic community-based nursing that can manage chronic disease, administer intravenous drugs at home and respond when and where required,” says Mr Edwards.
The report estimates that the number of emergency hospital admissions for ACSCs could be reduced by: - 18%, potentially saving £238 million, if all local authorities performed at the level of those which are best-performing; - 8%, potentially saving £96 million, if each local authority improved their service to the level of the next best local authorities; and - 11%, potentially saving £136 million, if the poorer-performing authorities (compared with the average) performed at the level of the better-than-average ones.
"Preventing admission is the right thing to do," says Mr Edwards. "Admission to hospital may treat the immediate problem, but over 35% of older people admitted to hospital are discharged in a poorer functional state than when they were admitted, and so there are good health, as well as economic, reasons for avoiding admission," he writes.