Accident and emergency improvement plan ‘unclear’ say MPs

24 Jul 13
Government hopes to sort out problems in accident and emergency departments are pinned on a new set of boards that don’t have the power to make service changes and whose purpose and status is unclear, MPs have warned.

By Mark Smulian | 24 July 2013

Government hopes to sort out problems in accident and emergency departments are pinned on a new set of boards that don’t have the power to make service changes and whose purpose and status is unclear, MPs have warned.

That accusation comes from the health select committee in a report on Urgent and Emergency Services, which said the failure of emergency departments to meet national waiting time targets in the early months of this year was due to increased numbers of admissions making it difficult to manage the flow of patients.

It said there was ‘pressing need’ for better information on factors that had driven increasing numbers of people into accident and emergency departments.

But committee chair Stephen Dorrell said NHS England was ‘flying blind’ as to why demand was increasing. ‘Even if the information was adequate it is unclear who is responsible for using it,’ he said.

The committee was told that responsibility for improving emergency services lies with Urgent Care Boards, which NHS England announced would be formed in May in response to concerns about the performance of A&E departments.

However, Dorrell said that many witnesses to the committee were ‘unclear about how many UCBs are planned, what powers they will have, and how they will relate to other commissioning bodies’.

In particular, it was unknown how the boards’ work will be coordinated with the health and wellbeing boards created following the government’s NHS reforms, whose remit also covers urgent and emergency care.

The committee said it was ‘not persuaded’ that UCBs would be able to implement reforms and influence commissioning because of their muddled status.

‘We believe UCBs have potential to provide local system management but they have no executive power and no clear direction,’ the report said.

UCBs are supposed to devise A&E improvement plans but these would be funded through the 70% of the emergency care tariff not paid direct to hospitals above the 2008 level of admissions.

However, this money is already being spent elsewhere in the NHS, and UCBs must therefore ‘identify opportunities for disinvestment elsewhere to fund the appropriate plans,’ the report said.

A lack of a clear role will make this difficult or them to implement, MPs warned. ‘They will be challenged by the fact that they have no statutory role but must exert authority over Clinical Commissioning Groups in order to deploy resources to support the improved delivery of emergency and urgent care.

‘We do not believe that the local re-organisation of care can be successfully managed in such a fashion.’

As a result, the new boards have simply lead to ‘blurred’ lines of responsibility, the Urgent and emergency services report concluded.

‘They feed in to a system which is already built around multiple commissioners and budget holders commissioning providers at regional and sub-regional levels.’

The committee said the structure of emergency care must change if patient need is to be met in the longer term.

‘We need to reorganise the way in which emergency and urgent care is delivered, Dorrell said. ‘Enabling primary care to assume a more active role in dealing with urgent cases is an important part of this.’

Responding to the committee’s concerns, health minister Lord Howe said: ‘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.

‘We are absolutely clear that we must work differently to respond to the changing needs of our ageing population.’

Steve Kell, the co-chair of NHS Clinical Commissioners Leadership Group, said commissioners must work together to ensure seamless patient care through active primary care commissioning.

‘This should not be based on a blueprint drafted in Whitehall but rather from clinically based solutions for each local health system,’ he added.

The NHS Confederation chief executive Mike Farrar added: ‘We need to rebalance the NHS's investment in primary and community-based health services, and ensure the payment system does not inadvertently reward or penalise NHS services for meeting patient's needs.’


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