Emergency health services are in crisis: Lords urge Government to address issues in a COBRA Committee

This is the conclusion of a report by the cross-party House of Lords Public Services Committee published today “Emergency healthcare: a national emergency” which recommends that the Government refer the crisis to a COBRA Committee (convened specifically to handle matters of national emergency or major disruption).

The report argues that the substantial delays featured extensively in the news over recent months have arisen from a broken model for primary and community care. Unmet need in community and primary care drives patients to hospital; and many are remaining in hospital longer than clinically necessary because there is inadequate social care if they are discharged. Recent funding injections for social care will not fully address this problem: the solution is a bold new operating model for the system as a whole.

The Committee heard powerful evidence that the crisis has left staff feeling overworked, disillusioned and frustrated with many looking for jobs elsewhere. The Committee’s July 2022 report, Fit for the Future? Rethinking the public services workforce highlighted substantial staff shortages and called for a solid plan for the future workforce. Efforts to address the problem were at far too small a scale and this remains unchanged. 

In addition to the calls for an emergency COBRA response from Government, the Committee’s action plan recommends;

• A call for the delivery of care at the right place, right time. Clinical staff deployed in call centres results in better triaging of calls meaning less patients are passed to emergency or urgent care services.  In the short term, the number of clinicians in 999 and 111 services should be increased so that patients are being directed to the right services at the right time.  The Department of Health and Social Care should mandate a greater presence of clinical staff in NHS 111 control centres.
  
  
• Unlocking the gridlock: Incentivise faster safe discharges from hospitals and increase capacity in hospitals and social care to make sure people can move through the health system and do not end up stuck in ambulances or at A&E. The Government should introduce further incentives to enable discharge at the right time for patients, freeing up hospital capacity.
  Clearer data to understand the problem: The current data published by NHS England on emergency department waiting times was described as “fundamentally dishonest”. It inaccurately portrays the true waiting times experienced by patients attending A&E. NHS England should publish monthly the number and proportion of patients waiting 12 hours or more from arrival at accident and emergency departments so that performance data accurately reflects the true waiting times experienced by patients. This information would present decision makers with a clear picture of the problem and a path to finding suitable solutions.  It would also provide increased public accountability.
  
  
• Addressing unmet need: Patients are often not being discharged when they are clinically ready, remaining in hospital for longer than they need to (with associated risk of infection). This leads to a shortage of available beds in hospital wards for patients to be admitted from A&E, leading to crowding and long waiting times. The crisis in emergency healthcare is a symptom of fundamental weaknesses arising from inadequate capacity across primary, community, and hospital and social care settings.
  
  
• A new model for emergency health services: Emergency and urgent care services are working to an outdated operating model which no longer reflects the reality of demand or clinical practice. Persisting with this outdated model will not allow services to deliver the care that patients need. New structures have potential to make significant improvements, but there is little clarity around how they will operate effectively and meet the high expectations placed on them to deliver these improvements. They will also need more leadership from the centre than is currently envisaged. The Government should establish a bold and ambitious new operating model for emergency healthcare that addresses pressures throughout the system. The model should provide strong leadership to reflect increasing demands for, and new ways of delivering emergency health services with clear expectations and arrangements for collaboration across emergency services. In addition, there should be appropriate performance measures to ensure accountability and better ways to share and encourage the implementation of best practice.

Baroness Armstrong of Hill Top, Chair of the Public Services Committee said;

“Increased pressures on the NHS and across the health and social care sector are not new, especially during wintertime and we were aware of this when we started this inquiry in September. We could not have envisaged the extent and the severity of the current crisis, which some estimates suggest is causing 500 additional deaths per week.

“The problems have been widely discussed, and it is time for solutions. The models for community and primary care are broken, and a new approach is needed. Our recommendations are for both the immediate, and the longer term and are more relevant than ever.

“We know what a functioning health system should look like. People should be able to obtain reliable care at the right place, right time, and access care in the community through a GP, a health visitor, or a pharmacist whenever it is required including in the evenings and at weekends. Patients should be able to call a non-emergency service staffed by clinicians who are able to make a balanced judgement on what care is needed and avoid sending people to A&E or sending ambulances unnecessarily. Those who do need to access ambulances, or to visit A&E should be able to do so in a reasonable timeframe and be assured of safe treatment and swift admission into hospital if required. At the moment, the health service is delivering the very opposite of this model.

“In the first instance we have called on the Government to treat this crisis with the urgency it deserves and address it as a national emergency. A referral for consideration by a COBRA Committee is the only appropriate way to begin to remedy the crises and we urge the Government to take this first step and follow the other recommendations in our report.”