The crisis in A&E cannot be fixed by a magic bullet, but a proper assessment of demand is critical to providing an effective service, Stephen Dorrell, Chair of the Health Select Committee and ex Secretary of State for Health, told delegates at a conference in London yesterday.

Addressing the Westminster Health Forum, Dorrell said "it is not possible to manage a service effectively over a number of years without understanding the demand", and called for a root cause analysis of what is driving patients into A&E, to help prevent unnecessary arrivals.

"Patients presenting at A&E are a lost opportunity", he noted, arguing that whole patient pathways must therefore be picked apart to determine any weak points that might have addressed healthcare issues earlier.

Dorrell also said there needs to be a much greater engagement with satellite factions such as pharmacy, housing managers and social workers, to help ensure efficient care and resolved demand.

From the hospital perspective, improving A&E depends on greater honesty, a better understanding of where emergency cases needs to go, service reorganisation to better meet need, and, equally important, efficient discharge at the end, he said.

Elsewhere, MP Paul Burstow, former Minster of State for Care Services, voiced surprise that the issue of mental health had not been given priority in the first part of Sir Bruce Keogh's emergency care review.

A much greater focus on mental health is key to resolving some of the demand issues facing A&E, he said, citing evidence that 41% of mental health patients use A&E at least one year compared to 19% of those without mental illness, with 54% of the former group arrived at A&E in an ambulance versus 26% of the latter.

Also addressing the issue of demand on A&E services, Cliff Mann, president of the College of Emergency Medicine, said there had been a year-on-year increase in arrivals in most A&E departments.

But he slammed the notion that those people leaving A&E without intervention were there unnecessarily. Many people present to A&E with symptoms similar to that of serious illness, which need ruled out, so "the myth that just because you didn't need treatment you shouldn't have been there doesn't hold", he said.

Urgent care centres

Mann argues that there is "plenty of money in the system" but "we are throwing good money at bad", and, much like Keogh, he advocates the creation of more urgent care centres to handle those serious but not quite emergency cases to streamline care and boost efficiency. 

The College of Emergency Medicine itself recently unveiled a list of 10 priorities to help resolve the A&E crisis, central to which is expanding services to provide effective alternatives to A&E for patients without acute severe illness or injury seven days per week and at least 16 hours a day.

Also included are: avoiding 'exit block', which it says creates crowding and increases mortality; amending tariffs so acute trusts are not penalised by non-elective admissions, as "perverse incentives produce dysfunctional systems"; revising employment contracts to better recognise unsociable hours and the intensity of A&E; and ensuring that money is well spent.