Senior doctors’ refusal to work weekends is pushing up the number of older patients facing unnecessary emergency admissions to hospital, a Whitehall audit has found.
The National Audit Office said that many of the growing number of emergency admissions to hospital were “avoidable” and that many of the patients admitted ended up staying longer in hospital than they needed to.
One of the causes of unnecessary admissions is the NHS’s failure to provide a consistent seven-day service, the report said. Care worsens significantly at weekends because consultants are not present to ensure a proper assessment of patients’ needs, the NAO said, suggesting that their contracts should be rewritten.
Reduced access to senior doctors at weekends leads to “unnecessary admissions and sub-optimal care,” the auditors concluded. Patients are more likely to die after weekend admissions than during the working week, the NAO said.
The “variable” quality of GP care is also linked to higher A&E attendance, as is Britain’s “growing frail, elderly population”, the report found.
A government target for all A&E cases to be dealt with in four hours is also driving up admissions rates, as staff are resorting to admitting patients shortly before they reach the deadline, instead of administering appropriate treatment.
A&E admissions are rising, putting the entire NHS under increasing pressure, the report said. Figures show there were 5.3 million emergency hospital admissions in 2012-13, an increase of 12 per cent in just five years. In the past 15 years, the number of people admitted for short stays has more than doubled.
The NHS is now spending more than £12 billion a year – almost a tenth of its budget – on emergency services.
Despite the rising spending, the NAO said the NHS was failing to provide adequate emergency care at weekends and out-of-hours. To remedy the problem, it said consultants’ contracts should be changed to require them to work weekends. The current contract allows them to refuse to work in hospitals at weekends.
The NAO also warned about an acute shortage in doctors training in emergency medicine. Half of all emergency medicine training posts were unfilled in 2011-12.
NHS England accepted the analysis of emergency care and promised “substantial steps to ensure patients receive the best possible care preferably out of hospital but also when necessary in hospital”.
Health Secretary Jeremy Hunt said his department was “tackling both the short and long-term problems: transforming out of hospital care by reversing the disastrous changes to the 2004 GP contract, joining up the health and social care system, and backing A&Es with £250 million to prepare for this winter”.
Andy Burnham, the Labour shadow health secretary, said the Coalition was mismanaging the NHS, leaving patients to suffer. He said: “Elderly people are drifting towards hospital in such numbers that many have to wait hours on a trolley just to get a bed. And when they do get a bed, they end up being trapped there because of delays in arranging discharge.”
- Warning on ‘too many’ A&E admissions (bbc.co.uk)
- A&E pressure increasing admissions (standard.co.uk)
- NHS hospitals admit too many patients on to wards from A&E, says NAO (theguardian.com)