NHS ‘must clear up confusion’ to ease pressure on A&E units

Widespread fragmentation and different names given to urgent care are causing confusion, leading to patients presenting at services which might not best suit their needs, a review has found.

“Urgent care services are characterised by variation and a lack of standardisation and clear information. This contrasts with the strong identity of A&E departments,” it said.

“Variation in acceptance and quality of care provided can result in delayed treatment or multiple contacts and a poor experience of care, as well as inefficient use of expertise and resources.”

Other factors affecting A&E units included variations in access to primary care services leading to many patients attending urgent and emergency care for conditions that could be treated at the GP surgery, the report found.

There is also a variation in the management of patients with long-term conditions in primary care. Some patients lack confidence in telephone advice and are likely to pursue a second opinion “inappropriately”, it added.

Sir Bruce Keogh, medical director for NHS England, who is leading the review, said better communication could reduce unnecessary demands on A&E.

“The current concerns around A&E performance should be seen as a stimulus and opportunity to improve the way we offer care between our hospitals, primary and community care and social services,” he said in a foreword to the report.

“Better integration and communication between these services could reduce unnecessary attendances at A&E and enable people in hospital to return home sooner. This in turn could free up hospital beds so patients who need admission from A&E would not be kept waiting so long.”

British Medical Association chairman Mark Porter said: “Spending on healthcare is squeezed, patient demand is rising and staffing levels are inadequate. So far the Government’s response to this has been overly simplistic, with the blame being put squarely on individual parts of the health service.

“We look forward to working with the review team to find a solution that enables NHS services to work together to provide the appropriate access to the care patients need.”

Meanwhile, health chiefs have announced information from patients, including whistleblowers, will play a key role in triggering new inspections of hospitals under proposals to overhaul the way health and social care is regulated.

The views of people who use services will become “one of the most important” sources of information used by new specialist teams when deciding which hospitals to inspect, the Care Quality Commission (CQC) said.

CQC chairman David Prior said: “We have not been looking at the right things when we have inspected hospitals and we have not had the right level of clinical expertise to get under the skin of organisations. These proposals firmly put patients at the heart of what we do.

“It should mean that when someone goes into hospital they have confidence that the hospital is getting the basic aspects of care right – the kind of care we all have a right to expect.

“Our inspectors will focus on things that are meaningful to people, not on bureaucratic processes. They will not tick boxes but miss the point.”

Under the proposals, CQC surveillance teams will assess risk based on information including details of mortality rates, “never” events – serious, largely preventable incidents – and results from staff and patient surveys, as well as information from the public.

This information could trigger action by inspectors who would judge a service using five key questions on whether a service is safe, effective, caring, responsive to people’s needs and well-led.

Mike Farrar, chief executive of the NHS Confederation, said: “Regulators and other national organisations must be careful that new proposals do not create a duplication of information, taking up valuable staff time and diverting resources away from care – that is in no one’s interest.”