MPs call for new measures to relieve ‘unprecedented’ A&E pressures over winter

Urgent action is needed to allow the NHS to cope with winter pressures on A&E departments, including the need to address the severe underfunding of adult social care, the Health Select Committee has stated in a new report.

The cross-party committee of MPs noted that hospitals were able to cope in the winter of 2015-16 because the weather was mild and the flu vaccine worked. But leaders of acute trusts warned that they were expecting a “substantially more difficult” winter this year, since they were working from a lower performance base.

A&E waiting times are currently at a record high. The most recent figures revealed that 91% of patients were admitted, transferred or discharged within four hours against a 95% target, leading to fears that pressures once only seen over winter are now occurring all year round.

Dr Sarah Wollaston MP, chair of the Health Committee, said: “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.”

The report said the government needed to provide additional social care funding, as one of the key causes of pressures on hospitals was a lack of social care provision, with some trusts establishing domiciliary care services to ensure they could get patients out of hospital.

“We believe that adult social care is underfunded and this is having an impact on the NHS,” it added. “The performance of the NHS and social care cannot be viewed in isolation.”

The committee stated that adequate funding of social care and appropriate development of the social care workforce are “worthy objectives in their own right, but the urgency of action on those two objectives is thrown into even sharper relief in the context of their contribution to the improved performance of the urgent and emergency care system”.

The MPs added the government should carry out an urgent review of the state of social care and its impact upon the NHS and vulnerable service users.

However, the committee expressed doubts about other service reforms. It asked for further evidence to support the government’s assertion that extended GP opening hours would relieve the pressure on A&Es, and said further research was needed to understand the effects of proposed models of co-location of primary care with emergency departments. It also warned that co-locating services would not be suitable for trusts with limited resources and capacity, or those located in rural areas.

Responding to the report, health minister Philip Dunne argued the NHS is better prepared for winter than ever before, with plans in place to help hospitals cope with additional demand.

“The NHS is performing well despite the pressure of an ageing population, with nine out of 10 people seen in A&E within four hours,” he added.

"Crucially, we are ensuring the money available to local authorities for social care will rise in the coming years – by up to £3.5bn extra in 2020. We are investing £10bn to fund the NHS's own plan for the future to reduce pressure on hospitals, and will have spent billions on capital projects by 2020.”

Infrastructure funding and tariff reforms

The committee said that pressure on beds could not be solved by just introducing more ‘step-up/step-down’ community rehabilitation beds.

Instead, it was “essential” that the government reviewed the real-terms cuts to NHS capital funding in the Spending Review, and ensured hospitals had funding to provide enough infrastructure to meet the performance targets.

The MPs said the first step will be an assessment of the infrastructure investment required to ensure that type 1 emergency departments are fit for purpose, which should be completed through the STP process.

The committee did not recommend ring-fencing winter resilience funding for CCGs, but said that NHS Improvement and NHS England should ensure “transparency” about which funding trusts and CCGs direct to winter pressures.

Furthermore, it called for the Department of Health to set out a clear timetable for “long overdue” tariff reform, to ensure funding to ambulance and hospital trusts and community services helped encourage prevention, facilitate early intervention, limit the escalation of morbidity and ensure that patients were seen by the most appropriate professional at the right time and in the right place.

Another recommendation was for NHS England to address the “unacceptable” variation in delays in patient handover from ambulances.

The report stopped short of supporting calls to abolish the four-hour waiting time target, and said that failure to meet the target “should be regarded as a matter of patient safety rather than a failure to meet a bureaucratic objective”.

It also suggested developing standards of performance for the wider health and social care system should be developed, and performance targets for ambulance trusts should be reformed to make it easier for ambulances to treat patients out of hospital.

Nigel Edwards, chief executive of the Nuffield Trust, said: “The NHS is going into its toughest winter yet with the odds stacked against it.

“Demand for healthcare is on the rise, funding for both health and social care is being squeezed and A&E departments are missing their targets. The committee is right to say that urgent action is required to address this.”

He added that “small changes” to how patients are handled could really help, but added: “Overall, however, the government must heed their calls for more investment in health and social care to ensure that the NHS is able to cope with the winter months ahead.”

Professor Jane Dacre, president of the Royal College of Physicians, said: “The Health Committee has clearly taken on board the evidence from health organisations including the RCP that the problems facing the NHS are complex and reflect the wider pressures on the NHS and social care. 

She added that underfunding of social care, staffing shortages, and lack of hospital beds all contribute to delayed transfers of care which place increasing pressures on A&E departments.

“We agree with the committee that there should be an increase in social care funding, which will help to alleviate the situation, but we also need a sustained increase for the whole of the NHS,” said Dacre.

(Image c. Andrew Matthews from PA Archive)

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