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Emergency care funding ‘not reaching A&E departments’, say senior clinicians

Less than 1% of the £700m that was allocated by the government for emergency care this winter ended up directly in A&E departments, according to a survey of senior clinicians in the NHS.

The Department of Health described the figures as “nonsense”.

The report, by the Royal College of Emergency Medicine (RCEM), asked clinicians what percentage of the funding had been allocated to their emergency department (ED).

Many senior clinicians (35 clinical leads) stated that they did not know what percentage of funding, if any, had been allocated to their ED and a further 23 said that they had received none of it. This demonstrates that over half of EDs in England were not directly supported at all, contrary to the anticipated purpose of the funding, states RCEM.

Based on respondent answers, it was estimated that only £6.7m was directly spent on ED from the £700m pot, and there were mixed reviews about how this money had been spent. Overall clinicians felt that the funding was “not spent in an efficient way” that would lead to long-term improvements in the delivery of urgent and emergency care services.

The survey of clinical leaders in emergency medicine across the UK was responded to by 142 clinical leaders in January 2015, representing almost two-thirds of the UK emergency departments.

However, the Department of Health (DH) and NHS England reject the figures.

Dr Clifford Mann, president of RCEM, said: “Throughout the past 18 months we have been working closely with the DH on the challenges facing A&Es over the winter months. It is so disappointing that our survey shows that the significant investment the government made to tackle the winter pressures has not reached the A&Es it was supposed to help.

“This report is an indictment of current decision making and investment in acute and emergency care. Patients and frontline staff deserve better and will be incredulous at the failure to adopt best practice and squander money on admission avoidance schemes that have self-evidently failed.”

The ‘Ignoring the Prescription’ report, also asked consultants about whether 13 recommendations drawn up by the RCEM, the Royal College of Surgeons, the Royal College of Physicians, and the Royal College of Paediatrics and Child Health last year had been put into effect in their hospital.

Respondents noted that none of the recommendations had been fully implemented, and that less than a third of EDs have an appropriate skill mix and workforce in place to deal with their patient volumes and case-mix.

On top of this, almost 90% of EDs do not have adequate IT infrastructures in place to provide reliable data of their urgent and emergency care system and two thirds of EDs report inadequate integration with telephone triage services properly supported by trained clinicians.

Dr Stephanie Smith, chair of the Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings, said: “The pressures on urgent and emergency care are daily concerns for healthcare professionals working there day to day and for many patients using the services. It is disappointing to see that many of the recommendations designed to ease the pressures on urgent care as set out in Prescribing the Remedy have not been acted upon – and stories of winter pressures again dominate the headlines.”

A Department of Health spokeswoman told NHE: “These figures are nonsense: acute hospitals that run A&Es are receiving over 60% of the record £700m winter funding. This has paid for 700 more doctors, nearly 4,500 more nurses and 5,000 more beds both inside and outside of hospitals to relieve pressure across the whole of the NHS and prevent people going to hospital in the first place.”

An NHS England spokesman added that hospitals report they are spending over £400m on extra services this winter in A&E and for their emergency patients.

RCEM had recommended that the co-location of primary care should be provided at every ED to ensure patients requiring urgent primary care are assessed and managed appropriately.

However, fewer than half of hospitals/commissioners (43%) have fully implemented this service, and a third have no service at all.

But NHS England added: “Most hospitals say they have brought in co-located GP services [43% said this recommendation had been implemented fully, while 24% said it had been partially] as the report suggests.

“What’s more, most people recognise that as well as spending in A&E departments, patients also need well-funded primary, community and social care to help them stay out of hospital in the first place.”

(Image source: Rui Vieira/PA Wire)

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