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A&E will be in permanent winter until shortfall in social care addressed

The Government urgently needs to address the underfunding of adult social care to relieve pressure on A&E departments, says a Health Committee report.

Unless the shortfall in social care provision is addressed, people will continue to face avoidable admission and delayed discharge from hospital the cross-party committee of MPs conclude.

For major emergency departments in 2015, only 88% of patients were admitted, transferred or discharged within 4 hours, well short of the national 95% target.

This figure masks great variation in the performance of trusts which cannot be explained by financial challenge, demographics and demand alone.

The current level of variation in meeting the four-hour waiting time standard is also due to differences in the way that trusts manage flows within hospitals, the report acknowledges.

It says whilst there are examples of excellent practice and systems alongside a culture of all staff supporting the A&E department because of its importance to patient safety, there are also examples of poor performance worsened by inadequate systems which have been allowed to continue for too long.

Some trusts are supporting patient flow out of their hospitals by creating their own services that provide social care in order to address the problem of delayed discharges.

These initiatives, it concludes, have a limited scope when trusts are themselves under such financial pressure. Investing in social and intermediate care should be a priority.

As identified by NHS England’s chief executive, emergency departments will struggle to manage demand unless additional infrastructure funding is made available to those struggling in inadequate premises.

It is essential that the Government ensures that sufficient capital funding is available for trusts to develop the infrastructure that will enable them to meet performance levels demanded by Ministers.

The first step will be an assessment of the infrastructure investment required to ensure that type 1 emergency departments are fit for purpose, which should be completed through the Sustainability and Transformation Plan process, the report says.

The Committee calls for NHS Improvement to consider the steps that it can take this winter to ensure that all A&E departments are properly staffed and for Health Education England to look again at the long term sustainability of staffing, including for paramedics, within major emergency departments and the ambulance service.

Dr Sarah Wollaston MP, Chair of the Health Committee, 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.”

President of the Royal College of Emergency Medicine, Dr Tajek Hassan, said: “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.

“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.”

Read the full report.

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