A&E plans 'lack sufficient urgency'
Published 24/07/2013 | 00:58
Plans to address the problem of bulging A&E departments "lack sufficient urgency", MPs have warned.
The Health Select Committee said it was not convinced the proposals were an "adequate response" to the growing crisis in emergency care. Health Secretary Jeremy Hunt has previously admitted that the "huge pressures" in A&E reflect other problems in the health service because accident and emergency is the barometer for the whole system.
Experts warned that the emergency care system could collapse in six months as a result of rising demand and, to address the problems, NHS England ordered local health authorities to form "urgent care boards" to ensure that all A&E departments had "recovery and improvement plans" in place.
However, MPs raised concerns about the boards, saying that experts who gave evidence to them were "unclear" about how many of these boards were planned, what powers they will have and whether they are voluntary or compulsory, temporary or permanent, established structures or informal meeting groups.
Committee chairman Stephen Dorrell MP called on NHS England to ensure that the recovery plans are agreed in each area before the end of September. He said: "We were not convinced that the plans presented to us represented an adequate response to the challenges the system faces. The committee is mindful of pressures which will build during next winter and is concerned that current plans lack sufficient urgency. We were concerned that witnesses disagreed about the nature of demand for urgent and emergency care. The system is 'flying blind' without adequate information about the nature of the demand being placed upon it."
MPs also said the decision to launch the troubled NHS 111 service in April - replacing NHS Direct as the number to call for urgent but non-emergency care - was "premature". The line suffered many teething problems, with patients complaining of calls going unanswered, poor advice given and calls being diverted to the wrong part of the country.
An NHS England spokeswoman said: "We will consider the report very carefully and will consider it when we report on our review into our urgent and emergency care, announced by Professor Sir Bruce Keogh in January this year. Most urgent care boards have now submitted their plans to address the issues in their local area to us for checking, and they will all have done so by early autumn."
Dame Barbara Hakin, the chief operating officer of NHS England, told BBC Radio 4's Today programme: "It's very disappointing that accident and emergency departments don't have as much consultant cover as we would all wish them to have. We need to work much harder at making this an attractive profession for young doctors, so we can recruit them. Inevitably if you have a situation where you don't have the best possible resource, then that can compromise making sure patients get the best treatment. We need to do two things about this. First and foremost, we need to look at how we can make our accident and emergency departments the very best they can be, which means improving recruitment. But also, we need to make sure that the patients who don't need to be there and don't want to be there aren't. That's about tackling issues in general practice, in community services and in social care which will help to keep the patients that we are most concerned about - the vulnerable and the elderly - in their own homes."
Dame Barbara agreed there were "difficulties" with the roll-out of the 111 service, adding: "If certain providers had done what they said that they were going to do and had the call handlers in place to talk to patients, then it would have been fine. That didn't happen. But we were able within a very few weeks to get a really great service, and the 111 service is now stable." She added: "There's no evidence that we're having more patients go to A&E because of the 111 service. In some places, we've seen a rise in people going to A&E just when we started to roll the service out. We do need to make sure that call handlers are more experienced when they start to take calls but, in stable situations, there is no evidence that more ambulances are being called or more people taken to A&E."
Dame Barbara denied the accusation that the NHS was not ready for the winter. "Local doctors and nurses and managers across the whole of England have submitted to us their plans for the winter and we are looking at those and trying to work out which ones look really resilient and where some of them can learn from others," she said. "We are already well ahead this year in winter planning."