04.03.14
‘Chronic shortage’ of specialist A&E consultants
The Public Accounts Committee says it is “amazing” that the DH and NHS England lack a clear strategy to tackle the critical shortage of A&E consultants, without which services will struggle to improve.
Committee chair Margaret Hodge MP said: “There is too much reliance on temporary staff to fill gaps. This is expensive and just does not offer the same quality of service. Struggling hospitals, such as those placed in special measures, find it even harder to attract and retain consultants. There are currently no incentive payments to make working in these hospitals a more attractive prospect.”
The committee’s new report on emergency admissions at English hospitals argues that no-one is clearly accountable for overall performance on this issue, or who should intervene when local provision is ineffective.
It says: “Delivery is fragmented, and the health sector does not consistently work together in a cohesive way to secure savings, better value and a better service for patients. Urgent care working groups, which have been established to create better integration, have no powers and are overly reliant on the good will of all those involved.”
It recommends that the DH confirms its overall responsibility and steps in proactively, that new financial incentives are offered, and that the DH, NHS England and Monitor review the whole urgent care funding model. The whole system needs a strategy for the future, the MPs say. They add: “The Department should evaluate promptly the impact of additional winter pressure money allocated for 2013-14 and the timing of when the money became available, and use this analysis to inform the early and effective allocation of this fund in 2014-15.
“We welcome the proposed shift to 24/7 consultant cover in hospitals, but are concerned about the slow pace of implementation and the lack of clarity over affordability. The introduction of round-the-clock consultancy care will start with A&E services, but will not be in place before the end of 2016-17. Round-the-clock hospital services are intended to reduce weekend mortality rates and make more efficient use of NHS assets and facilities. However, its implementation will rely on the BMA and NHS Employers negotiating a more flexible consultants’ contract, and neither the Department nor NHS England has direct control over the timescale or details of these negotiations.”
Chris Ham, chief executive at The King’s Fund, said: “Emergency admissions have been increasing for some time and have risen sharply this winter. Reducing emergency admissions has long been a goal for the NHS – avoidable admissions add to pressures on hospitals and can be disruptive and unsettling for patients.
“Reducing emergency admissions will become even more important when the Better Care Fund is introduced in 2015. The Fund is an opportunity to drive forward integrated care but will increase financial pressures on hospitals at a time when many are already running up deficits. NHS England has estimated that a 15% reduction in emergency activity will be needed to pay for the Fund – this suggests that many hospitals could be tipped into financial crisis unless admissions can be significantly reduced.
“Our work shows there are opportunities to reduce emergency admissions among older people and by tackling variations in admissions for conditions that can be treated outside hospital. This requires radical changes to services to provide integrated care that better meet the needs of patients, closer to their homes. In particular, general practices need to work together at scale and with other health and social care professionals to provide a much wider range of services outside hospitals.
“The Committee is right to highlight shortages of A&E consultants. While forecasts suggest a general over-supply of hospital doctors in future, shortages are developing in key specialities including A&E. We support the use of financial incentives as part of the strategy for addressing this.”
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