PAC report reveals regional disparities in access to emergency care

A new report by the Public Accounts Committee (PAC) shows a “depressing trend of deteriorating performance” within the NHS over the last decade, according to the BMA.

The report warns of wide regional variations in the quality of patients’ access to urgent and emergency care, with ambulance services in rural areas particularly challenged and disproportionately affected.

Indeed, average ambulance response times for serious incidents were roughly two and a half minutes slower in some rural areas such as the South West (10m 20s) compared to cities such as London (6m 51s).

999 call response times were also the slowest in the South West at 67.4s; this compares to 5.4s in the West Midlands.

High levels of staff ill health and turnover rates

The PAC is also warning that not enough is being done to tackle delayed discharges, with beds unable to be released for new patients.

The report found the number of patients staying in hospital despite being medically fit for discharge averaged at 13,623 across Q4 of 2022/23, up from 12,118 during the same period in 2021/22.

The report highlights a number of reasons for this, including:

• Problems discharging older patients from hospital into adult social care
• Delays in hospitals’ own discharge processes
• Delayed transfers from hospital to NHS community settings
• Delays in finding short-term care, nursing and residential care packages.

The report also highlights very high levels of staff ill health and turnover rates, with the PAC left unconvinced by NHSE’s approach to address workforce shortfalls.

NHSE hopes to retain 130,000 staff who would otherwise leave over the next 15 years, an aspiration which seems highly doubtful given multiple dependencies on other factors and unknowns.

The BMA says the PAC is “right to doubt” how far NHSE can achieve its optimistic assumptions about how many staff can be recruited and retained.

“We are currently in the middle of the most profound pay dispute in the history of the health service, and a horribly overstretched workforce is being asked to do more with less, with a projected shortfall of up to 360,000 staff by 2036 in NHS England,” said Prof Phil Banfield, BMA chair of council.

“Against such a backdrop, it is hard to see how the health service is going to recruit and retain the vast number of doctors required to make up shortfalls in their numbers.”

PAC says government must fully fund the NHS long term plan

Even NHS hospitals in areas with comparatively good performance are failing to meet targets, and the NHS has not met targets for ambulance handovers since November 2017 and for A&E waits since July 2015.

Given long-standing declines in performance, the PAC is not convinced NHS England has been sufficiently held to account for meeting targets and improving urgent and emergency care, an area in which the Government must improve.

NHS England’s National Clinical Director for Urgent and Emergency Care, Professor Julian Redhead, said while the report is “right to not the NHS has been under increasing pressure”, she emphasises that it includes data which is more than two years old and coincided with a “once in a generation pandemic”.

Prof Redhead said “it is testament to the hard work of staff and results of our NHS winter plan … that waiting times for ambulances, 999 calls and in A&E have improved across the country during this financial year.”

“This progress has come as the NHS has committed to delivering £12bn of annualised savings by 2024/25 – all while dealing with more than a 100,000 staff posts being vacant.”

The NHS Confederation says the government must now take a “system-wide approach” and provide proper funding for local communities, as well as providing funding for the NHS Long-Term Workforce Plan.

However, the BMA is warning that progress will be stunted unless the government makes an active effort to resolve the pay dispute with doctors, as only a “properly valued and fully staffed NHS is going to be able to make meaningful improvements to delayed discharges and unacceptable waiting times.”