Source · Select Committees · Public Accounts Committee
Recommendation 3
3
Accepted
Clearly set out causes of urgent care performance variation and initiatives to improve standards.
Conclusion
The quality of patients’ access to urgent and emergency care depends too much on where they live, particularly with wide variation in ambulance response times. There is significant regional variation in the performance of services for urgent and emergency care. For example, in 2021–22, average ambulance response times for the most serious incidents varied from six minutes 51 seconds for the London ambulance service to ten minutes 20 seconds for the South-West ambulance service, and average 999 call response times ranged from 5.4 seconds for the West Midlands ambulance service to 67.4 seconds for the South-West ambulance service. The length of stay in the worst performing areas for discharging patients when they are medically fit is over double that of the best performing areas. Local management of systems and digitisation are likely to play a critical part in patients’ access to services, but one in ten trusts still lacks an electronic patient record and only four trusts have an electronic bed management system that could be described as first class. NHS England only has plans to upgrade 16 further systems, but it is working with the Department on a business case to expand this capability. NHS England has identified where there is good practice and poor performance but is weak at implementing and rolling out best practice more widely. Recommendation 3: As part of its Treasury Minute response, NHS England should clearly set out the causes of variation in performance, and the specific initiatives it takes responsibility for to bring the worst-performing organisations closer to the standards being achieved by the best.
Government Response Summary
The government agrees and describes initiatives under the UEC recovery plan to standardise processes, increase referrals, and provide targeted support to challenged systems to reduce performance variation. NHS England commits to writing to the Committee in February 2024 to detail the underlying causes of this variation.
Government Response
Accepted
HM Government
Accepted
The government agrees with the Committee’s recommendation. improvements to Emergency Departments and ambulance performance requires working between secondary, primary, community and social care so the Urgent and Emergency Care (UEC) tiering support offer is taking place at system level to ensure a whole-system approach. The UEC recovery plan aims to improve and standardise processes to reduce unwarranted variation in the in-hospital UEC pathway. Specifically, NHS England is working with systems to improve their UEC performance through standardising service in the first 72 hours of care, increasing direct referrals to specialist care and Same Day Emergency Care (SDEC,) including paediatric SDEC, with focus on equitable access and consistency of delivery. NHS England’s approach will focus on providing maximum support to the most challenged systems, bringing in national experts, NHS England’s Emergency Care Improvement Team and a range of supporters from best practice organisations. A bespoke offer is provided to each system, helping them align their plans to ensure delivery of local UEC recovery. There has been significant improvement in emergency performance over 2023-24 compared to last year, and there is already evidence of these improvements in emergency performance being fastest in some of the most challenged. NHS England will write to the Committee in February 2024 setting out the underlying causes of variation in performance as more information will be available at this time.