A&E crisis plans 'not good enough', MPs say

Patients waiting to see a doctor Pressures have been growing on A&E units for a number of years

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Plans put in place to relieve the pressure on A&E units in England are not good enough, MPs have warned.

The Health Select Committee said it had been given "confusing" and "contradictory" information about what was being done.

It prompted the cross-party group to question how prepared the NHS would be for next winter.

NHS England said it was considering various measures to take pressure off A&E units ahead of the cold season.

The MPs said staffing issues and rising attendances were among the main causes of the problems.

Their evidence found just 17% of hospitals had the recommended level of consultant cover, while difficulties with discharging patients and a lack of beds at times meant the flow of patients through the system was disrupted.

The report comes after the NHS missed its four-hour waiting-time target in the first three months of this year.

'Flying blind'

In the long-term, the MPs urged NHS England's medical director Prof Sir Bruce Keogh, who is leading a review of urgent and emergency care, to look at the weaknesses across the rest of the health service.

They said there was much more the primary care system, which includes GPs, urgent care centres and minor injury units, could do to prevent unnecessary visits to A&E.

The MPs also suggested ambulances could treat more patients at the scene to reduce the number of transfers to hospital, while the new 111 non-emergency phone number needed to get better at offering advice.

The A&E crisis

  • The four-hour waiting time target was missed across the NHS from January to March - the first overall breach for nine years
  • In total 94 out of 148 providers missed the mark
  • More than 300,000 patients waited longer than they should have - a 39% rise on the previous year
  • Only 17% of trusts could guarantee the recommended level of consultant cover
  • The new 111 non-emergency phone number was not yet offering "timely and effective" advice

Earlier this year NHS England announced urgent care boards would be created to form action plans and release money to combat the difficulties being faced.

But in the evidence sessions with senior people in the health service, the MPs were left unclear whether they were voluntary or compulsory, temporary or permanent.

The MPs also highlighted differences in data they had been given about the scale of the problems, with vastly different impressions given of delayed discharges from hospital and the increases seen in attendances at A&E.

Committee chairman Stephen Dorrell said: "The system is 'flying blind' without adequate information about the nature of the demand being placed upon it."

He said all parts of the NHS - including social care, GPs, ambulance trusts and the 111 phone line - needed to have a plan place by the end of September to ensure they were ready for the winter peak.

"The committee is mindful of pressures which will build and is concerned that current plans lack sufficient urgency," he said.

Labour's shadow health secretary Andy Burnham said A&E departments were "routinely working below safe levels" because of inadequate staffing.

He said almost 5,000 nursing posts had been cut since the 2010 election and accused the government of taking "unacceptable risks with patient care".

"[David] Cameron must act on this report without delay if this coming winter is not to turn out even worse than the last," he said.

Patients Association chief executive Katherine Murphy said: "How much more evidence does the government and NHS England need before they take notice?

"The system is under increasing pressure and is coming apart at the seams. The time to act is now."

Find out more

Listen to File on 4's report into how hospital finances are adding to the A&E crisis.

NHS: Pricing Patients was broadcast Tuesday, 2 July on BBC Radio 4

An NHS England spokesman said it recognised there was work to be done and action plans would be in place by the autumn.

"The committee has raised some key issues," he added.

Dame Barbara Hakin, deputy chief executive of NHS England, said the organisation was "looking at a range of things that will take the pressure off our A&E departments", including supporting more patients at home and making sure people are discharged from hospital as soon as they are ready.

She said experts from across the health service were discussing how to improve care, especially for the growing number of elderly patients, in time for the winter.


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  • rate this

    Comment number 160.

    If people stopped going to A&E for extremely minor issues such as insect bites (I am not joking) then the staff would have more time for the more serious issues. Simply put a sign giving the ‘waiting time at the moment is..’ would dissuade the time wasters.

  • rate this

    Comment number 159.

    Ok, so 3 of my 4 comments have been removed.
    Lets try again..Britain is a tiny little island, with TOO many people on it

    You will find over population occurs in countries further down the economic scale in counties with large, poor rural populations - whereas technologically advanced nations such as Britain produce much less children.

  • rate this

    Comment number 158.

    Chuck all the alcoholics and drug addicts out and A&E departments might cope better. They are in there so often they are on first name terms with the staff!

