Urgent and emergency services - Health Committee Contents

1  Introduction

1. In January 2013 the NHS Commissioning Board Authority (now known as NHS England) announced that its Medical Director, Sir Bruce Keogh, would lead a review of urgent and emergency care services in England. The review, which will report in the autumn of 2013, is designed to determine how emergency care can be restructured in order to meet the demands of societal and demographic change. Soon after the announcement of the review evidence began to emerge that the problems facing NHS emergency care departments were becoming more acute.

2. In the first quarter of 2012-13, the majority of A&E departments failed to meet the headline four hour waiting time target. NHS England responded by publishing an improvement plan for A&E in May 2013. The plan set out how local providers and commissioners should respond to the challenges facing emergency care. Introducing the plan, NHS England said:

    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.[2]

3. In June 2013, NHS England published an evidence review and 12 design objectives for emergency and urgent care. This is to form the basis of their proposals for reform to be implemented from 2015-16. The review concluded that services are fragmented and that a lack of standardisation in urgent care makes it difficult for patients to understand alternative options to emergency departments. Additionally, it found that emergency departments rely too heavily on junior doctors and that there are insufficient middle grade and senior emergency consultants to meet staffing requirements on a seven day basis.[3] The design objectives were focussed on addressing these fundamental flaws.

4. Introducing NHS England's approach to the problems, Sir Bruce Keogh told us that:

    One thing everybody is agreed on is that the current position of urgent and emergency care is unsustainable and we need to do something. We need to do some things in the short term to address the immediate issues, and then we need to take a longer, more considered and deliberate view about how we address the future. [...]

    When A and Es were set up a few decades ago, or DGHs (District General Hospitals) came into their own, people could walk in with a problem and most DGHs were capable of dealing with it. But the inexorable advance of medical science means that now there are many common conditions that cannot be treated in an average DGH.[4]

5. We report on the Committee's inquiry into urgent and emergency services. We took evidence from Rt Hon Earl Howe, Parliamentary Under-Secretary of State for Quality, Department of Health, Professor Sir Bruce Keogh KBE, Medical Director, Dame Barbara Hakin, Chief Operating Officer and Deputy Chief Executive and Professor Keith Willett, National Director for Acute Episodes of Care, NHS England, Mike Farrar, Chief Executive, NHS Confederation, Dr Patrick Cadigan, Registrar, Royal College of Physicians, Dr Mike Clancy, President, College of Emergency Medicine, Anthony Marsh, Chair, The Association of Ambulance Chief Executives & Chief Executive of West Midlands Ambulance Service NHS Foundation Trust, Mark Docherty, Chair, National Ambulance Commissioners Group, Dr Clare Gerada, Chair, Royal College of General Practitioners and Andrew Webster, Associate Director Integrated Care, Local Government Association.

6. In a separate evidence session the Committee also took evidence on questions related to this inquiry from Rt Hon Jeremy Hunt MP, Secretary of State for Health and Sir David Nicholson KCB CBE, Chief Executive of NHS England.

Terminology used within this report

7. Outlined below are the types of accident and emergency department by the service performed:

i.  Type 1: Emergency departments which offer a consultant-led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients.

ii.  Type 2: Consultant-led accident and emergency services which offer emergency care in a single specialty (e.g. ophthalmology, dental) with designated accommodation for the reception of patients.

iii.  Type 3: Other types of A&E/minor injury activity with designated accommodation for the reception of patients. These departments may be doctor led or nurse led and can be routinely accessed without appointment. A service which is mainly or entirely appointment-based (for example a GP Practice or Out-Patient Clinic) is excluded even though it may treat a number of patients with minor illness or injury. The category also excludes NHS walk-in centres.

iv.  Type 4: NHS walk in centres which supply a primary care service that does not require an appointment and is not included in the data collection for A&E attendances and admissions.[5]

8. Type 3 urgent care centres and minor-injury units are often colloquially referred to as 'walk-in centres', but this obscures the differences in purpose between the different types of service. With the exception of quotations, for the purposes of clarity within this report the term 'walk-in centre' will only be used specifically in relation to type 4 services.

9. The term 'accident and emergency' has become interchangeable with the term 'emergency department'. In this report 'emergency department' will be used specifically in relation to type 1, consultant led A&E departments. 'A&E department' is only used to describe type 1, 2 and 3 services collectively or in direct quotation of witnesses.

2   Improving A&E Performance, NHS England, May 2013, p 1 Back

3   NHS England, the Evidence Base from the Urgent and Emergency Care Review, June 2013, p 11-12 Back

4   Uncorrected transcript of oral evidence taken before the Health Committee on 2 July 2013, (HC 2013-14), HC-119-iii, Q 217 Back

5   http://www.datadictionary.nhs.uk/data_dictionary/attributes/a/acc/accident_and_emergency_department_type_de.asp?shownav=1 Back

previous page contents next page

© Parliamentary copyright 2013
Prepared 24 July 2013