Hospitals: Emergency Admissions (Hansard, 15 February 1995)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, we do not know the reasons why there is an increase in emergency admissions. Studies looking at the causes are under way and more detailed information will be available later in the year.

§ Baroness Jay of Paddington
My Lords, I thank the Minister for that reply. Is she considering the report by the National Association of Health Authorities and Trusts? Is she aware that that report has already suggested that it may be part of the operation of the internal market which is leading to the very rapid rise in emergency admissions? For example, are GP fund-holders bypassing routine admissions in order to get fast-track admissions and taking the emergency route? Does she agree that once patients are in hospital, managers are under such financial pressure to improve what is called their patient throughput that they are discharging people too early and they are re-admitted as emergencies?

§ Baroness Cumberlege
My Lords, there is no firm evidence about that at all. That is why we are running the research studies, five o l which are due to take place. We shall be working with all the associations, including the joint consultative committee and the Confederation of Royal Medical Colleges as well as the Trust Federation and the national association.

§ Baroness Jay of Paddington
My Lords, if no one else wishes to intervene, perhaps I may press the Minister a little further on this point. If she does not yet accept the findings of the National Association of Health Authorities and Trusts, does she accept the findings of the clinical advisory group of the Department of Health, which also suggests that the commercial pressures of the 690 internal market are leading to that extraordinary rise of 13 per cent. excess emergency admissions this year compared with last year?

§ Baroness Cumberlege
My Lords, I have already said to the noble Baroness that there is no firm evidence. That is why we are running the research projects. We want to find out the reasons. There are a number of commentators who put forward suppositions, such as an increase in asthma cases. At the moment there is no definition of an emergency case. We shall also be looking at that. Overall, it is quite interesting that GP referral rates to A&E departments vary between three and fourfold. We shall be considering all those conundrums.

§ Lord McColl of Dulwich
My Lords, does my noble friend agree that the complication rate for those patients who are treated on a day-case basis is exactly half the complication rate for those who stay in hospital longer than one day?

§ Baroness Cumberlege
My Lords, the pattern of medicine is changing very fast indeed. Increasingly operations are being carried out on a day-case basis, rather than have the patients admitted to hospital.

§ Lord Carr of Hadley
My Lords, does my noble friend agree that whatever may be the reasons for the increase, it is not necessarily a bad thing? Does she further agree that it may indicate a greater flexibility in responses from the service?

§ Baroness Cumberlege
My Lords, I mentioned the GP referral rate. I believe that as waiting times are slashed and people wait less time to be admitted, GPs clearly feel that it is worth while to send patients to hospital to be investigated and sometimes admitted.

§ Baroness Robson of Kiddington
My Lords, will the Minister agree to look at another reason for the increase in emergency admissions? Could it have something to do with the lack of community care that exists in some parts of our country, so that elderly people become emergency admissions when that normally would not have been the case?

§ Baroness Cumberlege
My Lords, we do not have evidence on that matter. That is why we are running the five pilot schemes. It is interesting that not only has the number of emergency admissions increased but so have the referral rates to the London Ambulance Service and ambulance services around the country. The increase in their calls was 8.5 per cent. last year alone. There is something rather strange going on and we need to find out why.

§ Lord Rea
My Lords, will the noble Baroness accept the logic of the situation? Will she accept that there has been a great increase in the turnover in London hospitals, with a diminution in the number of beds? That has meant a much shorter stay for each patient. Is she aware that many people may well have been discharged 691 rather too soon and, therefore, have had to be readmitted in a hurry? That is certainly the experience of many of my colleagues in primary health care in London.

§ Baroness Cumberlege
My Lords, we do not agree with that supposition at all. In fact, we know that the number of patients being treated is increasing. There always seems to be some kind of correlation between the number of patients treated and the number of patients admitted through accident and emergency departments. We intend to find out the reasons why.

§ Lord Molloy
My Lords, can the Minister say whether the results of the examination her department intends to undertake will be reported to the House?

§ Baroness Cumberlege
Yes, my Lords.