Working Well - Health
Emergency Hospital Admissions
There has been a steady rise in the number of emergency inpatient admissions to hospital over past 30 years, which is a major source of pressure for the NHS
Reasons for this increase are complex and include an ageing population and changing social factors increasing the demand for formal care
A proportion of emergency admissions will always be completely appropriate, but there is a growing evidence that a significant proportion of patients treated in A&E are not there because it is the best place for them to be treated
It is important that we begin to understand what proportion of all emergency admissions could have been treated more appropriately elsewhere, and what that care could look like.
The impact on acute hospitals is being compounded by the increasingly complex needs of patients requiring an admission. In 2015/16, one in three emergency patients admitted for an overnight stay had five or more health conditions, up from one in ten in 2006/07. Emergency admissions have grown particularly rapidly for older patients, increasing by 58.9% since 2006/07 for people aged 85 years or older. These trends are challenging for hospitals to manage, since patients with more conditions spend longer in hospital once admitted.
Emergency hospital admissions have been aggregated over a five year period, and from this a standardised admissions ratio has been calculated, where the England’s rate is 100. Therefore any rate above 100 is higher than expected and any rate lower than 100 is lower than expected.
Hartlepool’s emergency hospital admissions for all reasons is 120.1. This is the 6th highest rate in the north east, but only the 11th highest amongst Hartlepool’s statistical neighbours.
Within Hartlepool there are 8 areas within the bottom fifth of England for emergency hospital admissions. These 8 areas account for a substantial proportion of the town, and highlight that emergency hospital admission are an area of concern across the town, rather than clustered around a specific location. The largest rate is 147.1, which is in the headland area of the town. The western area of Hartlepool has the lowest rate of 85.6, and sits in the 2nd highest fifth within England. The Headland has a rate which is more than one and a half times the lowest rate.
Looking at the specific conditions responsible for these emergency admissions will further develop the understanding of this issue with Hartlepool.
For coronary heart disease Hartlepool has 8 areas in the bottom fifth in England and 4 in the 2nd bottom fifth. The Headland are of the town again has the highest rate, 213.0, however its nearest neighbour has the lowest rate of 100.2. The highest rate is more than twice the size of the lowest rate. The 8 areas in the bottom fifth represent a substantial portion of the Hartlepool population, and highlight that coronary heart disease is an area of concern for Hartlepool.
For myocardial infarction, or a heart attack, the picture for Hartlepool is even starker. Here 10 of the 12 areas in Hartlepool are in the bottom fifth, and the other 2 are both in the 2nd bottom fifth. Again the outliers are the headland area with the highest rate, and the west of the town with the lowest rate. The volume of population in the bottom fifth of England is again a sign of how large of an issue this is within Hartlepool.
For chronic obstructive pulmonary disease (COPD) Hartlepool still has 9 areas in the bottom fifth, but also has 2 areas with a rate below 100, that is below the England standard rate. The area in the west of the town has a rate that is only two thirds of the England rate. The headland area again has the highest rate in Hartlepool, and is more than four times the size of the lowest Hartlepool rate.
For stroke, Hartlepool has 5 areas in the bottom fifth, which is the lowest of the admission reasons examined. There are also 5 areas with rates below the England standard rate. Like all of the other admission reasons the Headland area of the town has the highest rate. The highest rates are in two separate clusters with one centred around the Rossmere area of the town and the other on the Headland area. For the first time there is some level of localised variation in the rates, which show areas of greatest concern within the town.
Emergency Hospital Admissions
The delivery of integrated urgent care services ensures that the service user is treated in the right place at the right time by the most appropriate health professional. The service is:
- One integrated urgent care service (IUCS) model delivered across two agreed urgent care locations which includes University Hospital Hartlepool.
- GP led urgent care service provision 24 hours a day, 7 days a week, 365 days a year that incorporates services traditionally referred to as:
- GP Out of Hours (OOH) services to include clinical assessment, face to face consultation, home visiting and prison visiting services
- Appropriate primary care urgent walk-in provision
- Appropriate Minor Injury provision
- Assessment and referral to appropriate mental health services
- Diagnostic provision and referral if appropriate
The Long Term Plan has a focus on the pressures upon emergency hospital based services, identifying a need to focus on areas including pre-hospital urgent care and reforms to enable same day emergency care. The plan outlines a number of key milestones for urgent and emergency care:-
- In 2019 England with be covered by a 24/7 Integrated Urgent Care Service, accessible via NHS 111 or online (available across NHS Hartlepool and Stockton-on-Tees CCG)
- All hospitals with a major A&E department will:-
- Provide Same Day Emergency Care (SDEC) at least 12 hours a day, 7 days a week by the end of 19/20
- Provide an acute frailty service for at least 70 hours a week. They will work toward achieving clinical fragility assessment within 30 minutes of arrival
- Aim to record 100% of patient activity in A&E, UTC, SDEC via Emergency Care Dataset by March 2020
- Test and begin implementing the new emergency and urgent care standards arising from the clinical Standards Review, by October 2019
- Further reduction in delayed transfers of care, in partnership with local authorities
Under this Long Term Plan, every acute hospital with a type 1 A&E department will move to a comprehensive model of Same Day Emergency Care. This will increase the proportion of acute admissions discharged on the day of attendance from a fifth to a third.