Charities ‘ready to help tackle A&E crisis’

16 Jan 15

A senior charity leader has told Public Finance that third sector organisations are ready to help the NHS tackle current pressures in hospitals, but only if the health service is prepared to foot the bill.


Plans will be submitted to a Cabinet subcommittee on Monday setting out how charities can help alleviate demand on accident and emergency departments and hospital admissions.

The proposals have been drawn up by Sir Stephen Bubb, chief executive of the Association of the Chief Executives of Voluntary Organisations, who was asked to prepare them by Cabinet Secretary Sir Jeremy Heywood and the Department of Health permanent secretary Una O'Brien.

Bubb told PF the sector was ready to provide assistance with helping elderly people out of hospital and into care settings in the short term – but charities could not be expected to prop up the finances of the health service.

He highlighted that the recent decision by private provider Circle to pull out of its contract to run the Hinchingbrooke hospital in Cambridgeshire, which he said illustrated flaws in the current financial model that underpins the NHS’.

Circle announced on January 9 that it was to leave its ten-year deal due to funding pressures and increased demand on A&E services. Its decision came as figures from NHS England revealed that from October to December last year, 92.6% of patients attending A&E departments were seen within four hours – below the 95% target and the worst quarterly result since the target was introduced at the end of 2004.

Bubb said Circle's problems showed the business model that supports hospitals was ‘bust’.

‘It is ludicrous that in most hospitals 20% of their beds are occupied by people who are not sick. The financial system that supports that nonsense – which is based on the number of transactions rather than outcomes – is bust.

‘We all know that if you put more resources into community and prevention you’ll cut the number of admissions to A&E, you’ll cut the number of admissions from A&E into hospital beds and you can secure earlier discharge, but the commissioning and the financial arrangements don’t support that.’

Charities were ready to ‘move quite quickly’ to help address current pressures, he added.

‘I was asked to do this piece of work of what the sector could do to ramp up its offering in the next 12 weeks, and one of the points I’m going to make in the paper I’m doing for a Cabinet subcommittee that is looking in this on Monday is that we can absolutely make an intervention in the next 12 weeks.

‘We’re doing some mapping at the moment between organisations like the Red Cross, the Royal Voluntary Service and Age UK. All of them are providing services in hospitals already. You couldn't possibility set up new projects or new schemes in 12 weeks, it is unrealistic to do so, but you could increase the support that is already being provided if those services were commissioned straight away.

‘I will be saying this needs to be commissioned, you will have to find money to pay for it, and they’re going to have to pay for it.’

It would be impossible to move all of the estimated 20% of those in hospital who could be treated in care homes or their own accommodation, Bubb said.

However, ‘you can start making an impression’ on it, before putting wider changes in place to help people leave hospital quicker and ensure they do not need to be admitted.

This required an examination of the way the current system works, he added.

‘You need to move from transactions to outcomes, and you need to incentivise hospitals so they can work with our sector on early discharge.

‘Our long-term vision is that there will be a third sector in triage in every casualty department, there will be a third sector presence in every early discharge team, there will be a third sector presence in frail and elderly wards.’

Bubb also told PF he feared that the failure of Circle at Hinchingbrooke could hinder efforts to increase the use of third sector organisations in NHS care.

‘The danger in this debate is that politicians fail to distinguish between private sector provision and third sector provision,’ he said.

‘It relies on politicians being a little smarter in thinking about this issue and thinking that it isn’t a binary choice of pubic sector or private sector.’

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