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 380.

    You are looking at the end of the NHS, because we have listened and taken in what David Cameron has said a man well known for his lies and greed, and the urgent need to privatise everything this is what he is sneekly doing with the NHS, he will take care of the NHS on his watch so much so there will be no NHS never again on anyone elses watch and this is what you all voted for !

  • rate this

    Comment number 379.

    Labour screw most things up in this country, they are just ignorant fools, same as their supporters....

  • rate this

    Comment number 378.

    "It would certainly work out cheaper for many who pay thousands in tax but never need to see a GP or go into hospital like myself"
    Old saying, 'never say never' !

    The tax that you have paid has not been an 'insurance policy' for yourself. It has been used to pay for the actual treatment of the previous generation. It's the next generations taxes that will pay for your care.

  • rate this

    Comment number 377.

    The reality of the country’s fiscal situation and the changing demographics is that the amount of money available to the NHS will not be able to increase, but probably decrease in real terms, over the coming years.
    This is the reality the NHS has to face. It has to become more efficient with the money given to it, like it or not
    This will involve more use of the private sector

  • rate this

    Comment number 376.

    Why go to A&E? Doctors not always open, NHS 111 not trusted (I don't), and if you're foreign Mr Cameron will hassle you for your share of £20 million unpaid, while Formula 1 flies past his window with over £20 million unpaid.

  • rate this

    Comment number 375.

    Without the fast work and specialised knowledge of the A&E department at St Richards in Chichester I wouldn't be sitting contributing to this forum.I was admitted on the 27th March with an Abdominal Aortic Aneurism.Without the speedy diagnoses and the immediate transfer to the hospital in Brighton it would have been goodbye California.Get rid of excess managers, increase medics with the expertise.

  • rate this

    Comment number 374.

    I was in A&E a few years ago...it seems to out of sync...the blood test came
    last ...this test takes hours. to analyse....so it should be the first to be done..

  • rate this

    Comment number 373.

    this may have something to do with the number of people in receipt of benefits. Kids, disabled, unemployed, pregnant, over 60 = free prescriptions. so why go to the chemist & pay for cough/cold remedy when you can get a prescription for free? this is why GPs are clogged up & others can't get an appointment & end up at A&E.
    A fee = to a prescriptions charge to see a GP would counter this.

  • rate this

    Comment number 372.

    The Tories are systematically undermining the NHS with the aim of privatising it. 50% of NHS beds can be used by private patients, blood banks have been sold to a US company, the national network is being dismantled to a fragmented service.

  • rate this

    Comment number 371.

    I have a simple plan that will cut A&E waiting times. Based on what I have seen whenever I have been unlucky enough to have to visit A&E, send home anyone who is there purely because they are drunk or stoned. You'd empty the place in no time.

  • rate this

    Comment number 370.

    The Best I ever saw a hospital was in 1986, and the nurses where more dedicated to their work nowadays I have seen a young child dye in the A&E department given calpol because he was crying in pain they could not find anything wrong with him they did not notice the poor 2 year old had a twisted gut something you think the nurses would have noticed when the childs sick was brown? lack of knowledge

  • rate this

    Comment number 369.

    We’ve basically ended up with what we deserve. We stood back and let successive governments run the NHS into the ground with their constant interference. It is no surprise that the areas where politicians interfere the most; education, police, health and the economy, are all the areas where we do the worst. Politicians need to leave people to do their jobs. They are not up to doing their own.

  • rate this

    Comment number 368.

    With the desertion of Leah Totton from A&E - to chase fame & money - did things just get better? Or worse?

  • rate this

    Comment number 367.

    283 Ketchup

    I really think in this day and age we should have the ability to realise what is an emergency and was is not. Of course I do realise there may be some grey areas but no where near the volume that there currently is.
    I read numerous postings on these forums saying " Drs don't no what they are doing" and "the Ambulance should have taken me to hospital". But we still need advice?????

  • rate this

    Comment number 366.

    It's funny how out of hours care has imploded since they killed off NHS Direct. They killed an established service with trained nurses that had been easing pressure on urgent care services since 1997, Replaced it with a feeble clone staffed by min wage call centre staff, et voila! More serious incidents in 6 mo. than NHSD had in YEARS. And they wonder why people are clogging up A+E instead?

  • rate this

    Comment number 365.

    Well I never. And I thought it was all Labours fault because the NHS is safe in Dave hands.

    Ah well, A&E won't matter that much, Or to put it in Crosby speak "just cleaning the barnacles off the bottom"

  • rate this

    Comment number 364.

    MP's have warned,

    But NHS deny this and say plans in place as per usual. Are these the same MPs who have interests in Private Healthcare companies who will stop at nothing to privatise OUR NHS.

    Sick of these rubbish headlines, who cares what MPs think, they are all in it together

  • rate this

    Comment number 363.

    352. shaun

    "It would certainly work out cheaper for many who pay thousands in tax but never need to see a GP or go into hospital like myself"

    You need to replace the word "Certainly" with "Currently"

    I'm sure people benefitting from the system would rather swap to paying & not needing it.

    And I'd imagine those currently contributing more would squeal the loudest if then roles were reversed?

  • rate this

    Comment number 362.

    Two near death experiences for a 3 year old and adult daughter three years apart at same hospital, both entirely down to lack of care, not pre existing conditions.

    In both cases last minute manic panic saved both lives but is should not have got to that. Without the help of the public spotting the problem in the A&E queue, there certainly would have been one fatality.

    Staff shortages!!

  • rate this

    Comment number 361.


    I always thought A&E meant Accident and Emergency, not Anyone & Everything."

    But in the US model, which we are being forced towards, it does indeed mean "Anyone & Everything", though it's called ER - it's where those who cannot afford/get medical cover go for anything, including everything we go to our GP for, and run up a bill they will struggle to pay.


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