Source · Select Committees · Public Accounts Committee
Seventy-Third Report - Access to urgent and emergency care
Public Accounts Committee
HC 1336
Published 25 October 2023
Recommendations
4
Accepted
Set out actions to address delayed discharges caused by hospital, community, and social care constraints.
Recommendation
Not enough is being done to tackle delayed discharges, which cause inefficiencies both within hospitals and more widely across the care system. Delays with discharging patients when they are medically fit for discharge reduces available bed capacity, which in turn …
Read more
Government Response Summary
The government agrees and states the recommendation is implemented, detailing an investment of an additional £1.6 billion by 2025 and outlining a wide programme of measures from the Urgent and Emergency Care recovery plan to tackle delayed discharges, including new care transfer hubs and improved rehabilitation models.
HM Treasury
View Details →
16
Accepted
Address variations in trust capability to improve patient access and experience nationwide.
Recommendation
There are differences in the capability of individual trusts, including around management, clinical leadership, and technology, that must be addressed to reduce variations in patients’ access to and experience of services.38 We asked witnesses how the worst performing trusts were …
Read more
Government Response Summary
The government accepts the recommendation and states NHS England is actively working to reduce unwarranted variation in trust performance, focusing on the most challenged systems by providing maximum support, national experts, and improvement teams, with a target implementation date of February 2024. NHS England will also provide further details on causes of variation in a future letter.
HM Treasury
View Details →
Conclusions (13)
2
Conclusion
Accepted
NHS England’s improvement plans rely on better staff recruitment and retention to address significant shortfalls in the NHS workforce, but we are not convinced that NHS England’s current approach will achieve its very optimistic assumptions. NHS England has identified a potential shortfall of 260,000 to 360,000 staff by 2036–37, compared …
Government Response Summary
The government agrees with the recommendation, highlighting the positive impact of the Exemplar programme on staff retention and outlining the NHS Long Term Workforce Plan's projections to reduce leaver rates. NHS England will also submit its full cost estimates for the plan as part of the next Spending Review process.
3
Conclusion
Accepted
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 …
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.
1
Conclusion
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department) and NHS England about access to unplanned or urgent care.1
Government Response Summary
The government agrees and outlines a comprehensive plan to improve patient flow and urgent care, including boosting bed capacity, implementing digital tools, increasing paramedic numbers, and introducing care transfer hubs and discharge funding through the Urgent and Emergency Care recovery plan.
7
Conclusion
Accepted
The pandemic has also had an impact on NHS staff absence rates. NHS England pointed to mental health conditions and anxiety, musculoskeletal conditions and respiratory conditions that were affecting NHS staff.14 We asked whether NHS England has a percentage measure to assess how far staff sickness impacts on NHS productivity, …
Government Response Summary
The government agrees with the committee's finding, stating that the NHS is making progress in recovering lost productivity and reducing staff absences through ongoing efforts, the Long Term Workforce Plan, and incentive schemes, with a target implementation date of April 2024.
9
Conclusion
Accepted
The Department told us that when looking internationally, demand for health across OECD countries goes up around 4% a year and improving productivity had to be one of the ways of meeting that demand. Alongside an increase in productivity, increasing the supply of services, improvements to public health in order …
Government Response Summary
The government agrees and is implementing digital tools like electronic bed management systems and System Control Centres, aiming to improve patient flow and productivity with a target implementation date of April 2024. They are also boosting capacity with 5,000 extra beds.
14
Conclusion
Accepted
We and past Committees have repeatedly expressed concerns about variations in patients’ experience of health and care.32 The C&AG’s report highlighted considerable differences in both service performance and access across geographical areas and providers. Proportions of the most serious A&E patients waiting less than four hours in March 2023 ranged …
Government Response Summary
The government agrees with the committee's finding and states NHS England is actively working on improving and standardising UEC processes, providing targeted support to challenged systems. NHS England will write to the Committee in February 2024 to detail the underlying causes of variation.
15
Conclusion
Accepted
In 2021–22, mean Category 1 ambulance response times 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 …
Government Response Summary
The government agrees with the committee's finding, stating NHS England is working to tackle unwarranted variation in ambulance performance through the UEC recovery plan, providing targeted support to challenged systems, and will provide an update in February 2024.
17
Conclusion
Accepted
NHS England described several different initiatives that it had piloted to improve services, for example around electronic patient records and workforce flexibility measures.41 It also informed us that it had recently launched a new programme of work 32 Committee of Public Accounts, NHS ambulance services, Sixty-second report of Session 2016–17, …
Government Response Summary
The government agrees with the committee's observation, stating that NHS England is actively working to tackle unwarranted variation in performance through the UEC recovery plan. They commit to writing to the Committee in February 2024 to detail the underlying causes of variation.
18
Conclusion
Accepted
The different services for urgent and emergency care are highly connected and interdependent, meaning that issues in one service impacts throughout the rest of the system.46 If the NHS is unable to discharge patients from hospitals when they no longer need to be there it means that people waiting in …
Government Response Summary
The government agrees with the observation and outlines an additional £1.6 billion investment over 2023-25 for care services and measures within the Urgent and Emergency Care recovery plan aimed at tackling delayed discharges and improving patient flow.
19
Conclusion
Accepted
The number of patients staying in hospital despite no longer needing to be there averaged 13,623 across Q4 of 2022–23, an increase of 1,505 or 12% compared with 12,118 during the same period in 2021–22.49 We asked NHS England why delayed discharges had increased, and it told us this was …
Government Response Summary
The government agrees with the observation and details an additional £1.6 billion investment over 2023-25 to commission care services, alongside measures in the Urgent and Emergency Care recovery plan to tackle delayed discharges.
20
Conclusion
Accepted
NHS England told us that the reasons why patients might experience delays in leaving hospital could be divided into four categories. For one group of patients, accounting for around 20%, the delays are related directly to activity in the discharging hospital.51 NHS England told us it was largely the responsibility …
Government Response Summary
The government agrees with the committee's finding and states the recommendation is implemented, citing an additional £1.6 billion investment and a comprehensive programme of measures from the Urgent and Emergency Care recovery plan to tackle delayed discharges, improve processes, and increase social care capacity.
21
Conclusion
Accepted
We have previously noted that the fragility of the adult social care provider market was exacerbating the difficulties in discharging older patients from hospital.55 NHS England agreed that there is a clear challenge in social care. Different solutions are needed in different parts of the country, but health and social …
Government Response Summary
The government agrees with the committee's findings, stating the recommendation has been implemented through an additional £1.6 billion investment and the Urgent and Emergency Care recovery plan, which funds services for rehabilitation, improves discharge processes, and increases adult social care capacity to address delayed discharges.
22
Conclusion
Accepted
NHS England told us it had instructed the NHS to speed up discharge processes, for example by minimising waits for supporting services such as transport and medications. It was also asking hospitals to monitor patients more closely to assess whether they needed to remain in hospital. We asked whether this …
Government Response Summary
The government agrees with the committee's finding, stating the recommendation has been implemented through an additional £1.6 billion investment and a comprehensive Urgent and Emergency Care recovery plan to tackle delayed discharges, improve processes, and increase social care capacity.