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Select committee: Public Services Committee

2nd Report - Emergency healthcare: a national emergency

Published 19 January 2023

Public Services Committee Access to emergency services Report on parliament.uk ↗

At a glance4 recommendations and 16 conclusions · Government response published 24 March 2023 (deadline 19 March 2023)

The government's response

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

Sources

Recommendations and conclusions 20

  1. 1
    The state of emergency healthcare is a national emergency. Conclusion · paragraph 13 Conclusion (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.
  2. 2
    The emergency healthcare workforce is under unprecedented strain. Conclusion · paragraph 18 Conclusion (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.
  3. 3
    In many cases, patients are attending emergency care services because they have—or feel they have—no... Conclusion · paragraph 31 Conclusion (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.
  4. 4
    The Department of Health and Social Care should continue working to increase the number of... Conclusion · paragraph 32 Conclusion (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.
  5. 5
    The crisis in emergency healthcare is a symptom of fundamental weaknesses arising from inadequate capacity... Conclusion · paragraph 39 Conclusion (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.
  6. 6
    The Government should introduce further incentives to enable discharge at the right time for patients,... Recommendation · paragraph 42 Recommendation (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.
  7. 7
    While the Government’s interventions to boost capacity in social care are welcome, they will not... Conclusion · paragraph 44 Conclusion (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.
  8. 8
    Health systems on a local level cannot be expected to develop a common vision and... Conclusion · paragraph 48 Conclusion (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.
  9. 9
    The crisis of emergency healthcare should be referred to a COBR Committee. Conclusion · paragraph 50 Conclusion (the committee's words)
    The crisis of emergency healthcare should be referred to a COBR Committee.
  10. 10
    Emergency and urgent care services are working to an outdated operating model which no longer... Conclusion · paragraph 66 Conclusion (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.
  11. 11
    Integrated Care Boards and Systems have potential to deliver services that address local population need... Conclusion · paragraph 76 Conclusion (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.
  12. 12
    Following the Hewitt Review, the Government must set out accountability and governance arrangements for ICBs... Recommendation · paragraph 77 Recommendation (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.
  13. 13
    The Government should consider, consult upon, and establish a bold and ambitious new operating model... Recommendation · paragraph 78 Recommendation (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.
  14. 14
    The current data published by NHS England on emergency department waiting times inaccurately portray the... Recommendation · paragraph 84 Recommendation (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.
  15. 15
    There is no clear picture of the type of demand faced by urgent and emergency... Conclusion · paragraph 90 Conclusion (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.
  16. 16
    NHS England must improve the quality and interpretation of data gathered on urgent and emergency... Conclusion · paragraph 91 Conclusion (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.
  17. 17
    NHS England should resume publishing the Delayed Transfer of Care dataset. Conclusion · paragraph 93 Conclusion (the committee's words)
    NHS England should resume publishing the Delayed Transfer of Care dataset.
  18. 18
    The Department of Health and Social Care should mandate a greater presence of clinical staff... Conclusion · paragraph 103 Conclusion (the committee's words)
    The Department of Health and Social Care should mandate a greater presence of clinical staff in NHS 111 control centres.
  19. 19
    Regulators and inspectorates should place greater emphasis on the importance of collaboration between emergency services. Conclusion · paragraph 113 Conclusion (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.
  20. 20
    The What Works Centre for healthcare is not performing the function of evaluating, sharing, and... Conclusion · paragraph 127 Conclusion (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.