Seventy-Third Report - Access to urgent and emergency care

Select Committee

Public Accounts Committee HC 1336 25 October 2023

Report Status Government responded

Conclusions & Recommendations 31 items (2 recs)

Source View on Parliament website

Government Response (AI assessment · 29 of 31 classified)

Accepted 15

Rejected 9

Government response

Treasury minutes: Government response to the Committee of Public Accounts on the Seventy-third report from Session 2022-23 · published 14 Feb 2024

Read the government response ↗ Response on the tracker

Recommendations & Conclusions

15 results

2 Conclusion Accepted

Provide Committee with update on reducing NHS staff shortfalls and improving retention rates.

Conclusion

NHS England’s improvement plans rely on better staff recruitment and retention to address significant shortfalls in the NHS workforce, but we are not convinced that NHS England’s current approach will achieve its very optimistic assumptions. NHS England has identified a … Read more

Government Response Summary

The government agrees with the recommendation, highlighting the positive impact of the Exemplar programme on staff retention and outlining the NHS Long Term Workforce Plan's projections to reduce leaver rates. NHS England will also submit its full cost estimates for the plan as part of the next Spending Review process.

HM Treasury

3 Conclusion Accepted

Clearly set out causes of urgent care performance variation and initiatives to improve standards.

Conclusion

The quality of patients’ access to urgent and emergency care depends too much on where they live, particularly with wide variation in ambulance response times. There is significant regional variation in the performance of services for urgent and emergency care. … Read more

Government Response Summary

The government agrees and describes initiatives under the UEC recovery plan to standardise processes, increase referrals, and provide targeted support to challenged systems to reduce performance variation. NHS England commits to writing to the Committee in February 2024 to detail the underlying causes of this variation.

HM Treasury

4 Recommendation Accepted

Set out actions to address delayed discharges caused by hospital, community, and social care constraints.

Recommendation

Not enough is being done to tackle delayed discharges, which cause inefficiencies both within hospitals and more widely across the care system. Delays with discharging patients when they are medically fit for discharge reduces available bed capacity, which in turn … Read more

Government Response Summary

The government agrees and states the recommendation is implemented, detailing an investment of an additional £1.6 billion by 2025 and outlining a wide programme of measures from the Urgent and Emergency Care recovery plan to tackle delayed discharges, including new care transfer hubs and improved rehabilitation models.

HM Treasury

1 Conclusion Accepted

Evidence taken from DHSC and NHS England on access to unplanned or urgent care.

Conclusion

On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department) and NHS England about access to unplanned or urgent care.1

Government Response Summary

The government agrees and outlines a comprehensive plan to improve patient flow and urgent care, including boosting bed capacity, implementing digital tools, increasing paramedic numbers, and introducing care transfer hubs and discharge funding through the Urgent and Emergency Care recovery plan.

HM Treasury

7 Conclusion Accepted

NHS staff absence rates significantly impacted by pandemic, affecting overall productivity.

Conclusion

The pandemic has also had an impact on NHS staff absence rates. NHS England pointed to mental health conditions and anxiety, musculoskeletal conditions and respiratory conditions that were affecting NHS staff.14 We asked whether NHS England has a percentage measure … Read more

Government Response Summary

The government agrees with the committee's finding, stating that the NHS is making progress in recovering lost productivity and reducing staff absences through ongoing efforts, the Long Term Workforce Plan, and incentive schemes, with a target implementation date of April 2024.

HM Treasury

9 Conclusion Accepted

Effective electronic bed management systems improve patient flow, but wider rollout is stalled.

Conclusion

The Department told us that when looking internationally, demand for health across OECD countries goes up around 4% a year and improving productivity had to be one of the ways of meeting that demand. Alongside an increase in productivity, increasing … Read more The Department told us that when looking internationally, demand for health across OECD countries goes up around 4% a year and improving productivity had to be one of the ways of meeting that demand. Alongside an increase in productivity, increasing the supply of services, improvements to public health in order to reduce demand, and developing new technology would be crucial to improving performance in the NHS.18 NHS England also told us that effective electronic management systems could improve patent flows within hospitals and increase overall productivity.19 As an example, NHS England pointed to four organisations in England that have implemented fully functional electronic bed management systems, allowing them to track patients and bed occupancy in real time.20 NHS England told us that it planned to work with a further 16 trusts this year to implement this system that it knows works well. The initiative will not be funded by new money but will be paid for from capital identified in existing budgets from both NHS England and hospital trusts. We asked whether NHS England had done an analysis of the costs and benefits in productivity terms. NHS England told us that productivity benefits would be part of the business case it is discussing with the Department for rolling out electronic bed management systems more widely, but could not yet be confirmed 11 C&AG’s Report, para 4.13 12 Q 1 13 Qq 1, 2 14 Qq 2, 28, 29 and 118 15 Qq 27, 28 16 Qq 3, 4; NHS England, NHS Long Term Workforce Plan, June 2023 17 NHS England, NHS Long Term Workforce Plan, June 2023, page 71 paragraph 8 18 Qq 119, 121 19 Q 52 20 Qq 48, 50 10 Access to urgent and emergency care because the business case has not been formally approved.21 In written evidence after the session NHS England informed us that it expects the main productivity benefit from this system will result from better visibility of bed capacity leading to more informed decision- making, in turn reducing the down time between a bed bei Show less

Government Response Summary

The government agrees and is implementing digital tools like electronic bed management systems and System Control Centres, aiming to improve patient flow and productivity with a target implementation date of April 2024. They are also boosting capacity with 5,000 extra beds.

