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Researchers develop inequality monitoring system to reduce preventable A&E admissions

Posted on 19 January 2016

Researchers have developed a set of indicators which could help reduce preventable A&E admissions arising from social inequality – as figures reveal there were almost 38,000 deaths in England in one year from treatable conditions.

Using hospital data, the researchers at the University of York calculated that social inequality gave rise to more than 158,000 preventable emergency hospitalisations in the year 2011/12, and nearly 38,000 deaths from treatable conditions.

The study focused on emergency hospitalisation for patients with long-term conditions such as dementia, diabetes, respiratory and cardiovascular diseases, which previous research has shown can be reduced by more effective primary care and outpatient care.

Previous research has shown that the most deprived fifth of neighbourhoods in England suffer nearly two-and-a-half times as many preventable emergency hospitalisations as the least deprived fifth.

The new study reveals that past NHS investments in GP services led to improved healthcare across all socio-economic groups, particularly among the poorest, between 2004 and 2011.

During this period, the average number of registered patients per GP fell by 125 from 1,814 to 1,689, allowing for need, with an even larger fall of 218 from 1,850 to 1,643 in the most deprived fifth of neighbourhoods.

There was, though, only a modest reduction in inequality in preventable deaths and admissions through A&E, the report’s authors say.

The researchers say that appropriate investments in the NHS can reduce healthcare inequality and deliver measurable improvements to patient outcomes in deprived communities – and that reducing healthcare inequality is more than simply a matter of increasing the number of GPs in deprived areas.

In the wake of the study, a group of academics led by the Centre for Health Economics (CHE) at the University of York have developed a monitoring system for the NHS based on eight reliable indicators of healthcare inequality.  The report’s authors say, in time, these indicators will be able to help local hospitals reduce preventable A&E admissions, improve care for the most socially disadvantaged patients and reduce health inequalities.

The researchers note that there is a “social gradient” in preventable emergencies meaning everyone, not just the poorest, is affected.  The further down the gradient a person is, the greater the chances of suffering a preventable emergency hospitalisation.

Lead investigator, Professor Richard Cookson from CHE said: “In England the richest fifth of people can expect to live at least 12 more healthy years than the poorest fifth. One consequence is that poorer people have a lot of preventable illness, which is putting huge pressure on the health service. Some of that pressure could be relieved by improving the co-ordination of care between specialties, between primary and hospital settings, and between health and social care.

“NHS policymakers and managers have a legal duty to consider reducing inequalities. However, reliable information on healthcare inequalities is currently scarce: national monitoring focuses on the average patient, and little attention is given to local monitoring of healthcare inequality.

“These indicators could be used to help managers learn quality improvement lessons, to help regulators and others hold the NHS to account, and to help inform the public about healthcare inequalities within their local area.”

The eight indicators are: (1) patients per GP, (2) primary care quality, (3) inpatient hospital waiting time, (4) preventable emergency hospitalisation, (5) repeat emergency hospitalisation, (6) dying in hospital, (7) mortality amenable to healthcare and (8) overall mortality.

The first five of these can be used as local equity indicators, by comparing the local inequality gradient with the national gradient in England to see which areas are doing well or badly at reducing inequality.

Professor Cookson added: “The NHS can now start producing our equity indicators on an up-to-date, annual basis to help improve the co-ordination of care and reduce preventable hospitalisation and mortality arising from social inequality.” 

Co-investigator, Professor Peter Goldblatt, from the UCL Institute of Health Equity, said:  "This research has opened the way to more effective monitoring of health inequalities in the NHS.  It will support organisations in meeting the legal duties placed on the NHS in 2012 – to consider the need to reduce inequalities both in patients’ ability to access health services and the outcomes achieved for them.

“This would complement the monitoring of the causes of health inequalities in the general population, already being undertaken by the Institute of Health Equity and Public Health England."

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