Healthwatch Birmingham and Healthwatch Solihull Board Meeting

NHS needs to do more to understand why people are returning to Hospital after being discharged

• New analysis shows emergency readmissions rose by a fifth since 2012/13
• Over 500,000 cases recorded in 2016/17
• 1 in every 5 emergency readmissions take place in the first 48 hours

As part of a broader investigation into people’s experiences of leaving the hospital, Healthwatch England is today publishing a new analysis of NHS emergency readmissions data.

An emergency readmission is defined by the NHS as anyone who has to return to the hospital for unplanned further treatment within 30 days of having left. This covers unforeseen readmissions, such as people receiving chemotherapy having to be readmitted because of side effects. It also covers cases where people have been discharged too early or without the right social care support in place.

When Healthwatch went looking into the data to see what it could tell us about people’s experiences of being discharged from hospital we found that no complete national dataset has been published on this since December 2013.

Healthwatch England asked hospital trusts across England for a day-by-day breakdown of their emergency readmissions data for each of the last five financial years and found the following:

• In 2016/17 there were 529,318 emergency readmissions reported by 84 hospital trusts
• Between 2012/13 – 2016/17 the number of emergency readmissions rose by 22.8% (compared with a 9.3% rise in overall admissions)
• The numbers of emergency readmissions within 24 hours rose even faster with a 29.2% increase
• The number readmitted within 48 hours account for 1 in 5 of the overall total (21.6%)

Whilst not every emergency readmission is the result of a poorly managed discharge, such a high proportion of people returning to hospital within a short period raises important questions, such as:

–              Was the decision to discharge appropriate?

–              Was the correct care support provided to enable the person to recuperate?

–              Have avoidable emergency readmissions led to trusts changing processes and procedure in order to avoid such circumstances in the future?

Although the number of people experiencing an emergency readmission is comparatively small when we consider the huge numbers of hospital inpatients treated each year, it is important to remember the impact it has on people when discharge processes don’t go according to plan. In our 2015 report ‘Safely home’ and our updated briefing, published in early October, we heard from thousands of people who told us how incredibly distressing it had been for them and their families when they didn’t get the support they needed to help them after leaving hospital.

Reducing inappropriate emergency readmissions also needs to be a priority for the health and care sector, as each case adds additional burden to system which is struggling to free up beds.

Healthwatch is therefore calling for emergency readmissions data to be used alongside other more widely used datasets, such as delayed transfers of care (DTOC), to establish a broader understanding of how well health and social care services are doing in getting people out of hospital safely.

Imelda Redmond, National Director of Healthwatch England, said:

“We know that keeping people in hospital for longer than medically necessary is bad both for individuals and the NHS as a whole. So it’s absolutely right that doctors, nurses and care staff are doing their best to get people home as quickly and safely as possible.

“With health and care services being expected to each free up 1,250 beds through reducing delayed discharges, it is vital that these services also watch what is happening to the people being sent home from hospital. We are therefore calling for emergency readmissions data to be used alongside other datasets, such as delayed transfers of care, to establish a broader understanding of how well health and social care services are doing in getting people out of hospital safely.

“Our initial analysis raises some big questions, and it’s clear that health and care leaders need to take a closer look at why people are returning to hospital so quickly.

“There will always be unforeseen circumstances which result in people’s recovery not going according to plan. However, a better understanding of emergency readmissions will help identify potential trends and address the underlying reasons why things go wrong.”