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Emergency winter pressure funding ‘not used to best effect’, say MPs

The Government’s £250m emergency fund for winter pressures in 2013 was established too late, preventing hospitals from planning effectively and increasing wasted money on temporary staff, an influential group of MPs has found.

The Public Accounts Committee report into emergency admissions found that there were ‘chronic problems’ with the recruitment of A&E consultants, leading to higher emergency admissions, and that it was ‘not convinced’ that the Government had a ‘clear vision of how to address the immediate or longer term shortage of A&E consultants’.

The MPs also said that financial incentives for reducing admissions were not aligned, which undermined the co-ordination of care across the system.

The report was set up in response to the rise in emergency admissions. It said: ‘Many hospitals are struggling to cope with increasing levels of demand for accident and emergency services when budgets are coming under increasing pressure. Bed occupancy rates across hospitals continue to rise year-on-year and the ambulance service is also under stress.’

The MPs criticised the use of the £250m fund for 53 struggling urgent and emergency care systems, which was announced in September 2013 for the winter and included a further £250m for this year and was followed by an extra £150m worth of funding announced in November.

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They said: ‘We are not convinced that additional funding from the DH to support A&E services during winter has been used to best effect.’

‘The DH acknowledged that the allocation of this funding so close to winter was not ideal as it means that hospitals cannot plan ahead and instead resort to more expensive temporary solutions, such as engaging agency staff to meet demand.’

The report called on the DH to ‘evaluate promptly the impact of additional winter pressure money allocated for 2013-14 and the timing of when the money became available, and use this analysis to inform the early and effective allocation of this fund in 2014-15’.

The crisis in recruiting A&E consultants should be a priority, the report said: ‘Neither the Department nor NHS England has a clear strategy for tackling the chronic shortage of A&E consultants… the DH and NHS England should urgently develop and implement a strategy which considers all available options and addresses the immediate and longer term shortages of A&E consultants.’

It called on the DH, Monitor and NHS England to review the overall system for funding urgent and emergency care ‘to ensure that incentives for all organisations are coherent and aligned’.

This followed on from the report by the Nuffield Trust last week, which recommended the merging of QOF, enhanced services and CQUIN – the incentives system for hospitals – which NHS England said it was ‘considering’.

Dr Paul Flynn, chair of the BMA consultants committee said: ‘Consultants working in emergency medicine face increasingly challenging, high pressured and stressful work environments, often with limited resources and gruelling workloads. This has contributed to a recruitment and retention crisis meaning existing doctors are left working flat-out to meet rising demand, exacerbating the problem.’

‘Consultants already work around the clock to provide emergency care for patients but, as the report makes clear, there simply aren’t enough to meet rising demand.’