HM Treasury

14 Conclusion Accepted

Significant, persistent regional variations in patient experience and service performance across NHS.

Conclusion

We and past Committees have repeatedly expressed concerns about variations in patients’ experience of health and care.32 The C&AG’s report highlighted considerable differences in both service performance and access across geographical areas and providers. Proportions of the most serious A&E … Read more

Government Response Summary

The government agrees with the committee's finding and states NHS England is actively working on improving and standardising UEC processes, providing targeted support to challenged systems. NHS England will write to the Committee in February 2024 to detail the underlying causes of variation.

HM Treasury

15 Conclusion Accepted

Significant regional disparities in ambulance response times, particularly impacting rural services.

Conclusion

In 2021–22, mean Category 1 ambulance response times varied from six minutes 51 seconds for the London ambulance service to ten minutes 20 seconds for the South-West ambulance service, and average 999 call response times ranged from 5.4 seconds for … Read more

Government Response Summary

The government agrees with the committee's finding, stating NHS England is working to tackle unwarranted variation in ambulance performance through the UEC recovery plan, providing targeted support to challenged systems, and will provide an update in February 2024.

HM Treasury

16 Recommendation Accepted

Address variations in trust capability to improve patient access and experience nationwide.

Recommendation

There are differences in the capability of individual trusts, including around management, clinical leadership, and technology, that must be addressed to reduce variations in patients’ access to and experience of services.38 We asked witnesses how the worst performing trusts were … Read more

Government Response Summary

The government accepts the recommendation and states NHS England is actively working to reduce unwarranted variation in trust performance, focusing on the most challenged systems by providing maximum support, national experts, and improvement teams, with a target implementation date of February 2024. NHS England will also provide further details on causes of variation in a future letter.

HM Treasury

17 Conclusion Accepted

Rollout of electronic patient management systems faces significant dependency challenges.

Conclusion

NHS England described several different initiatives that it had piloted to improve services, for example around electronic patient records and workforce flexibility measures.41 It also informed us that it had recently launched a new programme of work 32 Committee of … Read more

Government Response Summary

The government agrees with the committee's observation, stating that NHS England is actively working to tackle unwarranted variation in performance through the UEC recovery plan. They commit to writing to the Committee in February 2024 to detail the underlying causes of variation.

HM Treasury

18 Conclusion Accepted

Interdependency of urgent and emergency care services creates system-wide bottlenecks from issues.

Conclusion

The different services for urgent and emergency care are highly connected and interdependent, meaning that issues in one service impacts throughout the rest of the system.46 If the NHS is unable to discharge patients from hospitals when they no longer … Read more

Government Response Summary

The government agrees with the observation and outlines an additional £1.6 billion investment over 2023-25 for care services and measures within the Urgent and Emergency Care recovery plan aimed at tackling delayed discharges and improving patient flow.

HM Treasury

19 Conclusion Accepted

Delayed hospital discharges increased by 12% in 2022-23, due to complex patient needs.

Conclusion

The number of patients staying in hospital despite no longer needing to be there averaged 13,623 across Q4 of 2022–23, an increase of 1,505 or 12% compared with 12,118 during the same period in 2021–22.49 We asked NHS England why … Read more

Government Response Summary

The government agrees with the observation and details an additional £1.6 billion investment over 2023-25 to commission care services, alongside measures in the Urgent and Emergency Care recovery plan to tackle delayed discharges.

HM Treasury

20 Conclusion Accepted

Delayed hospital discharges attributable to four categories, including hospital processes and social care.

Conclusion

NHS England told us that the reasons why patients might experience delays in leaving hospital could be divided into four categories. For one group of patients, accounting for around 20%, the delays are related directly to activity in the discharging … Read more

Government Response Summary

The government agrees with the committee's finding and states the recommendation is implemented, citing an additional £1.6 billion investment and a comprehensive programme of measures from the Urgent and Emergency Care recovery plan to tackle delayed discharges, improve processes, and increase social care capacity.

HM Treasury

21 Conclusion Accepted

Facilitate integrated working between health and social care services to reduce delayed discharges.

Conclusion

We have previously noted that the fragility of the adult social care provider market was exacerbating the difficulties in discharging older patients from hospital.55 NHS England agreed that there is a clear challenge in social care. Different solutions are needed … Read more

Government Response Summary

The government agrees with the committee's findings, stating the recommendation has been implemented through an additional £1.6 billion investment and the Urgent and Emergency Care recovery plan, which funds services for rehabilitation, improves discharge processes, and increases adult social care capacity to address delayed discharges.

HM Treasury

22 Conclusion Accepted

NHS England's current discharge speed-up processes show inconsistent results across the country.

Conclusion

NHS England told us it had instructed the NHS to speed up discharge processes, for example by minimising waits for supporting services such as transport and medications. It was also asking hospitals to monitor patients more closely to assess whether … Read more

Government Response Summary

The government agrees with the committee's finding, stating the recommendation has been implemented through an additional £1.6 billion investment and a comprehensive Urgent and Emergency Care recovery plan to tackle delayed discharges, improve processes, and increase social care capacity.

HM Treasury