The Public Accounts Committee has published its 46th Report on emergency admissions to hospital and chronic shortage of specialist A&E consultants. The results show that there is no clear strategy in place for tackling a lack of A&E specialists.
Commenting on the report findings, The Rt. Hon Margaret Hodge MP, chair of the Committee of Public Accounts, said: “Any attempt to improve emergency admissions services in the NHS is being completely stymied by the chronic shortage of specialist A&E consultants. Nearly one-fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012. There are also major problems in training enough doctors in emergency medicine. In 2012, only 18.5% of first year of higher training posts were filled. Neither the Department of Health (DH) or NHS England has a clear strategy to tackle the shortage of A&E consultants.
The slow introduction of round-the-clock consultant cover in hospitals – which will not be in place before the end of 2016-17 – is also having a negative impact. Changing this relies on the British Medical Association and NHS Employers negotiating a more flexible consultants’ contract, and neither the DH or NHS England has direct control over the timescale or details of these negotiations.
Emergency admissions to hospitals have increased by 47% over the last 15 years at a time when budgets are under pressure. Bed occupancy rates across hospitals continue to rise year-on-year and the ambulance service is also under stress. Hospitals, GPs and community health services all have a role to play in reducing emergency admissions – but financial incentives to make this happen are not in place. Attempts to ensure patients are treated without coming to A&E are not working. While hospitals get no money if patients are readmitted within 30 days, there are no financial incentives for community and social care services to reduce emergency admissions.
“Both the Department of Health and NHS England struggled to explain to us who is ultimately accountable for the efficient delivery of local A&E services, and for intervening when there are problems, yet, without clear accountability and responsibility, it is much more difficult to achieve the changes needed to improve the situation,” said Margaret Hodge.
In response to the report, the Committee of Public Accounts expects the DH to confirm that it is responsible for the overall performance of urgent and emergency care; and to set out how it will challenge local performance, step in when this performance is substandard and enforce beneficial local changes to save money and provide a better service when local agreement cannot be reached.
It also advised that the DH, NHS England and Monitor should review the overall system for funding urgent and emergency care, including the impact of the ‘year of care’ funding, to ensure that incentives for all organisations are coherent and aligned.
