How quickly an ambulance will arrive depends too much on where a patient lives. In a report published yesterday (October 25), the Public Accounts Committee (PAC) warns of wide regional variations in the quality of patients’ access to urgent and emergency care. The report further warns that not enough is being done to tackle delayed discharges, with beds unable to be released for new patients.
The PAC’s report finds that ambulance services covering large rural areas, for example services in the South-West and East of England, were particularly challenged and disproportionately affected by problems stemming from the flow of patients elsewhere in the system. Average ambulance response times for the most serious incidents varied from 6m51s (London) to 10m20s (South-West) in 2021-22. Average 999 call response times ranged from 5.4s (West Midlands) to 67.4s (South-West).
The PAC’s inquiry explored why delayed hospital discharges had increased. The number of patients staying in hospital despite no longer needing to be there averaged 13,623 across Q4 of 2022-23, up from 12,118 during the same period in 2021-22. The report highlights a number of reasons for this: problems discharging older patients from hospital into adult social care, and delays in hospitals’ own processes, transfers to NHS community settings, or with the provision of short-term care packages, or nursing or residential care. This last group can wait sometimes up to five weeks from when they are ready to leave hospital.
The NHS has not met targets for ambulance handovers since November 2017, and for A&E waits since July 2015. Given long-standing declines in performance, the PAC is not convinced NHS England (NHSE) has been sufficiently held to account for meeting targets and improving urgent and emergency care, an area in which the Government must improve.
There is a risk that future unsustainable financial pressures are built into the unfunded and uncosted NHS Long Term Workforce Plan, which only includes a commitment of an additional £2.4bn to cover training costs for the first five years of the 15-year plan. The report also highlights very high levels of staff ill health and turnover rates, with the PAC left unconvinced by NHSE’s approach to address workforce shortfalls. NHSE hopes to retain 130,000 staff who would otherwise leave over the next 15 years, an aspiration which seems highly doubtful given multiple dependencies on other factors and unknowns.
Dame Meg Hillier MP, Chair of the Committee, said: “Anyone who has had recent contact with the NHS knows it is in crisis. Patients suffering long waits and hard-pressed staff working in a system which is not delivering deserve better. The PAC’s role is to analyse the underlying numbers, and attempt to provide a Get Well Soon plan for the NHS.
“Excluding demand-led spending such as welfare payments, health takes up approximately 40 per cent of day-to-day budgeted spending by Whitehall departments. It is vital this is delivering benefits for patients. The Government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.”
Professor Julian Redhead, NHS England’s National Clinical Director for Urgent and Emergency Care, said: “While this report includes data which is more than two years old and coincided with a once in a generation pandemic, it is right to note the NHS has been under increasing pressure with staff experiencing record A&E attendances, hospitals fuller than at any point in their history and with thousands of beds taken up each day, in part, due to pressures in social care.
“It is testament to the hard work of staff and results of our NHS winter plan – rolling out 800 new ambulances, 10,000 virtual ward beds and work towards 5,000 extra core beds – that waiting times for ambulances, 999 calls and in A&E have improved across the country during this financial year.
“This progress has come as the NHS has committed to delivering £12bn of annualised savings by 2024/25 – all while dealing with more than a 100,000 staff posts being vacant.”