Access to urgent and emergency care – Report Summary

Summary

NHS services for urgent and emergency care have been under pressure for many years. Staff who went above and beyond during COVID have been let down by a system which has seen performance for these services fall far below the standard the NHS says patients should expect and receive. The NHS’s own target for A&E waits has not been met since 2015 and its target for ambulance handovers has never been met since it began reporting against this metric in 2017. The quality of service that patients can receive, for example, with regards to the speed of ambulance response or the length of A&E wait, still depends far too much on where they happen to live. There has also been too little progress in tackling delayed discharges, which have serious knock-on impacts throughout the whole urgent and emergency care system, with not enough being done to address the systemic issues with discharges that lie within the gift of the NHS and its hospitals, and which cannot be blamed on external factors.

The poorer performance for patients has been against a background where the NHS has more staff and money than ever before. But NHS productivity fell by 23% over the two years 2019–20 and 2020–21, after it had been improving before the COVID-19 pandemic, and NHS England needs to reverse that decline urgently. Investing in technology will be critical to improving productivity but the Department has not budgeted for this, and NHS England’s existing plans lack haste. Given the long-standing declines in both productivity and performance, we are not convinced that the Department is doing enough to effectively hold NHS England to account for making improvements.

The Department and NHS England have set out ambitious plans to recover services and improve patients’ access and experience, but there are significant assumptions and uncertainties attached to these plans. NHS England’s recently published workforce plan maps out NHS staff requirements for the next 15 years, but only has funding of £2.4 billion confirmed by government to cover the costs of training in the first five years. There are also many other areas of expenditure that will be critical to the plan’s success, such as on salaries, estates, and infrastructure, which currently lack any meaningful detail or commitment. In the absence of clarity and assurance on sufficient funding in the medium- and long-term, there is a real risk that the lofty ambitions of the workforce plan may build in unsustainable financial pressure for the NHS in future years.