Emergency hospital admissions via accident and emergency departments in England: time trend, conceptual framework and policy implications

The urgent and emergency care services in England’s National Health Service (NHS) are currently the subject of a national review. The existing system, which is experiencing increases in demand, has been described as unaffordable, unsustainable and fragmented. In August 2013, the Prime Minister’s Office and Department of Health announced that an additional £500 million would be made available to relieve pressures on accident and emergency (A&E) departments. Since then, the National Audit Office and Public Accounts Committee have both published reports on emergency admissions to hospital, focusing on the management of demand and the value gained from public expenditure. In this article, we briefly review the current roles of A&E departments in England and then describe how the proportion of emergency hospital admissions that occurred via A&E departments increased from 2001–2002 to 2010–2011. We present a conceptual framework for helping to explain this trend and discuss the potential implications for national policy.