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 320.

    So the orchestrated campaign of bad news about the NHS continues. When will the British public see through the government's lies and spin, aimed at softening us up for for privatisation (helped by a disguised cuts programme and a re-organisation designed to throw the system into chaos). Hunt is on record as wanting to move to a USA style helath insurance system and we are sleepwalking into it.

  • rate this

    Comment number 319.

    Lets give the budget for the NHS to the GPs...

    But the public can't get to see their GP they go to A&E instead...

    That's great the hospitals will go bankrupt....

    Bring on privatisation!

    Yours Faithfully AL, JH, DC.

  • rate this

    Comment number 318.

    Unfortunately a lot of people go to A&E instead of visiting their GP 1st. Visits to A&E cost a lot more for obvious reasons. Yes waiting times can be bad but they're doing their best. You don't want to start demanding better efficiencies in hospitals when quality of care could suffer. A lot of money could be saved by reducing the number of high ups in the NHS and spending money where it's needed.

  • rate this

    Comment number 317.

    312. Tanglewood

    "Why is my concern that others (and your numbers are a gross over-estimate) don't take responsibility for themselves?"

    its whats called being a human being

  • rate this

    Comment number 316.

    Why not have the same service that wills and kate got didn't see them using nhs why not we pay

  • rate this

    Comment number 315.

    Many people balming GP's.
    Just to let you know I rang my GP Surgery 08.15 today seen at 09.20. BP checked lesion on knee diagnosed QED. The wonders of the NHS and paid for through the tax and National Insurance I've paid since leaving school.

    Maybe those in Tory controlled NHS Trusts in the South East should ask their Councillors on local health boards whether they are representing them properly

  • rate this

    Comment number 314.

    The problem with A&E and the rest of the NHS is death by a thousand cuts and a thousand pieces of paper. The service is being systematically underfunded and undermined. Staffing numbers across all departments are now just a thin veneer of hard-working medics and clinicians. A massive bureaucracy exists to overwhelm the front-line with paper "solutions" when it is more medics that are really needed

  • rate this

    Comment number 313.

    The type of patients need to be looked at. I've thankfuly not had to attend A&E often however when there people are using it as a GP service e.g. someone turned up with a headache, someone looking for capol/paracetamol for free etc. They all had to be processed when they should be turned away.

  • rate this

    Comment number 312.

    #300: "Only if you have insurance and 45-57 million Americans didn't last year. Did they get to see their GP?"

    Why is my concern that others (and your numbers are a gross over-estimate) don't take responsibility for themselves?

  • rate this

    Comment number 311.

    NHS needs to ask everyone, patients, staff and management, what they want out of the system - How about an external panel, with representatives from all sections who are interested having a discussion.

    Far too important to be left in government hands.


    Especially BBC coverage.

  • rate this

    Comment number 310.

    "217. magictricks
    Oxygen Chambers even help drunks with hangovers."

    Maqking them drink a pint of water is a lot cheaper.

  • rate this

    Comment number 309.

    305. Cheddar Gorge.

    I didn't ask for a suppository, but thank you George.

  • rate this

    Comment number 308.

    This began Mrs Thatcher trying to run the hospitals like a family budget (she tried to run the whole country the same way). Her simplistic approach (squeeze as much as you can out of every asset) seemed to work for a while (since the new system took a long time to bite). So Blair (or rather Brown) carried on with it.

    But hospital depts should never be designed to run on more than 85% capacity

  • rate this

    Comment number 307.

    Mourn the death of the NHS. Succesive governments have played the public for fools and largely succeeded. There is going to be no relief. The very logic of cutting back on staff and facilities to improve services is living in a fool's paradise. Come straight. Better to pay thr bungling bankers and thr failing privatised services than the NHS.

  • rate this

    Comment number 306.


    "The whole culture, process, attitude was different in each"

    You learnt all this from one bad A+E experience, really?

    Can you name the two trusts involved or is it a secret. Thanks in advance.


    Only if you have insurance and 45-57 million Americans didn't last year. Did they get to see their GP?

  • rate this

    Comment number 305.

    Should I ever find myself trusting a tory ... I'd go along to the nearest acute mental health hospital and have myself sectioned.
    To be fair, on the other side we have Bliar and his "trust me" over the never found weapons of mass destruction. I think it's politicians generally we can't trust; they're all out to do what's best for themselves and screw Joe Public.

  • rate this

    Comment number 304.

    the real problem is that people go to the doctor for minor things such as a cold etc this clogs up the waiting rooms and creates the problem

  • rate this

    Comment number 303.

    294. Ignorance Is Bliss

    "the top 1000 wealthiest people in the country .. could pay the budget deficit and still have 30,000,000 each"

    Agree with the sentiment - but those figures are for the amount their wealth has INCREASED in the last 3 years

    The 1,000 uk richest have wealth of over £450 Billion (4 times the uk deficit) according to the telegraph - we are all in this together apparently

  • rate this

    Comment number 302.

    Not sure I know much about the NHS having always visited my Harley Street consultants. However I think some of my people may have used it when they fell over after a lower class drinking binge.

  • rate this

    Comment number 301.

    @293. toast

    "Never trust the Tories! "

    Should I ever find myself trusting a tory, any tory, it wouldn't be A&E I'd need.
    I'd go along to the nearest acute mental health hospital and have myself sectioned.


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