Shortages of senior staff, disorganised local services and the botched launch of the NHS 111 phone line mean Britain’s A&E services would struggle to cope with a major flu outbreak this winter, MPs have warned.
In a damning report on urgent care provision in the NHS, the House of Commons Health Select Committee found that emergency services were becoming “unsustainable” as demand increased.
Less than in one in five A&E wards had enough consultants on duty and new trainees were turning away from emergency care because of the demands, the report said. The health service was “flying blind” with senior figures at odds over the scale and cause of the increased pressures on A&E, and local health leaders were unsure which organisation or health board had overall responsibility for how GPs, A&Es and social care should link up.
MPs said that urgent action was needed to get patients to see senior doctors more quickly, adding that each local area must have an urgent care plan in place by the end of September, before pressures increase again over the winter.
Committee member Barbara Keeley MP said that major improvements to consultant cover, 111 and social care provision needed to be made urgently.
Pointing out that last winter, which saw nine-year highs in A&E admissions, had passed without a “pandemic” she said: “It doesn’t look as if we’re prepared for anything like that.”
As MPs published their report, it was announced that NHS Foundation Trusts will take on 10,000 more clinical staff next year, after an unprecedented number of trusts missed waiting time targets at A&E last year.
Stephen Dorrell MP, the committee chair, said that it was “extraordinary” that only 17 per cent of A&E departments could guarantee consultant cover for a minimum of 16 hours a day during the working week, with figures even lower at weekends.
“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,” he said.
The plans to recruit more than 1,100 new permanent consultants, 1,200 junior doctors and 4,100 nurses, along with additional healthcare assistants, paramedics, social care and theatre staff, will cost an estimated £500m.
Although trusts are under ever-increasing financial pressure, with 5 per cent of NHS staff being cut over the next three years, most of these losses are expected to be among clerical and agency staff.
In their report, MPs were scathing in their assessment of the new NHS 111 phone number which they said had not only failed to reduce pressure on casualty wards, but had actually encouraged patients to see A&E as their “first port of call” to avoid a “laborious triage process” and call handlers who were not trained clinicians.
The MPs’ report comes ahead of another review into emergency care by the NHS’ medical director Sir Bruce Keogh. Mr Dorrell said that he hoped Sir Bruce would take their recommendations into account.
“The A&E department is the safety valve,” he said. “When demand for care is not met elsewhere, people go to A&E because they know the door is always open. It is vital to ensure that the needs of patients who don’t need to be at A&E are properly met elsewhere so that those who do need to be there receive prompt and high quality care.”
Health Minister Lord Howe said the Government’s first focus in response to increased pressures on A&E was on “joining up services” to provide better care for the elderly. The ageing population has led to an increasing the number of patients with complex care needs reporting to A&E wards across the country.
"We know A&E departments are under increasing pressure and it is testament to the hard work and commitment of NHS staff that there has been a marked and sustained improvement in A&E waiting times,” Lord Howe said.
However, on the same day, new figures revealed that nursing numbers had dropped by nearly 1,000 in just one month between March and April this year, leading Labour to accuse the Government of “ignoring warnings” on understaffing. The number of full time nursing, midwifery and health visiting staff in the NHS now stands at 307,939 – 3,000 lower than when the Coalition government took office in May 2010.
The number of hospital and community doctors also fell by more than 900 in April.
Shadow health secretary Andy Burnham said: "The NHS simply cannot continue to take nursing cuts on this scale and maintain standards of patient care. Job losses on this scale are dangerous.”
Next year’s investment in new clinical staff comes amid a broader cut to the NHS workforce of 5 per cent over three years, which the Government claims will be found predominately among clerical and agency staff.