Can they really be avoided?
Primary care trusts (PCTs) have strong incentives under Payment by Results (PbR) to prevent people being admitted to hospital with conditions which ideally should never warrant it. Benchmarking individual performance against the national trends is important. It can also help identify those PCTs which have been most successful.
Ambulatory Care Sensitive (ACS) conditions, in other words conditions which in theory should never require hospitalisation, account for about 15 per cent of all non-elective admissions. They cost over £1 billion nationally per year and £7 million per PCT.
Admissions for ACS conditions are associated with relative levels of deprivation. Those PCTs with the lowest rates tend to be those in affluent areas. Unlike in the remaining emergency admissions for conditions which may require hospitalisation, age is hardly a significant factor at all.
Audit Commission analysis, available for any PCT, takes account of the dependence on deprivation, and indicates the scope for improvement across the 19 main categories of ACS conditions. In the PCT shown, the PCT would save over £0.5 million at current tariffs if it reduced ACS admissions just to the expected level, in other words after allowing for its level of deprivation based on national averages. Some PCTs do better than this.
There are many national initiatives like this to help PCTs reduce these admissions. The King's Fund's PARR (Patients At Risk of Re- hospitalisation) tool, the Information Centre's productivity indicator on this topic, and the government's drive to implement case management, to say nothing of PbR, are all pushing in the same direction.
The national picture shows what is possible. Three-quarters of PCTs managed to reduce avoidable admissions for ACS conditions between the first half of 2005/06 and the same period in 2006/07.
It may not be possible to untangle which national initiative should take the credit for this net reduction. But what is most important to know is what action works best at the local level. It is straightforward to chart the change. The Audit Commission is discussing, with those PCTs which have exhibited the most significant reductions, what it was that led to these changes, and hopes to make available case studies to local auditors and their PCTs.