Failing A&E pay incentives urged
Specialist emergency care doctors should be paid more to work in struggling hospitals, MPs have suggested.
The Public Accounts Committee (PAC) said the improvement of A&E services has been "hampered" by the lack of emergency consultants.
They criticised both the Department of Health and NHS England for not having a "clear strategy for tackling the chronic shortage of A&E consultants".
The committee's latest report on emergency care suggests that doctors could be enticed to work at struggling hospitals if they were paid more.
"Many hospitals, especially those facing the greatest challenges, struggle to fill vacant posts for A&E consultants," the report states.
"There is too great a reliance on temporary staff to fill gaps, which is expensive and does not offer the same quality of service."
It adds: "We are not convinced that the department has a clear vision on how to address either the immediate or longer term shortage of A&E consultants."
They said that emergency admissions to hospitals have increased by 47% in the last 15 years. But it is not clear who is actually accountable for the delivery of local A&E services, they said.
The MPs welcomed the plans to provide 24/7 consultant cover in hospitals but said they were "concerned" about the "slow" pace of implementation.
The Department also drew criticism for the cash it injected into the system last winter, after the committee said that it was "not convinced" the money was used to best effect.
PAC chairwoman Margaret Hodge said: "Any attempt to improve emergency admissions services in the NHS is being completely stymied by the chronic shortage of specialist A&E consultants.
"Nearly one fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012. There are also major problems in training enough doctors in emergency medicine.
"What we found amazing is that neither the Department nor NHS England has a clear strategy to tackle the shortage of A&E consultants.
"With many hospitals struggling to fill vacant posts for A&E consultants, there is too much reliance on temporary staff to fill gaps. This is expensive and just does not offer the same quality of service.
"Struggling hospitals, such as those placed in special measures, find it even harder to attract and retain consultants. There are currently no incentive payments to make working in these hospitals a more attractive prospect.
"So, we raised with the department the possibility of paying consultants more to work at struggling hospitals."
She added: "Emergency admissions to hospitals have increased by 47% over the last 15 years at a time when budgets are under pressure. Bed occupancy rates across hospitals continue to rise year-on-year and the ambulance service is also under stress.
"Both the Department of Health and NHS England struggled to explain to us who is ultimately accountable for the efficient delivery of local A&E services, and for intervening when there are problems.
"Without clear accountability and responsibility it is much more difficult to achieve the changes needed to improve the situation."
Dr Paul Flynn, chair of the British Medical Association (BMA) consultants committee, said: "Consultants working in emergency medicine face increasingly challenging, high-pressured and stressful work environments, often with limited resources and gruelling workloads.
"This has contributed to a recruitment and retention crisis, meaning existing doctors are left working flat-out to meet rising demand, exacerbating the problem.
"Consultants already work around the clock to provide emergency care for patients but, as the report makes clear, there simply aren't enough to meet rising demand.
"The Government needs to urgently address issues such as workload pressures, resourcing and work-life balance if the NHS is to attract doctors in training and the consultant numbers that are needed, not least because spending large amounts on locum doctors is not financially sustainable in the long run."
Health Minister Dr Dan Poulter said: "Warnings about problems in recruiting and retaining A&E doctors date back to 2004 - and when this Government came to office six years later, Labour had left no plan in place to deal with them.
"By contrast, working with the College of Emergency Medicine we have a clear strategy to tackle the shortage, and have 414 more A&E consultants than there were in 2009, as well as filling all training places for doctors choosing to specialise in A&E.
"It takes six years to train an A&E consultant, and there is no easy fix - but our long-term plans are robust, increasing the number of training places by 75 next year, and planning for all trainee doctors to spend time in A&E.
"We are also looking at making an A&E career more attractive as part of our negotiations on the consultant contract."