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Select committee: Public Services Committee

Access to emergency services

Closed Opened 22 Sep 2022 Closed 20 Jul 2023 4 recommendations 16 conclusions

Public Services Committee Inquiry on parliament.uk ↗

Inquiry scope (the committee's words)
This inquiry will investigate the barriers to accessing emergency services, and how emergency services can be organised to ensure that the welfare of service users is always at the forefront of decision-making. It will look at processes organising these services at the local and national levels, and how priorities and targets are set. It will, for example, ask where and how creative practices could be rolled out to improve services, and how enhanced collaboration between police, fire and rescue, and emergency healthcare services could provide better outcomes for patients.

Where it stands

The inquiry is closed, opened 22 September 2022.

The committee has published 1 report, most recently 2nd Report - Emergency healthcare: a national emergency on 19 January 2023.

The government's response

Published 24 March 2023. The deadline was 19 March 2023.

Summary written by Accountability Index from the government's response. It is not the government's own words.

The government sets out its recovery plan for urgent and emergency care in response to the committee, agreeing on some recommendations while not agreeing to a COBR referral or the committee's view of NICE.

  • It does not agree to refer the state of urgent and emergency care to a COBR committee, stating that DHSC and NHS England have "established functions to tackle issues within the health system".
  • It agrees with the recommendation to establish functional mechanisms to share good practice, and says NHS England will establish a programme to reduce unwarranted variation "By April 2023".
  • On the Hewitt review, the Department "will carefully consider the findings of this review, and plan next steps accordingly". It describes accountability arrangements as "clearly set out in legislation".
  • It does not agree that NICE "is not performing" its function of evaluating and sharing best practice, though it says the Government and NICE recognise areas where it can develop and improve.

Read the government's response ↗ Report an error

Recommendations and conclusions

All 20 recommendations and conclusions

Reports

All reports

Evidence

  • 5 oral evidence sessionsLatest 9 November 2022
  • 21 witnesses
All evidence

Recent activity

Recommendations and conclusions 20 shown

Conclusion 1

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
The state of emergency healthcare is a national emergency. The substantial delays that patients face when trying to access emergency health services create considerable emotional distress and an unprecedented clinical risk.

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Conclusion 2

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
The emergency healthcare workforce is under unprecedented strain. Without concerted action to address the emergency in the system, many of them will leave the health service.

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Conclusion 3

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
In many cases, patients are attending emergency care services because they have—or feel they have—no alternative. The models for primary and community care are broken.

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Conclusion 4

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
The Department of Health and Social Care should continue working to increase the number of physical beds in hospitals. This work must ensure that additional beds are sufficiently staffed.

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Conclusion 5

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
The crisis in emergency healthcare is a symptom of fundamental weaknesses arising from inadequate capacity across primary, community, and hospital and social care settings. A new model for primary care is needed.

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Recommendation 6

Recommendation · 2nd Report - Emergency healthcare: a national emergency

Recommended (the committee's words)
The Government should introduce further incentives to enable discharge at the right time for patients, freeing up hospital capacity. This could include further use of NHS budgets to cover social care costs.

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Conclusion 7

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
While the Government’s interventions to boost capacity in social care are welcome, they will not be sufficient to fully address the problem.

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Conclusion 8

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
Health systems on a local level cannot be expected to develop a common vision and purpose without a clear national steer on their common purpose. There is no such steer.

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Conclusion 9

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
The crisis of emergency healthcare should be referred to a COBR Committee.

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Conclusion 10

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
Emergency and urgent care services are working to an outdated operating model which no longer reflects the reality of demand or clinical practice. The limited efforts to address this seem to have stalled. Persisting with an outdated model will prevent services from delivering the care that patients need.

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Conclusion 11

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
Integrated Care Boards and Systems have potential to deliver services that address local population need and make significant improvements. There appears, though, to be little understanding of how they will function, or who will be accountable for the delivery of services. We consider it unlikely that ICSs and ICBs will be able to deliver on the high expectations placed on them without further clarity on these matters. They will also need more leadership from the centre than is currently envisaged.

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Recommendation 12

Recommendation · 2nd Report - Emergency healthcare: a national emergency

Recommended (the committee's words)
Following the Hewitt Review, the Government must set out accountability and governance arrangements for ICBs and ICSs. These systems must consider how to ensure system accountability where challenges in one service have a domino effect on others.

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Recommendation 13

Recommendation · 2nd Report - Emergency healthcare: a national emergency

Recommended (the committee's words)
The Government should consider, consult upon, and establish a bold and ambitious new operating model for emergency healthcare. This operating model must address pressures throughout the system and provide strong leadership to: reflect increased demand for, and new ways of delivering , emergency health services; establish robust accountability arrangements at national, ICS , and service level; set clear expectations and arrangements for collaboration with other emergency responders; and establish functional mechanisms to improve the sharing of good practice.

