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 220.

    the failure of any organisation historically can be partly blamed on adopting a 'throw bodies at it' approach. the opposite of this is evident in the nhs. if you apply swingeing cuts which leave 1 person being expected to do the jobs of 2 people then you are inviting a shortfall in quality or quantity. economic theory suggests you can have quality, quantity or cost. you can't have all three.

  • rate this

    Comment number 219.


    " - how are GPs to blame? If anything its the patients that are to blame for making unnecessary appts and taking too long over them"

    And its GPs who say things like that deter the genuine people from seeking the help they need and deserve.

  • rate this

    Comment number 218.

    These are all problems caused by Govt ministers creating a tick-box culture, GPs rationing appts causing bottlenecks in our services while minsters close perfectly good hospitals creating mayhem elsewhere in services. Will ministers of all political shades leave the NHS alone now!!

  • rate this

    Comment number 217.

    Oxygen Chambers even help drunks with hangovers..I'll keep banging on about it because it should be available for everyone. The more people who put my comments down shows how ignorant you are an shows you deserve the health you get, It's more effective treatment till you think about it I'll keep saying it.

  • rate this

    Comment number 216.


    Yet more opinions IGNORANT of the FACTS.....

    ....get yourself EDUCATED in what does/does not constitute a VALID sample size/demographic spread in statistical analysis......

    ...or just keep gobbing off your prejudices regardless of the FACTS.....

  • rate this

    Comment number 215.

    a few weeks back i broke a bone in my hand while working,this did not become apparent for some hrs,only after discovering i could no longer grip i eventually went to a&e,was seen quickly,x rayed and strapped up.on that same evening there were 5 drunks,1 nutter and a sprained ankle in,along with an array of serious injuries,breaks,lacerations etc,the time wasters amtd to app 30% sat in waiting rm

  • rate this

    Comment number 214.

    When I lived in the USA I paid less tax than the UK, I used the savings plus or minus a little bit to buy health insurance. Boy could you tell there was competition working in the private health institutions! My money funded an entire insurance industry AND an entire first class health industry yet cost about the same as UK tax wise. Just get on with it and let us opt out please.

  • rate this

    Comment number 213.

    Accident and Emergency - not 'Anything and Everything'. It does make sense - but also it does appear that misuse of A&E is, in many cases, due to the time it takes to get an appointment with a GPs surgery (do people still have a GP? At mine, you just see whoever has a spot). Also, A&E is open when you're not at work (even in 2013, many employers don't like people taking time off to see a doctor!).

  • rate this

    Comment number 212.

    200 Pete

    I totally agree Pete.

    The trouble is if you mention that chap who you could have a pint with you get the P.C. brigade on here bashing you as you don't agree with their blinkered opinion.

  • rate this

    Comment number 211.

    The mental health services are clearly failing to adequately medicate or restrain their clientele.

    Actually we generally try to cure, manage and help them. Which backwater were you thinking of? And as for their impact on A&E, we often can't get support at the patient's home in a crisis and have little choice but to refer on to A&E. This is a much wider issue than A&E or even the NHS.

  • rate this

    Comment number 210.

    The NHS in total mess
    Hopefully when Jeremy hunt takes over the running of the NHS he will be able to put right the total mess make by the idiots who are running it at the moment
    By the way who is running at the moment?
    I am so glad the Tories have only made saving to the NHS and not cuts

  • rate this

    Comment number 209.

    All hospitals have problems.%0 years ago I went to my local casualty dept,was diagnosed with a broken wrist ,plastered ,and back on the street in 1 hour.Nowadays,you give your deals ,wait for the raffle to be drawn ,then be treated.
    Sadly,it is no better if taken in by ambulance. Please never be ill at night.there are no doctors on to give instructions,then there are no beds.

  • rate this

    Comment number 208.


    "No more drunks to be taken to A&E"

    I would charge them the full cost. The cost of the ambulance and the cost of their treatment.


    And how would I know my ankles is sprained and not broken?

  • rate this

    Comment number 207.

    The A & E staff faced a difficult job before the cuts that are being made.

    The obstructions caused further down the line by less wards, less staff and those wards themselves being clogged up by bed blocking as a result of the cuts to social care.

    Then there's the pressure from sick people not being able to get a GP appointment for 7 days

    The system is creaking and one crisis away from collapse

  • rate this

    Comment number 206.

    @190. Farlington Bob
    Just get up and go to the GP if you are REALLY ill"


    Trust me my friend I have tried. I once rang for over 20 minutes to my local GP. When I eventually got through it was past 8.30 so no appointment. So its not worth even trying any more, much better to just get treated and job done! The nurse also advised me to GP and I also had to explain to them my situation!

  • rate this

    Comment number 205.


    So the second report (for example) interviewed approx. 3857 doctors and patients (assuming a 'finger in the wind' 30:70 split then 2,699 patients) were interviewed - hardly a representative sample of each country?

  • rate this

    Comment number 204.

    When they can find a solution for why people dont want to become doctors they may be able to solve this. We have some of the highest paid medical staff in the world yet there still are not enough people without importing from abroad (which as we've seen has its own problems). People go to A&E when they dont need to and when they can't get to their GP which comes full circle.

  • rate this

    Comment number 203.

    Hospital A&E units have only themselves to blame for the state they are in, because they persist in handling trivial complaints and injuries, such as cuts, bruises and sprained ankles, that patients can and should see to themselves.

    By turning malingerers and time-wasters away, and focusing on injuries that really need their attention, the pressures they're under would disappear rapidly.

  • Comment number 202.

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

  • rate this

    Comment number 201.

    Run down the NHS, destroy public confidence, then sell it off.

    That is the only explanation I can come up with for the ongoing gross mismanagement of the NHS stemming from a string of Health Ministers (and I include the last Labour lot!).

    What other explanation could there be for putting Jeremy "Sky lackey" Hunt in the position of Health Minister?


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