  • rate this

    Comment number 157.


    "The triage nurse should be sending the non-urgent cases home".

    That might involved a long journey in many cases

  • rate this

    Comment number 156.

    The blame is put on the A&E when it isn't their fault. A lot of this is bed blocking by other departments...or issues with GP appointments before becoming an emergency.
    The NHS needs to look at the wider picture and support the excellent job the A&E staff do.

  • rate this

    Comment number 155.

    If there is a crisis in A&E, or any other part of the NHS for that matter it is from the constant meddling (aka "reforms") by career politicians. Their sole objectives political gain and (eyeing up creeping privatisation) financial gain for their supporters (aka paymasters) and themselves (via their "outside interests").

    About time it stopped and patients (not "customers") put first and always.

  • Comment number 154.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 153.

    146.Vicki - "Three issues: Too many managers, ............"




  • rate this

    Comment number 152.

    The problem is with the whole of the NHS, not just with A&E.
    There does however appear to be a very distinct failure to educate the general public about what purposes hospital A&E departments were intended to serve.
    A&E stands for Accident & Emergency. It was for example, never intended to be a stand in for G.P.'s.
    Now for the bad news: This country is falling apart at the seams.....

  • rate this

    Comment number 151.

    Medical staff is not the problem, its layers of Managers who run the hospitals, their fat cat salaries/bonuses. With increases in the population & closing down of hospitals no wonder there is a crisis. Pity the poor staff who have to cope with idiotic targets/paperwork. Dont know about compassion amongst the nursing staff what about a dose of this for the Department of Health.

  • rate this

    Comment number 150.

    A & E departments would run better if people didn't turn up for things that are neither Accident nor Emergency-the clue is in the title folks. A lot of A & E time recently has been taken up by people in the sun without a hat or sunscreen.....wake-up people and take some responsibility for your lives.

  • rate this

    Comment number 149.

    After heaping praise on the private hospital where the royal baby was born, it is now time to slag off the NHS.

  • rate this

    Comment number 148.

    I cant see my GP as you have to ring between 8 and half past and the phone is either always engaged or I am asleep so I dont even bother anymore I just go to A n E and they sort me out although you often have to wait which is irritating!!

    The nurses however are very hard working and although they are rushed they do a very good job, One even massaged my sprained ankle last week!

  • rate this

    Comment number 147.

    A&E in general is quite good but in my experience the majority of staff are agency, which apart from being very expensive is usually a problem with communication between them and the permanent staff. They are slow, literally shuffling between beds at an extraordinary slow pace (not like ER) and sometime not being able to speak English, which can cause a lot of problems.

  • rate this

    Comment number 146.

    Three issues: Too many managers, not enough workers; managers not running their departments effectively and the Government constantly chucking out negative spin until the only thing we can do is privatise (apparently) - when that day comes those of us who earn a national average or below average working wage are well and truly stuffed. I take my hats off to the doctors and nurses of A&E.

  • rate this

    Comment number 145.

    67 mobass,94 pete,both of you speak common sense & i agree whole heartedly with you both,sadly we now live in an americanised sue culture brought about by nanny state regulations and eu interference,until that is sorted out there will be little hope for improvement,it is a sad,sad state of affairs

  • rate this

    Comment number 144.

    I used to believe in the NHS. But that was when people didn't have the sense of entitlement they have today.

    The NHS - like the welfare system - was designed to take care of Britain's population after World War II. Back then it was just over 43 million. Now we're at 61+ million.

    Too many people want it. Perhaps Labour didn't think of the consequences of letting all these immigrants in.

  • rate this

    Comment number 143.

    Baza - would you like to show me a GP who earns £110K? The only way they do this is by managing their practice well as a business as well as treating patients - doesn't seem a lot of money for a highly pressured, responsible job that takes 12 hours a day.

  • rate this

    Comment number 142.

    Its not the nhs thats the prob its the gov that wants us to be run like South Africa and the USA.

  • rate this

    Comment number 141.

    Would you rather a) go to A and E and wait or b) get an out of hours home GP visit
    If it can be dealt with by a GP, it can probably wait until morning. I certainly wouldn't go to A&E and risk the lives of those in genuine peril because of a xenophobic phobia of German doctors.
    The system is failing because of the selfishness of people like you. Hang your head in shame.


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