By Richard Johnstone | 9 September 2013
A lack of adult social care places is one of the key reasons why pressure on NHS accident and emergency services has increased, senior health service managers have said in an NHS Confederation survey.
The confederation said the poll revealed it was ‘a myth’ that the problematic roll-out of NHS 111 services earlier this year has been the main cause of strain on A&E.
Across England, A&E departments have met the four-hour waiting time target for 95% of patients in only eight weeks of 2013 so far, and the government has been warned that the system is ‘at breaking point'.
Of the 125 senior figures polled, nearly half said the main cause of this pressure was the rising number of frail older people with multiple long-term conditions. More than a quarter identified difficulties with discharging patients or transferring them to alternative care settings as the top cause of A&E pressures.
Other factors, such as the perceived impact of changes to local primary care, and a lack organisational and system-wide emergency care planning, were also ranked above local difficulties with the NHS 111 service. The roll-out of the new phone line, which replaced NHS Direct, has been criticised as an ‘abject failure' by doctors.
Also in the poll, less than half of respondents (45.7%) said they were likely or very likely to meet the hour waiting time target for the next quarter, from October to December 2013.
Respondents were also asked to prioritise possible ways of easing A&E pressures in their organisation. More than half said giving organisations earlier notice about funding designed to ease winter health pressures would be helpful. For example, one chief executive stated her trust only received 2012/13 winter funding in February 2013.
Other solutions proposed included increasing incentives for staff to work in A&E to help relieve the squeeze on the workforce in A&E departments, as well as encouraging more senior staff working during the evenings and weekends.
The confederation, which represents groups across the health service, also called for changes to the payment system so that hospitals can fully recoup the cost of emergency admissions. 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.
Chief executive Mike Farrar said A&E services were facing unprecedented demand, but added ‘misinformation’ over the NHS 111 service was creating ‘a vicious spiral’.
‘As if the genuine rise in seriously ill, frail A&E attendees wasn't putting enough strain on the system, the NHS is also struggling from ill-informed speculation about what is causing the pressures and what services they can rely on to meet their needs,’ he said.
‘The knock-on effect is that the public have so little confidence in alternative options for meeting their healthcare needs that they believe the only recourse is to turn up at A&E.’
