More patients are being admitted in hospitals because of increased pressure on A&E departments, a new report has found.
The National Audit Office (NAO) study found many emergency admissions through A&E are avoidable and many patients stay in hospital "longer than is necessary".
Factors putting pressure on A&E include patients finding the range of NHS services "confusing", poor access to out-of-hours GP care in some areas and the four-hour A&E waiting time target, which means patients cannot be kept in A&E for observation.
The introduction of the 111 non-emergency telephone number for the NHS also had a negative impact on A&E.
The report said: "The number of emergency admissions to hospitals - admissions that are not planned and happen at short notice because of perceived clinical need - continues to rise at a time when NHS budgets are under significant pressure.
More patients attending major A&E departments are now being admitted than in the past, it said.
In 2012/13, more than a quarter of all patients attending major A&E departments were admitted to hospital, up from 19% in 2003/04.
Only a quarter of this rise was due to an increase in the number of people attending A&E, with the rest due to a higher admission rate.
The report said: "Over the last 15 years, short-stay (less than two days) admissions have increased by 124%, whereas long-stay (two days or longer) admissions have only increased by 14%."
The study pointed to problems with people getting help in the community, from GP practices and other services.
It estimated at least one-fifth of admissions could be managed effectively in the community and criticised a "lack of alignment between hospital services and other health services", with poor seven-day care on offer outside of hospitals.
Other factors include an increasingly frail elderly population, who are far more likely to need emergency care.
Amyas Morse, head of the NAO, said: "Growth in emergency admissions is a sign that the rest of the health system may not be working properly."
Health Secretary Jeremy Hunt said: "We know demand for A&E services is increasing as the population ages, with more people needing more healthcare.
"That's why we are tackling both the short and long-term problems: transforming out of hospital care by reversing the disastrous changes to the 2004 GP contract, joining up the health and social care system, and backing A&Es with £250m to prepare for this winter."
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