Growing demand on A&E departments will make them unsustainable if effective action is not taken quickly to relieve the pressures on them, MPs warn.
“The A&E department is the safety valve – when demand for care is not met elsewhere, people go to A&E because the know the door is always open,” said MP Stephen Dorrell MP, chair of the House of Commons Health Committee, reporting on the Committee’s inquiry into emergency services and care.
“It is vital to ensure that the needs of patients who don’t need to be at A&E are properly met elsewhere,” he said.
Sir Bruce Keogh, medical director of NHS England, is currently conducting his own review of urgent and emergency care. “We hope that our recommendations will be reflected in his findings,” say the MPs.
They say they are “unconvinced” that the plans presented to them are an adequate response to the problems facing the system. Witnesses disagreed about the nature of demand for urgent and emergency care, they say, and warn that the system is “flying blind,” without adequate information about the nature of the demand being placed upon it.
Even if the information was adequate, it is unclear who is responsible for using it. The MPs heard that this is the responsibility of Urgent Care Board (UCBs), but witnesses were unclear about how many UCBs are planned, what powers they will have and how they will relate to other commissioning boards.
The MPs also call for the provision of urgent and emergency care to be restructured if patient need is to be met longer-term, and this includes a more active role for primary care in dealing with urgent cases. NHS England, as commissioner of GP services, needs to actively seek innovative proposals for community-based urgent care services, they say.
And the MPs are concerned at low staffing levels in emergency departments. They consider it “extraordinary” that consultant coverage for a minimum of 16 hours a day during the working week is guaranteed in only 17% of designated A&E departments. The figure is even lower at weekends and there are high vacancy rates for senior staff and consultants.
“We know that early assessment by a senior clinician can improve outcomes and accelerate a patient’s progress through hospital, but for this to happen there must be sufficient numbers of senior staff in the emergency department,” they say.
