Government agencies must do more to ensure accident and emergency departments are properly staffed this coming winter, according to an influential group of MPs.
The government itself also urgently needs to address the underfunding of adult social care to relieve pressure on accident and emergency departments, they said.
“The pressures are now continuing year round without the traditional respite”
Unless the shortfall in social care provision is addressed, patients will continue to face avoidable admission and delayed discharge from hospital, warned the Commons’ health select committee.
Last year only 88% of emergency patients were admitted, transferred or discharged within four hours, well short of the government’s 95% target, noted the committee.
In a report published today on winter planning in A&E departments, the MPs said some trusts were supporting patient flow out by creating their own social care services to address delayed discharges.
However, such initiatives had a limited scope when trusts were “under such financial pressure” themselves, said the report, adding that investing in social and intermediate care must be a priority.
The warning follows that made last month by the Care Quality Commission, which chose to highlight in particular the pressures facing social care services in its annual review of performance across the health and social care system.
The Commons committee also blamed the current level of variation in meeting the four-hour waiting time target on differences in the way that trusts managed patient flows within hospitals.
It noted some “examples of excellent practice and systems alongside a culture of all staff supporting the A&E department”, but said there were also examples of “poor performance worsened by inadequate systems which have been allowed to continue for too long”.
“They are struggling to cope with rising demand and to recruit and retain staff”
The MPs said it was “essential” that ministers ensured that sufficient capital funding was available for trusts to develop the infrastructure to enable them to meet government performance standards.
The “first step” should be an assessment of the infrastructure investment required to ensure that type 1 emergency departments are “fit for purpose”, they said.
The committee called for regulator NHS Improvement to consider the steps it could take this coming winter to ensure that all A&E departments “were properly staffed”.
Meanwhile, it said Health Education England should “look again” at the long term sustainability of staffing within major emergency departments and the ambulance service.
Dr Sarah Wollaston
Dr Sarah Wollaston, chair of the committee and Conservative MP for Totnes, 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,” she added.
Saffron Cordery, director of policy at NHS Providers, which represents trusts, said she “endorsed” the committee’s call for an urgent review of the state of adult social care and its impact on the NHS.
“Emergency departments up and down the country are under significant pressure,” she said. “They are struggling to cope with rising demand and to recruit and retain staff.”
She added: “There is now a fundamental mismatch between the demand for emergency services and the resources available.
“However, there are wider issues that need to be tackled to deal with the current pressures,” she said. “High up this list is the need to address social care.”
In response to the report, health minister Philip Dunne said: “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.
“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,” he said.
He added: “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.”