NHS England has announced a rescue plan for struggling A&E departments and the creation of new urgent care boards across England – including GPs, consultants and patient representatives – to ensure emergency services are working properly and to vet the quality of local NHS 111 services.
The announcement comes after the governing body found that there was ‘no single trend or factor’ to explain the deterioration in A&E departments, despite Government ministers insisting that ‘poor primary care provision’ was to blame for a rise in A&E attendances.
In the plan, NHS England admitted for the first time that the troubled rollout of the NHS 111 service has contributed to the rising pressure on emergency services, but also added that a ‘perceived lack’ of availability of primary care and out-of-hours care could have added to the pressure on A&E departments.
It said the plan it has put together to tackle the issue in the short term will be followed by a longer term plan drawing on the ongoing review into urgent care which is being led by Sir Bruce Keogh.
The new urgent care boards – due to be formed by the end of the month – will be led by NHS England’s local area teams and have been tasked to ensure that all services involved are reviewed by the CCG, including the effectiveness of primary care, GP out-of-hours care and admission avoidance schemes.
The boards will report nationally to NHS England, Monitor and NHS Trust Development Authority, will also be responsible for ensuring the quality of local NHS 111 services. NHS England referred to planning guidance from last December that gave it powers to intervene in CCG’s commissioning of urgent care if their providers were ‘not maintaining a sufficient level of performance’.
In the last quarter of 2011/12, 47 out of 152 providers failed to meet the 95% standard for patients being seen and discharged within four hours. For the last quarter of 2012/13 this figure had increased to 94 out of 148 providers, double the previous number.
NHS England said a number of factors ‘are assumed to have played a part’ in the deterioration including: more patients arriving at A&E; hospitals being less proactive and more delayed discharges because primary, community or social care services are not in place.
It added that these factors were likely to have been worsened by a ‘perceived lack’ of availability of primary care and community services out of hours, a lack of beds and staff in hospitals as they tried to cut costs and the introduction of NHS 111 (see box below).
The document said: ‘Long waiting times in A&E departments not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness.
‘Despite much analysis there is no single trend or factor to explain the deterioration and there remains a wide variation in performance both across the country and within the same areas where similar factors apply.
‘A number of factors are assumed to have played a part in this deterioration, and not all of them pertain to every situation… There are also many assumptions as to why these factors have played a greater part than in previous years.
‘Working closely with other key stakeholders, and building on the views already shared from CCGs and providers, NHS England will put in place an approach that will support the emergency and urgent care system, reduce pressure and ensure that patients do not have to wait longer than the agreed standards as identified in the NHS constitution and thus meet the national operating target of 95%.
‘This document outlines the overall approach and identifies the actions which area directors should now put in place to ensure that the commissioning system responds appropriately to support providers of A&E and urgent care services.’
Potential reasons for deterioration in A&E department performance
– Perceived lack of availability of primary care and community services out of hours
– Lack of beds and staff in hospitals as they tried to cut costs
– Commissioners lacking focus and clarity during the 1 April transition to the new commissioning system
– Pressure on social care budgets
– Introduction of NHS 111