Government 'acted too late' to prevent crisis this winter, MPs warn after auditors' report

'It shouldn't be like this,' medical experts say of entirely congested and underfunded health service

Pressures made worse as patients discharged too soon or without support are increasingly readmitted (Rex)

The winter crisis has been made worse by the Government’s failure to reverse dwindling bed numbers in hospitals and invest in community services to help prevent emergency admissions, auditors have shown.

A report by the National Audit Office (NAO) says the NHS spent £13.7bn in 2015/16 on emergency admissions, and these are up by a quarter in a decade.

Despite the best efforts of hospitals, which are discharging increasing numbers of patients the same day they're admitted, admissions are“far from being in control”, the NAO says.

Some of this pressure could be relieved by investing in social care and health services in the community, which could prevent patients becoming critically ill, or give paramedics an alternative to bringing them to hospital.

The NAO estimates 5.8 million admissions to A&E departments were avoidable in 2016/17.

“Despite early warnings, the Government acted too late to prevent the crisis in our A&Es this winter,” said Meg Hillier MP, chair of the Commons Public Accounts Committee of the NAO’s findings.

“Emergency admissions continue to rise, and last year plans to take pressure off hospitals with better care in the community stalled.”

Emergency admissions increased 24 per cent in total between 2007 and 2016 the NAO found.

They also became more costly, increasing 2.2 per cent in real terms since 2013/14 and medical experts said the failure to treat people before they become acutely unwell is “symptomatic of an entirely congested and underfunded system”.

Most of the rise comes from older, sicker patients – those 65 and over were admitted 12 per cent more often in 2016/17 than four years earlier.

But bed numbers aren’t keeping up, the NAO estimates there were 6,268 fewer beds available on average across the NHS since 2010.

While most of this increase was in patients admitted and discharged the same day, the report warns that this rapid turnaround may mean more people are being sent home too early, or without support.

The number of patients being re-admitted after being discharged by the NHS is up 22.8 per cent in four years, according to estimates by the Healthwatch charity, meaning the health service is creating work for itself.

“It shouldn’t be like this,” said Dr Chaand Nagpaul, council chair at the British Medical Association. “Patients are having trouble receiving the earlier treatment they need which is symptomatic of an entirely congested and underfunded health system.

“It is becoming increasingly clear that the health service just doesn’t have the resource nor capacity to meet rising demand year-round.”

The NAO’s findings come as NHS winter figures, released on Thursday, show bed shortages are again at record levels.

Data for the week ending 25 February show that on average 95.2 per cent of hospital beds in England were occupied, well above the safe threshold of 85 per cent identified by the NAO.

This is partly driven by high levels of the norovirus vomiting bug which have closed nearly 1,000 beds a day.

But performance could fall further as they do not include data for this week where snow storms have led to operations being cancelled, patients being unable to go home, and the RAF being called in to support hospitals.

Amyas Morse, head of the NAO, said today: “It is a problem for all of us that A&Es remain overloaded and a constant point of stress for patients and the NHS. A lot of effort is being made by NHS England.

“At the centre of this is increased ‘day case’ treatment but the decision to stop methodical measurement of emergency readmissions a few years ago makes it difficult to understand whether day case interventions achieve enduring results.”

The Government committed £457m to help the NHS prepare for winter, however £357m of this was only announced in the November budget – far too late for hospitals to plan.

While £2bn was pledged for social care in March 2017, this has been focused on enabling patients to be discharged more quickly and cash-strapped councils said more needs to be spent on prevention.

A Department of Health and Social Care spokesperson said: “As the NHS has said itself, planning for winter this year was more meticulous than ever before, supported by a dedicated £437 million in addition to the extra £2.8bn allocated over the next two years in the Autumn Budget.

“As this report points out, the NHS remains extremely busy but it is doing well to manage with the continued increase in demand, treating nearly 2 million more people in A&E in 16/17 than in 10/11.”