HCAF have discovered a 3 to 8 (average 5 to 6) year pattern in medical admissions which is international in scope, age, gender and diagnosis specific and shows infectious-like spatio-temporal spread. In England, each 'outbreak' creates around 600 million of unexpected costs and step-increases in medical admissions, ED attendance, GP referral, a period of excess deaths, changes in the incidence of particular cancers and a cycle in the gender ratio at birth (see below for more detail).


The herpes virus, cytomegalovirus (CMV) may be directly or indirectly involved. A review of the mechanisms by which CMV could cause such outbreaks, especially in the elderly, has been published as has the clinical basis for hospitalisation and death and inflammation and autoimmunityThis ground breaking work has profound implications to all aspects of commissioning,  capacity planning and the funding of health services internationally.




   Emergency Admissions







Trends & cycles in emergency admissions 


Increase in emergency

   admissions - trend or

   step change?


Additional studies


A new infectious disease?


A cycle of surplus & deficit, or a new immune disease?


Cycles in population health


The Public Health England report and how increased deaths in 2012 were massaged away. This is a three part series.

Part 1, Part 2, Part3


The NHS's best kept secret?


Winter Mortality


The Public Health England report on recent trends in life expectancy. What this report omitted to say.








































Please note that draft versions of the papers (with permission from BJHCM) are for browsing. The final published article may be different to the draft. Please obtain a copy from your library or institutional login.


BJHCM articles are available from www.bjhcm.co.uk



Those who have an Athens login 

can access articles on the BJHCM website.



While some of the articles may not appear to be directly related to emergency admissions, after reading you will discover that there are common links which extend beyond just emergency admission.



Research published in J Virology (2013) 87(6): 3062-3075 'An Endothelial Cell-Specific Requirement for the UL133-UL138 Locus of Human Cytomegalovirus for Efficient Virus Maturation'  gives a possible mechanism by which strains of CMV could exert different clinical effects. Read



A recent study in Norfolk (England) on CMV related mortality is relevant:

Clinical Infectious Diseases56(10): 1421-1427.  Read


Refer to the 'Financial Risk' web page for details of the effect upon costs and to the 'Hospital Beds' web page for details of the effect on hospital beds occupancy and bed numbers.
































































































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There are considerable misconceptions about emergency admissions. Some have claimed that they follow roughly the same pattern every year, i.e. implying precision or certainty. However the link between the weather (temperature, air pressure, humidity, etc) and environment (air quality, viral & other infectious outbreaks) creates the opportunity for emergency admissions to show highly erratic trends over time, i.e. while there may be general seasonal and day of week patterns the upper and lower limits around the average are widely spaced.


The financial risk associated with emergency admissions is up to 3-times higher than due to chance variation alone. There are considerable implications to the longer-term bed requirements of hospitals, to health care costs, commissioning and financial risk in GP commissioning. These issues are covered in the 'Hospital Beds' and 'Financial Risk' folders respectively.


HCAF has discovered that the trend to higher than expected medical admissions, which has been ongoing for the last 40 to 50 years, is made up from a repeating pattern of step-like increases occurring at three to eight year intervals. It is these steps rather than the trend between the steps which is contributing (along with technological change) to higher than expected growth and patterns in the total costs of health care. These step increases appear to occur in a manner expected of an infectious spread and are most apparent using small area data. In England, the 2002 and 2007 'outbreaks', which occurred in the last quarter of the financial year, appears to be linked to 8,000 excess deaths in 2003 and 2008. A further outbreak in early 2012 lead to a period of higher deaths which did not abate until mid-2013. Details of this research can be found in the paper dealing with end-of-life costs in the 'Financial Risk' page and additional papers listed below.


Other long-term cycles appear to apply for trauma admissions (mostly weather-related) and the economic cycle influences psychological and general health and leads to counter-cyclic changes in the mortality rate. It is becoming increasingly clear that health care costs behave in ways that simple demographic forecasts can never predict. These findings are of immense practical significance and greatly affect the pattern of costs over time (see 'Financial Risk' page).


Emergency Admissions Series


British Journal of Healthcare Management (BJHCM)

British Journal of Medicine and Medical Research (BJMMR)


Jones R (1997) Emergency admissions: Admissions of difficulty.

   Health Service Journal 107(5546): 28-31 Read Me

Jones R (2009) Trends in emergency admissions. BJHCM 15(4): 188-196   Read Me

Jones R (2009) Cycles in emergency admissions. BJHCM 15(5):  239-246   Read Me

Jones R (2009) Emergency admissions and hospital beds. BJHCM 15(6): 289-96  Read Me

Jones R (2009) Emergency admissions and financial risk. BJHCM 15(7): 344-350  Read Me

Jones R (2010) Cyclic factors behind NHS deficits and surpluses. 

