Problem of pressure on emergency services won’t be solved overnight, government warns

BMJ 2013; 346 doi: (Published 25 June 2013) Cite this as: BMJ 2013;346:f4143
  1. Adrian O’Dowd
  1. 1London

Growing pressure on accident and emergency departments in hospitals in England could last for the foreseeable future, government officials have admitted to MPs, and there are no overnight solutions.

Health officials and the health minister Earl Howe appeared before the parliamentary health select committee on 25 June as part of its inquiry into emergency services and emergency care.

A review of urgent and emergency care review was announced in January,1 led by Bruce Keogh, medical director of NHS England, and an evidence base for that review was published last week.

MPs asked about the ongoing review of emergency services and whether naming a broad range of 12 priorities for commissioners in the year 2015-16, as part of that review, was too “blunt a message.”

Howe, the parliamentary undersecretary of state for quality at the Department of Health, giving evidence, said, “The broad range of priorities reflects our view that there is no single cause of the recent pressures on A&E. The causes were many and various.

“We have to address the problems in the short term, but this is very much a medium to long term issue. If one looks at the growth in pressure on A&E over the last few years, it is evident that this is not just a short term problem.

“Whilst looking at 2015-16 may seem like a long way away, we need that sort of run up in order to have the kinds of conversations that are necessary to make sure we’ve got a system that is configured properly.”

Fellow witness Keith Willett, national director for acute episodes of care at NHS England, said that the 12 were not so much priorities as “system design objectives” to be built on, criticised, discussed, and added to.

MPs asked officials about urgent care boards, local groups led by NHS England area teams and involving clinical commissioning groups, hospitals, and local authorities. These boards, announced in May,2 were specifically set up to tackle issues in the short term.

Willett said, “What we have to do for the winter that is coming is optimise the system that we have. We recognise the system we have at the moment is unsustainable, and we will need to make more substantial redesign.”

Keogh, also giving evidence, agreed, saying, “The current position with urgent and emergency care is unsustainable, and 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.”

MPs asked about the power and influence of the urgent care boards and whether they would have a long term future.

Fellow witness Barbara Hakin, interim chief operating officer and deputy chief executive at NHS England, said, “We have left these to local discretion. It varies as to what they do.

“We simply asked them [areas] to set them up. We haven’t as yet determined whether we would say they could cease. It seems to me to be a very good thing to do for patients.”

Mostly the boards would look at the “day to day” changes needed in an area to improve services for patients, Hakin added, but if they identified more substantial changes necessary, those would have to be referred back to clinical commissioning groups and health and wellbeing boards.


Cite this as: BMJ 2013;346:f4143


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