The quality of patients’ access to urgent and emergency care in England ‘depends too much’ on where they live, the House of Commons Public Accounts Committee (PAC) has said in a scathing new report into urgent and emergency care access.
Entitled ‘Access to urgent and emergency care‘, the report said staff ‘have been let down by a system which has seen performance fall far below the standard the NHS says patients should expect to receive’.
It highlights that NHS’s own target for A&E waits had not been met since 2015, and its target for ambulance handovers had been missed each year since it began reporting against this metric in 2017. Regional variation was found to be particularly prevalent, it said.
Proportions of the most serious A&E patients waiting less than four hours in March 2023 ranged from 53.3% in the Midlands to 62.1% in the South East.
Ambulance services covering large rural areas, like the South West and East of England, are especially challenged, with Category 1 response times in 2021/22 varying from 6 minutes and 51 seconds in London to 10 minutes and 20 seconds in the South West.
The PAC said that evidence suggested the Department of Health and Social Care had ‘not sufficiently held NHS England to account’ for meeting targets and improving urgent and emergency care.
What’s more, differences in the capability of individual trusts, including around management, clinical leadership, and technology, were also highlighted. The PAC said these must be addressed to reduce variations in patients’ access to and experience of services.
Commenting on the report, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: ’This is another report that lays out the damning reality of emergency care. Our members and their patients are being let down.’
And he described the Committee’s finding that performance varies from region to region as ‘disheartening but not surprising’.
He added: ’We must be able to better understand what is happening at a local level. At the moment we do not know how well or how poorly individual hospitals are doing because the official data is published by each trust, which may encompass several sites.
’RCEM is campaigning for NHS England to publish transparent performance figures for individual A&Es, so increased resources and support can be provided to the sites that are struggling the most. Improving equality of care and resulting in significant benefit to patients and staff.’
Delayed discharge and winter pressures
The PAC report also highlighted that not enough is being done to tackle delayed discharges, which has a serious knock-on impact throughout the whole urgent and emergency care system, with beds unable to be released for new patients and thus exacerbating A&E waiting time issues.
The number of patients staying in hospital when they no longer need to stood at an average of 13,623 in Q4 of 2022/23, up from 12,118 in the same period one year before.
To this end, Dr Boyle said: ’We are on the cusp of what looks likely to be another devastating winter. Having adequate capacity for our patients is vital. This will reduce dangerous levels of bed occupancy and improve flow through our hospitals and go some way to easing the pressure on the system.
“We know that since the pledge [to] increase bed numbers by 5,000 was made in January, we have not made nearly enough progress on this fundamental solution. The priority must now be on significantly increasing bed numbers before the cold weather, and the inevitable winter pressures hit.’
Workforce retention plans
The PAC also called into question the ‘assumptions underpinning’ NHS England’s plan to retain 130,000 staff over the next 15 years, as set out in its recent workforce plan, particularly given the staff turnover rate in the health service was 9% in 2022/23.
And despite having ‘more money and staff than ever before’, the NHS has made ‘poor use of it’ to improve urgent access for patients with urgent and emergency services ‘deteriorating’ in spite of greater spend, it concluded.
It also flagged a 23% fall in NHS productivity following the Covid-19 pandemic, even though it had been improving pre-pandemic.
It has now called on NHS England to set out its understanding of the causes for the fall in productivity and how it will address them.
Similarly, it urged NHS England to establish the causes for variation in performance, and how it might bring the ‘worst-performing organisations’ closer in line to the standards achieved by the best.
‘NHS under increasing pressure‘
Committee chair and Labour MP Dame Meg Hillier said: ‘Excluding demand-led spending such as welfare payments, health takes up approximately 40% of day-to-day budgeted spending by Whitehall departments. It is vital this is delivering benefits for patients. The Government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.’
Responding to the inquiry report, NHS England’s national clinical director for urgent and emergency care, Professor Julian Redhead, said: ‘While this report includes data which is more than two years old and coincided with a once in a generation pandemic, it is right to note the NHS has been under increasing pressure with staff experiencing record A&E attendances, hospitals fuller than at any point in their history and with thousands of beds taken up each day, in part, due to pressures in social care.
‘It is testament to the hard work of staff and results of our NHS winter plan – rolling out 800 new ambulances, 10,000 virtual ward beds and work towards 5,000 extra core beds – that waiting times for ambulances, 999 calls and in A&E have improved across the country during this financial year.
‘This progress has come as the NHS has committed to delivering £12bn of annualised savings by 2024/25 – all while dealing with more than a 100,000 staff posts being vacant.’