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Spending Watchdog Paints a Gloomy Picture of NHS Urgent Care

Patient access to urgent and emergency care in England is deteriorating and the NHS faces a "significant challenge" to improve services as it grapples with increasing demand and record bed occupancy rates, according to an assessment by the Government spending watchdog.

The report, Access to unplanned or urgent care, published by the National Audit Office (NAO), found that the NHS had not met key operational standards in this arena since before the COVID-19 pandemic.

Time to 'Wake Up' to NHS Capacity Problems

Responding to the findings, Meg Hillier MP, chair of the Commons Public Accounts Committee, said it was time for the Government and NHS England (NHSE) to "wake up" to the severity of long-term declining performance trends. The Department of Health and Social Care (DHSC) insisted it was working to make sustained improvements in waiting times and hospital capacity.

The NAO report is designed to provide Parliament with a factual overview of NHS services for people in need of urgent, emergency, or other non-routine health services. It found that, despite the number of NHS staff having increased, backed by a total budget of £152.6 billion in the current financial year, and £28.4 billion more in real terms than for 2016-17, it had been unable to secure the full benefits, and had seen productivity drop since the pandemic.

It set out a range of problems faced by the NHS. Among them:

  • Record general and acute bed occupancy during the last quarter of 2022-23, with an average 92.3% occupancy rate
  • The NHS had not met its target for 95% of A&E patients to be admitted, transferred, or discharged within 4 hours of arrival since July 2015, and for patients at type 1 A&E departments it was June 2013
  • The NHS had not met its target to complete all ambulance handovers at hospitals within 30 minutes since it started collecting data in November 2017, whilst 25.9% of handovers exceeded that threshold in March 2023
  • The mean time for answering 999 calls for health issues was 88 seconds in December – an all-time high
  • 8.4 million calls to 111 were answered within 60 seconds in 2021-22, compared with 11.2 million to 13.3 million between 2014-15 and 2020-21 
  • Ambulance response times for category 2, 3, and 4 incidents rose after February 2021, and reached record highs in December 2022, before falling in the first months of 2023.

Patient satisfaction with GP appointment times reached their lowest levels in 2022, the NAO reported, with 55.2% expressing satisfaction in 2022, compared with 65.9% in 2018. Over the same period, dissatisfaction rates had increased 6.6%, to 23.5%. That was set against a background of rising patient demand for GP services, with 336 million appointments in 2022-23 – up from 285.3 million in 2018-19, the report noted.

Meanwhile, positive satisfaction rates with the 111 service fell from an average of 88.8% between 2011-12 and 2020-21 to 78.7% in 2021-22.

Rising Demand, Higher Costs, Worsening Patient Satisfaction

Comptroller and Auditor General, Gareth Davies, the head of the NAO, commented: "More people than ever before are receiving unplanned and urgent care, with NHS England spending increasing amounts of public money and employing record numbers of people. Yet patients' satisfaction and access to services have been worsening, suggesting there is no single, straightforward solution to improving a complex and interdependent system."

He said that while NHS England had a plan to improve services, "long-term trends in workforce, activity, spending, and performance indicate this will be a significant challenge."

Giving her response to the findings, Ms Hillier said: "Increasing demand for healthcare is pressuring a strained health service.

"The NHS has more funding and staff than ever before, but patient access to urgent and emergency care – both in hospitals and in the community – is deteriorating across a suite of measures, with this decline long predating the COVID-19 pandemic. It's clear more of the same won't work. The Department of Health and Social Care and NHS

England need to wake up to the severity of these long-term trends if they are going to give patients the service they deserve."

Long-term Workforce Planning

NHS Providers said a "growing mismatch" was evident between high demand and limited capacity in the system. Miriam Deakin, director of policy and strategy, commented: "This problem will continue until longstanding challenges including the need for better national workforce planning and better capital investment are properly resolved."

She said although trust leaders were working hard on solutions, "efforts need to be bolstered by action on a national level, including with the publication of the Government's long-awaited long-term workforce plan."

A spokesperson for the DHSC said : "We are working to achieve one of the fastest and longest sustained improvements in emergency waiting times in the NHS' history. The NHS' Urgent and Emergency Care Recovery Plan, includes getting 800 new ambulances on the road and increasing hospital capacity with an additional 5000 more beds, as well as delivering an extra 3000 virtual ward beds to safely care for people from home.

"The NAO acknowledges that there is no single solution to the complex challenges facing the NHS, but we are pleased it has recognised progress made in increasing staff working in urgent care, and providing tens of thousands more GP appointments."