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“We need an A&E transformation fund and much improved funding of social care”

Richard Humphries, Assistant Director of Policy at The King’s Fund

We welcome the Health Select Committee’s report which highlights the increasing pressures on A&E services.

Demand is increasing and the numbers of patients medically fit to be discharged but still in hospital has reached record levels. This increase has mainly been driven by delays in arranging social care for people who need support when they leave hospital, a direct result of year after year of cuts in social care funding.

As well as unnecessarily occupying beds for patients who need them, this is taking a huge toll on the older people affected, their families and carers and the cost of delayed discharge for older people is over £800 million a year.

The top priority for the Autumn Statement later this month must be to increase funding for social care. It defies all sense and reason that social care spending will slip back to less than one per cent of GDP by the end of the parliament when the number of older and disabled people is increasing and pressures on other parts of the system are rising.

We also need a shift in the way that services are provided towards primary and community health services so that people don’t end up in A&E in the first place. While this report once again highlights the huge pressures facing the health and care system, it should also be a wake-up call for local services to work together to improve performance.

Dr Tajek Hassan, President of the Royal College of Emergency Medicine

We greatly welcome and fully endorse the findings of the Health Select Committee’s report into winter pressure.

For some time we have warned about the effect that cuts to social care is having on emergency department performance and we have seen the situation worsen each year.

Whereas traditionally winter would be a busy period, the system would always, to an extent, recover. We are now failing to see recovery with almost year round pressure resulting in delays and overcrowding.

This overcrowding is due to exit block which we know can be fatal to patients – lengthy waits in emergency departments are associated with increased deaths, lack of dignified care and stressful working conditions.

Exit block occurs when there is a lack of access to hospital beds and then when patients are delayed from getting back into the community – cuts to social care provision mean that there is nowhere for them to go.

The recent CQC report into the state of care also highlighted this problem, and with an ageing population with increasingly complex needs, attendances at emergency departments will increase further unless action is taken.

The increase in attendances in the last 5 years is equivalent to the workload of 10 extra medium sized departments in England alone, yet we have the lowest number of beds per capita in Europe. The recent suggestion that the forthcoming Sustainability & Transformation Plans (STPs) will look to remove more beds and close departments will, if true, only exacerbate the problem.

We also estimate that the country is short of at least 2000 A&E doctors. At present there is only one consultant for every 11,000 attendances, and yet we spend £703m on locums to patch the system rather than plan well for the future.

There are marginal gains to be made by individual departments to help ease pressure – learning from hospitals that are managing flow well and the sharing of best practice around system design, maintaining safety and supporting staff to work sustainably in the intense ED environment, is crucial in such challenging circumstances.

But this alone will not be enough to fix emergency medicine and the system cannot go on like this. We cannot continue to resource emergency departments for the demand that is hoped for instead of the demand that we actually face, which is why we are calling for an A&E transformation fund and for the correct funding of social care.

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