Hotlines to keep patients away

Emergency admissions to hospital are rising at 1,000 a day yet at least a quarter of the patients involved do not need to be there. Jeremy Laurance, Health Editor, looks at new ways of keeping NHS beds empty.

Hot lines for patients and GPs who need emergency advice and training for ambulance staff to discriminate among 999 callers are being tried by NHS trusts in an effort to curb the soaring number of emergency admissions.

The NHS Confederation said hospitals around the country were struggling against the rising tide of emergencies and warned that a flu epidemic, or sustained cold spell, could put the health service under intolerable pressure this winter. Last December, emergency admissions rose 37 per cent compared with December 1995.

Stephen Thornton, chief executive of the confederation, which represents health authorities and trusts, said the extra pounds 300m for the NHS this year, announced by the Government in the autumn, might be too little. "It is going to be a tough winter and we don't know if it will be enough to get us through. The NHS needs to be properly resourced with long-term funding, not short-term handouts."

A report by a working party of the confederation and the Royal College of Physicians, published yesterday, says that emergency hospital admissions rose 9.9 per cent in the four years from 1991-92 to 1994-95, an increase of 335,000, equivalent to an extra 920 a day. As with previous inquiries no single cause was found for the rise which is attributed to a combination of social, medical and professional factors. The decline of the extended family, the high divorce rate and the growth in people living alone are all thought to increase the likelihood of emergency admissions.

Professor Michael Shepherd, chairman of the working party, said evidence suggested that 20-25 per cent of patients admitted to hospital could be cared for more appropriately in their own homes or elsewhere. Some estimates have put the figure as high as 40 per cent.

At King's College hospital in south London, patients can phone an emergency line to discuss their problem with a specially trained nurse who can advise them whether to call 999 or wait to see their GP.

l A new "scorecard" to assess the performance of NHS trusts is to be introduced under Labour's planned reforms to the NHS, Alan Milburn, the health minister, said yesterday. The "National Performance Framework" will list the costs of treatments and operations provided by each NHS trust providing a benchmark maximum which all trusts must meet.