    BJHCM 16(1): 48-50  Read

Jones R (2010) Emergency preparedness. BJHCM 16(2): 94-95   Read Me

Jones R (2010) Unexpected, periodic, increase in medical inpatient care: Man-made or

    new disease? Medical Hypotheses 74(6): 978-983  Read Me

Jones R (2010) Can time-related patterns in diagnosis for hospital admissions help identify

   common root causes for disease expression? Medical Hypotheses 75(2): 148-54  Preview

Jones R (2010) The case for recurring outbreaks of a new type of infectious disease

    across all parts of the United Kingdom. Medical Hypotheses 75(5): 452-457  Preview

Jones R (2010) The nature of health care costs and financial risk in commissioning.

    BJHCM 16(9): 424-430  Read Me

Jones R (2010) Forecasting emergency department attendances. 

    BJHCM16(10): 495-496  Read Me

Jones R (2010) Trends in programme budget expenditure.

    BJHCM 16(11): 518-526.  Read Me

Jones R (2010) Gender ratio and hospital admissions. BJHCM 16(11): 541  Read Me

Jones R (2010) A fair tariff for emergency assessment activities - lessons learned.

    BJHCM 16(12): 574-583  Read Me

Jones R (2011) Impact of the accident and emergency target in England. 

    BJHCM 17(1): 16-22  Read

Jones (2011) Infectious outbreaks and the NHS Capitation Formula. 

    BJHCM 17(1): 36-38  Read Me

Jones R (2011) Costs of paediatric assessment. BJHCM 17(2): 57-63  Read Me

Jones R (2011) Cycles in inpatient waiting time. BJHCM 17(2): 80-81  Read Me

Jones R (2011) Cycles in gender-related costs for long-term conditions.

    BJHCM 17(3): 124-125  Read Me

Jones R (2011) CMV and health care costs. BJHCM 17(4): 168-169  Read Me

Jones R (2011) Unanswered questions from the trends in international bed occupancy.

    BJHCM 17(7): 307-313  Read Me

Jones R (2011) Volatility in bed occupancy for emergency admissions.

    BJHCM 17(9): 424-430. Read Me

Jones R (2012) Time to re-evaluate financial risk in GP commissioning.

     BJHCM  18(1): 39-48  Read Me

Jones R (2012) Gender ratio and cycles in population health costs.

    BJHCM 18(3):  164-165.  Read Me

Jones R (2012) Are there cycles in outpatient costs? BJHCM 18(5): 276-277.  Read Me

Jones R (2012) Increases in GP referral: jump or infectious push? 

    BJHCM 18(9):  488-497  Read Me

Jones R (2012) Age-related changes in A&E attendance.

    BJHCM 18(9): 508-509.  Read Me

Jones R (2012) Diagnoses, deaths and infectious outbreaks. 

    BJHCM 18(10):  539-548.  Read Me

Jones R (2012) Excess deaths following a procedure in 2008. 

    BJHCM  18(10): 554-555.  Read Me

Jones R (2013) Could cytomegalovirus be causing widespread outbreaks of chronic poor

    health? In: Hypotheses in Clinical Medicine,  pp 37-79,  Eds Shoja M, et al.

    Nova Science Publishers  Read-only Full Text 

Jones R (2013) An unexplained increase in deaths in England and Wales during 2012. 

    BJHCM 19(5): 248-253.  Read Me

Jones R (2013) Trends in unscheduled care.  BJHCM 19(6): 301-302, 304.  Read Me

Jones R (2013) Hidden complexity in A&E attendances in England.

    BJHCM 19(7) : 354-355.  Read Me

Jones R (2013) Is the demographic shift the real problem? BJHCM 19(10): 509-511  Read

Jones R (2013) Widespread outbreaks of a subtle condition leading to death and

     hospitalisation. Epidemiology: Open Access  3(4): 1000137 Read

Jones R (2013) Trends in elderly diagnoses: links with multi-morbidity.

     BJHCM 19(11): 553-558.   Read

Jones R (2013) A lagged cycle in cancer emergency admissions.

    BJHCM 19(12): 606-607.  Read Me

Jones R (2013) Analysing excess winter mortality. BJHCM 19(12): 601-605.  Read

Jones R (2013)  Do recurring outbreaks of a type of infectious immune impairment trigger

    cyclic changes in the gender ratio at birth? Biomedicine International 4(1): 26-39.  Read

Jones R (2013)  A recurring series of infectious-like events leading to excess deaths

     and medical admissions in  Scotland. Biomedicine International  4(2): 72-86. Read

Jones R (2014) Increased deaths in 2012: which conditions? BJHCM 20(1): 45-47. Read

Jones R (2014) Forecasting conundrum: a disease time cascade. BJHCM 20(2):  90-91.  Read

Jones R (2014) What is happening in unscheduled care?

