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
| 
