The government urgently needs to address underfunding of adult social care to alleviate growing pressures on A&E departments, or people will continue to face avoidable admission and delayed discharge from hospital, the Health Committee has concluded.
Last year, only 88 percent of patients were admitted, transferred or discharged within four hours at major emergency departments across the country, falling well short of the 95 percent standard and reflecting a widespread decline in performance across the service.
The figure "masks great variation in the performance of trusts which cannot be explained by financial challenge, demographics and demand alone", according to the Health Committee's report on winter planning for A&E departments.
It says some trusts are supporting patient flow out of their hospitals by creating their own services that provide social care in order to address the problem of delayed discharges, but argues that these initiatives have "a limited scope when trusts are themselves under such financial pressure".
"Accident and Emergency departments in England are managing unprecedented levels of demand. The pressures are now continuing year round without the traditional respite over the summer months as departments try to cope with increasing numbers of patients with complex needs," noted Dr Sarah Wollaston MP, Chair of the Health Committee.
The response, finds the report, must focus both on managing the patient's journey through the hospital and on addressing the increasingly inadequate provision of adult social care services available to enable safe discharge.
The report concludes that "additional investment in community step-up/step-down beds and adult social care is essential to addressing the widespread pressures on A&E," noting that "emergency departments do not exist in isolation and their performance will be supported by investing in services that can prevent admission via A&E and allow swift and safe discharge from hospital".
Address underfunding
"We call on the Government urgently to address the underfunding of adult social care and to evaluate fully the wider impact of this underfunding on the NHS".
The Royal College of Emergency Medicine has welcomed the findings.
"For some time we have warned about the effect that cuts to social care is having on emergency department performance and we have seen the situation worsen each year," said president of the College, Dr Tajek Hassan.
"Whereas traditionally winter would be a busy period, the system would always, to an extent, recover. We are now failing to see recovery with almost year round pressure resulting in delays and overcrowding. This overcrowding is due to exit block which we know can be fatal to patients".
The College also estimates that the country is short of at least 2000 A&E doctors. "At present there is only one consultant for every 11,000 attendances, and yet we spend £703m on locums to patch the system rather than plan well for the future," argues Dr Hassan.
"We cannot continue to resource emergency departments for the demand that is hoped for instead of the demand that we actually face, which is why we are calling for an A&E transformation fund and for the correct funding of social care."
