A&E in England 'at breaking point'

15 May 13
The way the English NHS pays hospitals for accident & emergency admissions is ‘broken’ and could lead to care failures within six months, foundation trusts warned today.

By Richard Johnstone | 15 May 20

The way the English NHS pays hospitals for accident & emergency admissions is ‘broken’ and could lead to care failures within six months, foundation trusts warned today.

An analysis by the Foundation Trust Network found that emergency services were ‘under huge pressure’ due to an increase in the number of people requiring treatment. Latest figures show 4 million more people a year are using A&E services than in 2004.

This has led to concerns that an increasing number of patients have to wait longer than the four-hour target time to see a doctor. FTN chief executive Chris Hopson said many hospitals were running close to capacity.

In a warning to ministers, he said funding for casualty admissions must be reformed to improve treatment.

Current rules mean that, if a hospital admits more A&E patients than it did in 2008, it gets paid only 30% of the cost of treating those patients. This is intended to help reduce unnecessary hospital admissions and free up funds to improve community services.

However, Hopson said two-thirds of hospitals were admitting more patients than they did five years ago, with some treating as many as 40% more people. As a result, some trusts were losing more than £5m a year through the cap and there was 'a danger the system will fall over in six months’, he said.

Responding to the warning, Health Secretary Jeremy Hunt highlighted that NHS England last week had launched a ‘support plan’ for hospitals to improve A&E performance, including reallocation of some funds.

The plan also proposed that hospitals would get a say in spending the 70% of treatment costs withheld.

Hopson said this was ‘a good start’ but clarity was still needed about available resources, and the government should pledge to abandon the 30% cap as quickly as possible.

He added: ‘Hospital, ambulance and community service trusts need to plan with certainty. We need to know by the end of June at the latest exactly how much money will be committed from the NHS’s risk reserves to address what Jeremy Hunt has correctly identified as the biggest operational problem facing the NHS. We also need a guarantee that the NHS will use its risk reserves to allocate the funding required by each area even if that area is facing a funding shortfall.’

The NHS Confederation said the whole of the health service must respond to alarm bells in casualty departments.

Chief executive Mike Farrar said demand for urgent and emergency care services was now consistently at the highest level since the inception of the NHS.

‘The key thing is to understand that A&E doesn't stand alone. Pressure in our A&E departments is a visible symptom of a whole system under great strain – and tackling it requires a whole-system solution.

‘We urgently need to look at the alternatives. This includes fundamentally reviewing how we organise and fund our services outside traditional hospital settings, the way staff work throughout the whole week, and how we provide effective alternatives to hospital-based emergency care.’


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