Health Select Committee report on urgent care shows need for radical reform

Today’s Health Select Committee report on Urgent and Emergency Care Services follows a well-trodden path and for its authors must have felt like a paper they could have drafted before seeing their first witness. This is because the problems of urgent and emergency care services stem from the fact that this ‘last line of defence’ is far too often being called upon to provide support to patients who could much more effectively have been treated in the community and who turn up at A&E because they don’t know where else to go. They’re like the San Marino goalkeeper playing against World Champions Spain – however well they play they know full well that they simply won’t be able to cope with what’s thrown at them.

What is doubly frustrating is the fact that this crisis has been one which the NHS has been grappling with for years. In January 2006 the Labour Government produced the Our Health Our Care Our Say White Paper committing to a ‘new approach for community services’. It said that ‘a strategy built on high-cost hospitals will be inefficient and unaffordable’ and committed the NHS to a strategy of improving access to primary and community care, to supporting those with long-term conditions outside of the hospital and to reforming funding to enable step-down care to improve. This followed on from the 2002 Wanless report which painted a bleak picture of rising costs and higher mortality if patient engagement and radical reform were not to happen.

More than a decade on from Wanless we have seen policy changes that have attempted to meet the 2006 White Paper’s objectives, several of which, such as the marginal tariff, are referenced in the Select Committee’s report. Unfortunately however simply penalising Trusts for having too many patients coming through their doors merely serves to starve the system of resource and places even greater pressure on the managerial and clinical staff working 24/7 to meet the unplanned needs of patients.

What is now needed is radical reform rather than tinkering around the edges. All parts of the NHS must work together to look at what improvements are needed in primary, community and homecare to begin to move towards a situation where patients themselves both know where the best point of access is and how to navigate their way towards it. If this means taking risks with new models of care or different types of providers then so be it. For what is clear today is that, following many, many reviews, reports and White Papers, that our ailing urgent and emergency care system will simply collapse if radical surgery is not applied.


David Hare