It’s a good report but we need a firm strategy for A&E too

They will need to do a lot of work to give patients the confidence to ring 111

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This is a very sensible report and it has the potential to deal with many of the issues in A&E, but it is worth remembering that quite a lot of the problems are actually symptoms of wider issues – how care is provided to frail, older people with complex medical conditions, and how to discharge these people from hospital in a more timely manner. It’s about the back door of the hospital as well as the front door.

The logic for two different levels of A&E is pretty unassailable. There are indeed a number of places that call themselves A&E departments, which aren’t really A&Es in the way most people understand them.

There is an argument for changing the name so as to be much clearer about what these wards provide. Make the system simpler, make it easier to navigate, make sure people can understand it. But the “A&E brand” is strong, and changes could be politically contentious.

The idea of enhancing phone services is a good one. If you can direct more people to phone their GP, the ambulance service or 111, then you can direct patients to the right place at an early stage.

It is unfortunate that 111 had a rocky start. There are quite a few examples around the world, including in Denmark, where people have managed to shift more patients with minor conditions on to phone services. But they will need to do a lot of work to give patients confidence that they will get a definitive answer from 111, given recent negative publicity.

But what’s really needed is a strategy alongside this. This includes reforms to primary care to ensure it better meets the needs of people with long-term conditions by providing a wider range of services, closer to people’s homes. More timely discharge is also essential to free up beds for patients who need to be admitted to hospital from A&E – this requires much stronger co-ordination between hospitals, social care and community services.

Nigel Edwards is a senior fellow at health think-tank The King’s Fund

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