The FTN’s new report, Emergency Care and Emergency Services 2013 – View from the frontline, shows that more than seven out of ten trusts (72%) believe the accident and emergency system is at a tipping point. Most trusts (62%) cite more demand as a factor, with four in ten (42%) naming more seriously ill patients and 32% pointing the finger at failures of primary and social care services.
Chris Hopson, chief executive of the FTN, said: “Over a hundred trusts responded to our survey, with the majority expressing deep concern about pressure on their A&E service. Our report is concrete evidence, highlighting the dangers facing the system unless each local health economy plans effectively for the coming winter.
“In the short term, we need urgent action to ensure that the A&E system is able to function effectively this coming winter. While we welcome the recent focus on developing local plans, these must be fully supported financially, drawing on funding from NHS England’s commissioning risk pool, with funding levels agreed by the end of June 2013. We must also create the right funding mechanism to support NHS providers, rather than penalise them. The 30% marginal tariff in A&E (for admissions over trusts’ 2008-9 level) is fundamentally flawed, and must be replaced as soon as possible.
“It is equally important that any short-term actions to stabilise the system should be consistent with the longer-term changes needed to address this complex issue, which covers the whole health and social care system.”
Respondents saw revised roles of community and primary care as fundamental to reducing demand on the A&E system. However, the majority lamented the lack of commissioner investment in out-of-hours, community and primary care services.The overall view was that until primary care was able to operate a 24/7 structure to match that of A&E, little will or can change.
While most respondents report engaging with their commissioners to address the pressures, overall they feel these discussions are taking a long time to translate into real change, or are being frustrated by a lack of incentives for commissioners to fund new and different care models.
Chris Hopson added: “Our members told us that on average, 25% of patients turning up to emergency departments could and should be treated elsewhere in the system. The wider NHS urgent and emergency care pathway is not working effectively. We need a longer-term, system-wide approach to tackle these issues. This requires fundamental redesign of the whole pathway, including appropriate investment in primary, community and social care services and much better patient signposting to these services.”