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Emergency care is a postcode lottery, MPs warn NHS England

The Public Accounts Committee has warned of stark regional variations in access to urgent health services.

By Zoë Grünewald

There are alarming disparities in access to urgent and emergency care across different regions in the UK, according to a report published today, 25 October, by a committee of MPs.

The Public Accounts Committee (PAC) has released its report following an inquiry into access to emergency and urgent care. The committee found that as well as wide variations in ambulance response times, delayed hospital discharges is a pressing issue. It expresses concerns over the long-term sustainability of the NHS‘s workforce.

The report reveals a “postcode lottery” of ambulance waiting times in large rural areas, particularly in the south-west and east of England. The average ambulance response times for the most serious incidents ranged from six minutes and 51 seconds in London, to ten minutes and 20 seconds in the south-west during 2021-22. Similarly, 999 call response times varied from 5.4 seconds in the West Midlands to a staggering 67.4 seconds in the south-west.

As a result, the committee recommends that NHS England should “clearly set out the causes of variation in performance, and the specific initiatives it takes responsibility for to bring the worst-performing organisations closer to the standards being achieved by the best”.

The report also highlights how the crisis is exacerbated by the alarming increase in delayed hospital discharges. The number of patients remaining in hospitals despite being medically fit to leave rose from 12,118 in the last quarter (October to December) of 2021-22 to 13,623 in the same period of 2022-23. The report identifies various reasons for this, including challenges in discharging older patients into adult social care, internal hospital processes, transfers to NHS community settings, and the provision of short-term care packages or nursing and residential care.

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The committee expressed concern over the “unfunded and uncosted” NHS long-term workforce plan. The report warns that its allocation of an additional £2.4bn for training costs over the first five years of its 15-year span might lead to unsustainable financial pressures.

The workforce plan aims to retain 130,000 staff who would otherwise leave the NHS over the next 15 years, but the PAC questions the feasibility of this aim, considering high levels of ill health among staff, high turnover rates and dependencies on various other factors. The committee has therefore asked NHS England to provide an update to the committee of the full expected cost.

Finally, the committee raised concerns over the productivity of the NHS, stating that the “NHS has more money and staff than ever before but has made poor use of it to improve access for patients when they are in urgent need”. The committee suggested that the NHS has not provided enough “meaningful detail” about how it plans to improve staff productivity in the coming years. It wants reassurances from NHS England that it will address these concerns.

Meg Hillier MP, chair of the PAC, emphasised the urgency of addressing the crisis: “Anyone who has had recent contact with the NHS knows it is in crisis,” she said. “Patients suffering long waits and hard-pressed staff working in a system which is not delivering deserve better.

“The government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.”

[See also: The NHS workforce may have grown but so have its vacancies]

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