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Many hospitals are struggling to cope with increasing levels of demand for accident and emergency (A&E) services when budgets are coming under increasing pressure. Bed occupancy rates across hospitals continue to rise year-on-year and the ambulance service is also under stress. While all parts of the health system have a role to play in reducing avoidable emergency admissions and helping to manage more effectively those people who are admitted to hospital, financial incentives across the system are not aligned so attempts to ensure patients are treated without coming to accident and emergency departments are not yet working. The improvement of A&E services is hampered by the lack of specialist A&E consultants, the slow introduction of round-the-clock consultant cover in hospitals and a lack of quality performance data. Accountability and responsibility for driving the changes needed remain diffuse and unclear. Without this clarity, the service transformation vital to coping with constrained NHS budgets will not be achieved in the necessary timescale.
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