News / Funding for social care will relieve A&E pressure, MPs say

In a report on pressures in emergency departments, the committee of MPs added that some trusts were struggling to meet A&E performance targets because of inadequate premises.

The report, Winter pressures in accident and emergency departments, said 88% of patients were admitted, transferred or discharged within four hours in 2015 – the standard set by the government is 95%. However, there was ‘great variation’ in trust performance and this could not be explained by demography, financial challenge and demand alone.

The report insisted investment in social and intermediate care was a priority. Lack of community provision was a significant factor in winter NHS pressures in some areas. The MPs said they were frustrated that the Department of Health has yet to undertake the national benchmarking exercise, which would inform an assessment of the impact of social care cuts on A&E.

Tariff reform was overdue and the Department should set out a timetable for its delivery when responding to the report, the committee said. Payment should incentivise ambulance, hospital and community services to work together for the good of the patient.

‘This means developing payment mechanisms that will suppress demand by encouraging prevention, facilitating early intervention, limiting the escalation of morbidity and helping to ensure that patients are seen by the most appropriate professional at the right time and in the right place,’ it said.

However, trusts’ processes contributed to the variation in A&E performance. Though there were some good examples of managing patient flows with staff supporting the emergency department, the pressure on others was heightened by inadequate systems. Long waits to transfer patients from the care of ambulance staff to A&E were unacceptable and must be addressed, the committee said.

Trust initiatives to set up their own domiciliary care services to address delayed discharge had some effect, but this was limited given the financial pressure facing the provider sector. That trusts felt the need to set up the services ‘only served to underline the perilous state of adult social care in England and the fundamental inadequacy of provision in some parts of the country,’ the report said.

The committee repeated its call from earlier this week in a letter to the chancellor for an urgent review of adult social care and its impact on the NHS and the most vulnerable individuals who depend of both services.

It also urged NHS Improvement to consider the steps needed to ensure all A&Es are adequately staffed this winter. And it asked Health Education England to re-examine the long-term sustainability of staffing in major emergency departments and the ambulance service.

Committee chair Sarah Wollaston said: ‘Accident and emergency departments in England are managing unprecedented levels of demand. The pressures are now continuing year round without the traditional respite over the summer months as departments try to cope with increasing numbers of patients with complex needs.’

Izzi Seccombe, chairman of the Local Government Association's community wellbeing board, said councils must get a fairer share of health and care funding.

‘Councils have long argued that pumping money into the NHS while making cuts to adult social care is a false economy. Unless social care is properly funded, the NHS is in real danger of collapse.

In a report published this week, the LGA estimated social care for the elderly and disabled could be facing a potential funding gap of at least £2.6bn by the end of the decade. ‘Our own public polling has also found that two-thirds of people believe a greater share of the total health budget should be spent on care for the elderly and disabled, provided by councils.

‘Councils, care providers, charities, the NHS and the public are all united around the need for central government to fully fund adult social care. The government must use the Autumn Statement to provide councils with the funding to ensure we have a fair care system that keeps people out of hospital and living independent, dignified lives at home and in the community. This will then alleviate the pressure on the NHS.’