    Journal of Paramedic Practice 6(2): 66-68. Read

Jones R (2014) Unexpected changes in outpatient first attendance.

    BJHCM 20(3): 142-143.   Read

Jones R (2014) Long term cycles in admissions for neurological conditions.  

    BJHCM 20(4): 192-193.  Read

Jones R (2014) Unexpected single year of age changes in the elderly mortality rate in England & Wales

    during 2012.British Journal of Medicine and Medical Research 4(16): 3196-3207.  Read

Jones R (2014)  Infectious-like spread of an agent leading to increased medical hospital

    admission in England. Biomedicine International 5(1): in press Read

Jones R (2014) Untangling the A&E crisis. BJHCM 20(5): 246-247.  Read

Jones (2014) Unexpected and unexplained increase in death due to neurological disorders in 2012 in 

    England & Wales: Is cytomegalovirus implicated? Medical Hypotheses 83(1): 25-31. ReadExtract

Jones R (2014) Trends in death and end-of-life costs in the UK. BJHCM  20(6):298-299.   Read

Jones R (2014) Infectious-like spread of an agent leading to increased medical admissions and deaths in

   Wigan (England), during 2011 and 2012.  BJMMR 4(28): 4723-4741.  Read

Jones R (2014) Trends in admissions for allergy. BJHCM  20(7):  350-351.   Read

Jones R (2014) A study of an unexplained and large increase in respiratory deaths in England and Wales:

     Is the pattern of diagnoses consistent with the potential involvement of cytomegalovirus?

     BJMMR 4(33): 5179-5192.   Read

Jones R (2015) A new type of infectious outbreak? SMU Medical Journal 2(1): 19-25.  Read

Jones R (2015) An unexpected increase in adult appendicitis in England (2000/01 to 2012/13): Could

    cytomegalovirus (CMV) be a factor?  BJMMR 5(5): 579-603.  Read

Jones R (2015)  A previously uncharacterised infectious-like event leading to spatial spread of deaths

    across England and Wales: Characteristics of the most recent event and a time series for past events. 

    BJMMR 5(11): 1361-1380.   Read

Jones R (2015) Roles for cytomegalovirus in infection, inflammation and autoimmunity.

   In Infection and Autoimmunity.  2nd Edition, Eds NR Rose, Y Shoenfeld, N Agmon-Levin,

   Elsevier: Amsterdam, Chapter 18, in press.

Jones R, Beauchant S (2015) Small area spread of a new type of infectious condition across Berkshire

   in England between June 2011 and March 2013: Effect on medical emergency admissions.

   BJMMR 6(1): 126-148.  Read Me

Jones R (2015) Unexpected and disruptive changes in admissions associated with an infectious-like

   event experienced at a hospital in Berkshire, England around May of 2012. 

    BJMMR 6(1): 56-76.  Read Me

Jones R (2015) Unexplained infectious events leading to deaths and medical admissions.

   BJHCM 21(1): 46-47.   Read Me

Jones R (2015) Recurring outbreaks of an infection apparently targeting immune function, and

   consequent unprecedented growth in medical admission and costs in the United Kingdom:

   A review.  BJMMR 6(8): 735-770.  Read Me

Jones R (2015) Forecasting medical emergency admissions. BJHCM 21(2): 98-99.  Read Me

Jones R (2015) Why is it so difficult to accurately forecast medical costs? BJHCM 21(3): in press.  Read

Jones R (2015) Has the UK experienced a four-in-a-row epidemic? BJHCM  21: in review  Read

Jones R (2015)  A regular series of  unexpected increases in total deaths for residents of Scottish Local

   Authority areas: Is an infectious source implicated? Biomedicine International (submitted)  Read

Jones R (2015) Unexpected growth in deaths from Alzheimer's and dementia and other neurological

   disorders in England and Wales during 2012 and 2013.

   Journal of Neuroinfectious Diseases (in revision)  Read

Jones R (2015)  A time series of deaths in New Zealand - are hidden epidemics concealed in the trends?

   in preparation  Read

Jones R (2015) A time series of infectious-like events in Australia leading to increased deaths and medical

   admissions. in preparation Read

Jones R (2015) The rise in medical admissions, a "wicked problem" with additional complexity arising

   from periods of unexplained higher deaths. in preparation  Read