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Recommendation 14

Recommendation · 2nd Report - Emergency healthcare: a national emergency

Recommended (the committee's words)
The current data published by NHS England on emergency department waiting times inaccurately portray the true waiting times experienced by patients attending A&E. NHS England should publish monthly the number and proportion of patients waiting 12 hours or more from arrival at accident and emergency departments.

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Conclusion 15

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
There is no clear picture of the type of demand faced by urgent and emergency care providers. This will significantly hinder effective planning and service design.

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Conclusion 16

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
NHS England must improve the quality and interpretation of data gathered on urgent and emergency caseloads to explain accurately the type of cases faced by ambulances and A&E.

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Conclusion 17

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
NHS England should resume publishing the Delayed Transfer of Care dataset.

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Conclusion 18

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
The Department of Health and Social Care should mandate a greater presence of clinical staff in NHS 111 control centres.

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Conclusion 19

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
Regulators and inspectorates should place greater emphasis on the importance of collaboration between emergency services. This has the potential to enable and incentivise greater collaboration between police, fire and rescue and emergency health services, leading to better outcomes for patients.

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Conclusion 20

Conclusion · 2nd Report - Emergency healthcare: a national emergency

Concluded (the committee's words)
The What Works Centre for healthcare is not performing the function of evaluating, sharing, and encouraging the implementation of best practice. Other arrangements, where they exist, are patchy and limited, and there is a lack of urgency in driving best practice. Innovations are often, therefore, abandoned, or not utilised at scale nor as effectively as they should be.

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Reports

1 report

Oral evidence sessions

5 sessions

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Date Session and witnesses Source
9 Nov 2022
Oral evidence session
Dr Vin Diwakar · NHS England, Jaee Samant CBE · Department for Business and Trade, Matthew Style · Department of Health and Social Care, Rt Hon Chris Philp MP · Home Office, Will Quince MP · Department for Education 		View ↗
2 Nov 2022
Oral evidence session
Dr Vin Diwakar · NHS England, Professor Julian Redhead · NHS England, Sarah Scobie · Nuffield Trust, Victoria Vallance · Care Quality Commission (CQC) 		View ↗
26 Oct 2022
Oral evidence session
Daren Mochrie · Association of Ambulance Chief Executives, Dr Adrian Boyle · Royal College of Emergency Medicine, Len Richard · Mid-Yorkshire Hospitals NHS Trust, Professor Julia Williams · University of Hertfordshire 		View ↗
19 Oct 2022
Oral evidence session
Chief Constable Pam Kelly · Gwent Police, Daniel Elkeles · London Ambulance Service NHS Trust, Dennis Keeley · Dublin Fire Brigade, Dr John Martin · College of Paramedics, Lisa Elliott · Royal College of Nursing, Miriam Deakin · NHS Providers 		View ↗
12 Oct 2022
Oral evidence session
Professor Inga Heyman · Edinburgh Napier University, Professor Leo McCann · The University of York, Professor Peter Murphy · Nottingham Business School 		View ↗

Who gave evidence

21 witnesses

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WitnessOrganisationSessions
Dr Vin Diwakar · Medical Director National Transformation and Medical Directorates NHS England 2
Chief Constable Pam Kelly · Chief Constable Gwent Police 1
Daniel Elkeles · Chief Executive Officer London Ambulance Service NHS Trust 1
Daren Mochrie · Chair Association of Ambulance Chief Executives 1
Dennis Keeley · Chief Fire Officer Dublin Fire Brigade 1
Dr Adrian Boyle · President Royal College of Emergency Medicine 1
Dr John Martin · President College of Paramedics 1
Jaee Samant CBE · Director General, Business Group Department for Business and Trade 1
Len Richard · Chief Executive Officer Mid-Yorkshire Hospitals NHS Trust 1
Lisa Elliott · Deputy Director of Nursing: Workforce, Professional Practice, and Quality Royal College of Nursing 1
Matthew Style · Director General for Secondary Care and Integration Department of Health and Social Care 1
Miriam Deakin · Director of Policy and Strategy and Deputy Chief Executive NHS Providers 1
Professor Inga Heyman · Associate Professor, Policing and Public Health Edinburgh Napier University 1
Professor Julia Williams · Professor of Paramedic Science & Associate Dean – Research University of Hertfordshire 1
Professor Julian Redhead · National Clinical Director for Urgent and Emergency Care NHS England 1
Professor Leo McCann · Professor of Management The University of York 1
Professor Peter Murphy · Director of the Public Policy and Management Research Group, Centre for Economics, Policy and Public Management Nottingham Business School 1
Rt Hon Chris Philp MP · Minister for Crime, Policing and Fire Home Office 1
Sarah Scobie · Deputy Director of Research Nuffield Trust 1
Victoria Vallance · Director of Secondary and Specialist Healthcare Care Quality Commission (CQC) 1
Will Quince MP · Minister for Children and Families Department for Education 1