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 520.

    518. RememberTianSquare

    Cheers mate & likewise.

    Am off to bed, laters ;)

  • rate this

    Comment number 519.

    I'm not "right-wing". Dismay indeed. I didn't change the subject, in fact I introduced it, agreed with you, and you still insulted me. I think you need to work on your debating skills, like getting some. Because you clearly only have 1 tool in the box: belittle - the tool of the scared.

  • rate this

    Comment number 518.

    # 514-although deleted, have a go at figuring out what my thoughts were at 516 about the poster in question, mate :))))) Ain't difficult is it ??:))
    The idea of privatising the NHS, as she is advocating, is as wild as so many of her ideas which have been seen on BBC Blogs for months and which are now ermmmmmmm "well-known".
    BTW, thx for ure good posts,sprout , which I often see and agree with.

  • rate this

    Comment number 517.

    516. RememberTianSquare

    Ta for the advice bud

  • Comment number 516.

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

  • rate this

    Comment number 515.

    The NHS needs a radical change in all departments, the government needs to lead this. Make the NHS except from any VAT, this will save them from 20% on all purchases , Bring those responsible for signing up to the PFI deals and re-negotiate these deals. This is bleeding the NHS dry! Stop outsourcing, bring everything back in house. Invest in local people!, start apprenticeship schemes for locals

  • rate this

    Comment number 514.

    511. Sally the contrarian

    Sorry, but many of your points definitely require dismay to be shown. You supply nothing by way of proof in your right wing rantings.. based on nothing more than your odd opinions yet you ask proof from others? (which you conveniently change subject when supplied)

    There used to be a saying in the UK "I'm alright Jack" - did no-one tell you we stopped using it years ago?

  • rate this

    Comment number 513.

    So if I'm in the US and I pay my $16,000 (506) for several years and I don't use a doctor, which fortunately for me most years I haven't.....where's all my money gone??.....mmmm I think that I can guess.

  • rate this

    Comment number 512.

    508. Tio Terry

    "About time individuals took responsibility for their own futures, including pensioners."

    A tory staple

    Not everyone gets the chance or has the capability. There are always accidents/unforeseen. In US no1 cause bankruptcy & homelessness -healthcare bills

    We should be proud that we help those in need

    "A nation's greatness is measured by how it treats its weakest members." Gandhi

  • rate this

    Comment number 511.

    Not enough space to make point AND properly express dismay ;)
    Then don't.

    "But.. by your own logic them smoking is a good thing.. as they are shortening their life and will so claim alot less benefits?"
    Nope, that's your logic. I said we should pay for ourselves. It matters not if they smoke or live to 100 to me - I'm not forced to pay for them one way or the other.

  • rate this

    Comment number 510.

    507. That may be true regarding the number of people Britain 'was designed for' I have some sympathy but as only around 7m were born abroad what are we going to do with the rest of the excess 13m-23m?

  • rate this

    Comment number 509.

    497. Sally the contrarian

    Not enough space to make point AND properly express dismay ;)

    "X has been a net recipient of benefits their whole life (little to no employment nor taxes paid). When they become ill from their smoking habit, who pays for them, again?We all do"

    But.. by your own logic them smoking is a good thing.. as they are shortening their life and will so claim alot less benefits?

  • rate this

    Comment number 508.

    How do you think the cost is born today? How do you think the unemployed are financed for their health benefits? Thats right, all us working tax payers foot the bill. About time individuals took responsibility for their own futures, including pensioners. Time to take control of your own life.

  • rate this

    Comment number 507.

    A&E is in a mess now---and will be breaking in the Winter.
    How have we allowed this to happen? I believe we have a population of over 60m in an island designed for about 30-40m at most, and we are rapidly sinking into the North Sea.It's not just the NHS that can't cope:it's so many agencies etc.
    NB --S-Alert on this site !! Post #473 is a joke coming from you dearie.....why do you come here ??

  • rate this

    Comment number 506.

    498. Tio Terry

    "Abolish Employees NI but make it a legal requirement for individuals to have personal Health Insurance"

    & what of the unemployed? Or pensioners or those deemed High risk?

    You know the "average" cost of family health insurance in the US is almost $16,000?

    How would they afford it? Or do they not matter? Even if you are in good health now you will be a pensioner one day too?

  • rate this

    Comment number 505.

    Instead of stuffing doctors mouths with gold, how about we just train LOTS of Doctors? We hear many top students fail to get in due to limited places & problems faced in gaining experience if they dont have a friend in nhs, so lets just train more, increase talent pool and reduce the wage bill. It might also cause more doctors to take positions in less glamorous locations / cover unsocial hours.

  • rate this

    Comment number 504.

    The selling off of the nhs to private mega corps will come back to bite the tories at the next election. It will make private healthcare more expensive for the rich too, as without the nhs private healthcare will have to buy machines and fund research themselves and provide their own 24/7 A and E. When that happens we will get the nhs back again- when the rich are priced out of healthcare.

  • rate this

    Comment number 503.

    500. Good job about the immigration as nearly 40% of the doctors practising in the UK were trained overseas.

  • rate this

    Comment number 502.

    495. Tio Terry

    "No, every one (legal) has an NI number, credit it with £120, debit every visit."

    Wouldnt this just benefit criminals supplying your valid NI details or forged documents?

    Surely it would just mean even more paperwork, nurses spending time checking your details/credit or wasting time verifying who you are when you have forgotten your details - rather than actually treating you?

  • rate this

    Comment number 501.

    Ed Milliband stand up please and show some guts. Pledge to reverse NHS privatisation under Cameron - this is what people want you to do. What is stopping you?


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