Inadequate care blamed for rise in emergency readmissions to hospital

Royal College of Nursing says 40,000 job vacancies are taking a toll on nurses’ ability to treat patients

SOARING numbers of patients are being readmitted to hospital for conditions that could be avoided.

Figures reveal a 40 per cent rise in emergency readmissions for problems such as pressure sores and pneumonia. Experts say the findings are “concerning”, and a sign that patient care may have been compromised during or after a hospital visit.

The report by the Nuffield Trust shows that the number of potentially preventable emergency readmissions to hospital rose from 130,760 to 184,763 between 2010/11 and 2016/17, and includes a trebling in the number of emergency readmissions for bedsores, plus a 73 per cent rise in patients contracting pneumonia. Researchers say it suggests patients suffer poor care in hospital, are discharged too soon or receive inadequate care once at home.

Jessica Morris, a research analyst at the trust and the report’s author, said: “Emergency readmissions to hospital, for conditions that were not diagnosed during their first visit are potentially a warning sign that a patient’s quality of care may have been compromised.”

Prof John Appleby, the trust’s research director, added: “Unnecessary trips and overnight stays in hospital put a strain on elderly patients and their families. That is why it’s concerning that our research shows the number of people being readmitted to hospital within 30 days with potentially preventable conditions is greater than it was seven years ago.”

The briefing from Quality watch, a research programme run by the trust, aims to highlight where improved quality of care in hospital or in the community might prevent readmission.

Dame Donna Kinnair, director at the Royal College of Nursing, said: “These findings reflect the impact 40,000 nurse vacancies has on patient care. Nurses want to do the best for their patients but with hospitals struggling to recruit and shifts left unfilled there are too few nurses to deliver the best care.”

The research comes on the fifth day of a series by The Daily Telegraph exploring the state of the health service and its role in modern Britain as the NHS approaches its 70th birthday.

Theresa May is expected to mark the anniversary by announcing extra funding. The Prime Minister is understood to back the view of Jeremy Hunt, the Health Secretary, that the public would accept tax increases to pay for the NHS if the money is used wisely. But they are being resisted by Philip Hammond, the Chancellor.

Alan Milburn, Labour’s former health secretary, said money was being wasted on cure rather than prevention and called for reform of NHS funding.

Jeremy Hunt probably has the hardest job in politics, but not for the reason many people think. His difficulty isn’t running the National Health Service, the most expensive and important public service in Britain. His challenge is not running it.

Ever since Aneurin Bevan allegedly said that a bedpan dropped on the ward should echo in Whitehall, political debate about health has supposed that the health secretary runs the NHS. That never made much sense – would you want the defence secretary to command British troops in battle? – but the 2012 Health and Social Care Act formally relieved ministers of the duty and gave it to the head of NHS England.

Today that’s Simon Stevens, probably Britain’s most powerful unelected official and arguably one of its more successful politicians. Mr Hunt takes blame for problems in a service he doesn’t really run, and Mr Stevens takes credit for successes. Mr Hunt finds money and Mr Stevens spends it.

Hence Mr Hunt’s quest for more cash. No party has ever been punished by the electorate for overspending on health, so his battle with the Treasury makes political sense. But spending is the wrong gauge on which to measure the NHS – or at least, an insufficient one. What really matters is NHS productivity: that is, how much care does each pound spent on health actually buy?

As Social Market Foundation calculations will next week set out, small differences in productivity growth can make a huge difference to the value of the NHS budget. If the NHS had seen the near-revolutionary gains in efficiency that Mr Stevens suggested in his 2014 “five year plan”, Mr Hunt would not now need to fight so hard for new money. The same urgent need to make the NHS more productive also explains both Mr Hunt’s occasional battles with the medical profession and his enthusiasm for technology.

It’s true that NHS productivity has grown faster than that of the whole economy in the past 10 years – but only on average. There were big gains at the start, but now it seems productivity growth has almost stalled, just as politicians discuss spending more. That’s ominous because history suggests that the more the NHS has, the slower productivity grows.

For instance, one reason growth has slowed is the relaxation of pay curbs. “Austerity” had human and political costs, but on a narrow economic analysis it made the NHS more productive, squeezing more from every penny of the £50 billion wage bill. Boosting pay again might be politically wise, but will complicate Mr Stevens’ job of raising productivity.

What’s to be done about this? Our new research offers some answers, including ideas for how to use some of the budget to encourage – and reward – innovation within the NHS. But it certainly requires a hard-headed defence of NHS managers. Even if some could do better (there is no workforce on earth of which this could not be said) the notion that too much management is the NHS’S biggest problem is not just mistaken but harmful, since it means good management is not properly attracted or rewarded.

It’s natural for the life-saving skills of doctors and nurses to command public attention and admiration, but powerful “bureaucrats” can save or squander life on a much greater scale than the finest medic. Good management means the NHS deploys its resources where they are most needed, ensuring patients progress through the system as swiftly as possible and are properly managed after formal treatment is complete.

This isn’t all about AI or shiny technology, though they can certainly help. Boring old process management matters. One senior health professional told us about two surgeons of equal skill doing the same operation on similar groups of patients at nearby hospitals. One surgeon’s patients rarely return for costly treatment of postoperative complications; the other’s patients often do. The difference is management: the first hospital used administrative staff to oversee patients after they left surgery, giving them proper advice on medication, exercise and recovery. The second did not.

Making the NHS more productive isn’t exciting. It doesn’t have the headline-grabbing power that comes from spending more billions. But the difference it can make isn’t just measured in pounds.

James Kirkup is Director of the Social Market Foundation