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Emergency healthcare: a national emergency Contents

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Emergency healthcare: a national emergency

Chapter 1: Introduction

1.Access to emergency healthcare is in crisis. The situation is a national emergency. Delays and overcrowding are putting patients in danger and posing a serious risk to the sustainability of the National Health Service. There are two key causes of this: at the front door of hospitals, and the back. At the front door, demand on emergency services, including for the high-acuity (high-risk) cases, has risen dramatically over recent years. There has been an upswing in cases presenting at Accident and Emergency (A&E) which should have been addressed elsewhere, with substantial unmet need in primary and preventative care. At the back, it is very difficult to discharge patients into community or social care (these services either are not available or do not have capacity), so patients remain in beds which cannot then be used for A&E patients. This means ambulances wait longer to unload their patients and respond to the next 999 call.

Box 1: How should it be?

In a functioning health system, patients should be able to obtain reliable care at the “right place, right time”,2 accessing care in the community through, for example, their GP, a health visitor, or a pharmacist. When needed, patients should be able to access first aid or advice from services, including in the evenings and at weekends. Patients should be able to call a non-emergency service staffed by clinicians who could make a balanced judgement on what care was needed, not sending people to A&E or sending ambulances unnecessarily. Those who do need to access ambulances, or to visit A&E should be able to do so in a reasonable timeframe and be assured of safe treatment and swift admission into hospital if required.

2.Fault for the current situation in emergency healthcare does not lie with the staff. Health and care workers, wherever they are working, are doing challenging work for relatively little reward. The situation leaves staff overwhelmed and frustrated, with low job satisfaction; meaning they are more likely to leave and find work elsewhere.3

3.We set out on our inquiry to establish how the health service could ensure that decisions made at every level always had the welfare of patients at the forefront. We found an emergency service that was fragmented and lacking leadership, with a service model that no longer fits the reality of demand or clinical practice. This is characterised by outdated targets, a lack of clarity throughout the system, an over-cautious approach to triage, and missed opportunities to spread good practice and collaborate with other services. Above all, we found an unwillingness to take the action that is now absolutely necessary: to create a new operating model which takes account of how patients move through the health system and addresses the fundamental flaws which have created the situation we are currently facing.

4.Along with many others in the country and among civil society, this report makes recommendations which address the health system as a whole. We call for strategic leadership and a new operating model. These solutions will not be in effect overnight, but they must be begun now. We also encountered some specific areas where smaller changes could make a substantive difference, and have made recommendations on these, too. As has become ever clearer over recent months of media coverage, action on both are necessary.

5.Our last report, Fit for the Future? Rethinking the public services workforce, highlighted substantial staff shortages across the public sector, and looked at the need to develop a solid plan for the future workforce. We found then that efforts to address the problem were at far too small a scale. This inquiry has reaffirmed those findings.4

Our inquiry

6.We launched our inquiry on 22 September 2022. In addition to taking oral and written evidence and holding a private seminar, we held an online engagement event with front-line emergency staff and some senior leadership. We are grateful to all who helped us with this inquiry.

7.We began with the intention to examine the role of all emergency responders, and to establish what role collaboration between services could play in ensuring that decision making at every level always kept the interests of the patient paramount. As we progressed it became clear that the most acute issues were in emergency healthcare. Our report therefore reflects this, although some later chapters cover emergency services in general.

8.As our inquiry covers largely devolved matters, our recommendations apply primarily to England, although recommendations on policing in particular will be relevant in Wales. Others will be of interest to the devolved administrations more widely.

Box 2: An action plan for emergency health services

An emergency response: Recognising this is a national emergency, the Government should refer the crisis in emergency health services to a COBR Committee. Deliver care at the right place, right time: In the short term, boost the number of clinicians in 999 and 111 services so that patients are being directed to the right services at the right time. Unlock the gridlock: Incentivise faster safe discharges from hospitals and increase capacity in hospitals and social care to make sure people can move through the health system and do not end up stuck in ambulances or at A&E. Understand the problem: Data on A&E waiting times do not accurately reflect the patient experience. Performance data should accurately report the true waiting times experienced by patients so that decision makers have a clear picture of the problem, and so the public can hold them to account. Address unmet need: Boost capacity in hospitals and social care. Make it easier for patients to get care in the community both before they reach crisis point (preventing admissions) and following discharge. A new model for emergency health services: The Government must develop a new model for emergency health services which recognises the current crisis, the type of demand services face and clinical best practice and, for accountability purposes, sets out appropriate performance measures.

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