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Quality of NHS care too dependent postcode lottery, PAC finds

Quality of NHS care too dependent postcode lottery, PAC finds
By Jess Hacker
25 October 2023

The quality of patient’s access to urgent and emergency care ‘depends too much’ on where they live, the Public Accounts Committee (PAC) has said in a scathing assessment.

Regional variation in how patients access care is too wide, particularly in the case of ambulance response times, the PAC warned in a new report into urgent and emergency care access published this morning (25 October).

Ambulance services covering large rural areas, like the South West and East of England, are especially challenged, with response times for the most serious incidents varying from 6 minutes and 51 seconds in London to 10 minutes and 20 seconds in the South West in 2021/22.

The Committee also highlighted that not enough is being done to tackle delayed discharges, with beds unable to be released for new patients.

The PAC also called into question the ‘assumptions underpinning’ its plan to retain 130,000 staff over the next 15 years, particularly given the staff turnover rate in the health service was 9% in 2022/23.

And despite having ‘more money and staff than ever before’, the NHS has made ‘poor use of it’ to improve urgent access for patients with urgent and emergency services ‘deteriorating’ in spite of greater spend, it concluded.

It also flagged a 23% fall in NHS productivity following the Covid-19 pandemic, even though it had been improving pre-pandemic.

The PAC has now called on NHS England to set out its understanding of the causes for the fall in productivity and how it will address them.

Similarly, it urged NHS England to establish the causes for variation in performance, and how it might bring the ‘worst-performing organisations’ closer in-line to the standards achieved by the best.

Other key findings from the PAC’s inquiry include:

  • The number of patients staying in hospital despite no longer needing to be stood at an average of 13,623 in Q4 of 2022/23, up from 12,118 in the same period one year before
  • The NHS has not met its targets for ambulance handovers since November 2017, and since July 2015 for A&E waits
  • The Department of Health and Social Care (DHSC) has ‘not sufficiently held NHS England to account’ for meeting targets and improving urgent and emergency care.

Committee chair and Labour MP Dame Meg Hillier said: ‘Excluding demand-led spending such as welfare payments, health takes up approximately 40 per cent of day-to-day budgeted spending by Whitehall departments. It is vital this is delivering benefits for patients. The Government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.’

Responding to the inquiry report, NHS England’s national clinical director for urgent and emergency care, Professor Julian Redhead, said: ‘While this report includes data which is more than two years old and coincided with a once in a generation pandemic, it is right to note the NHS has been under increasing pressure with staff experiencing record A&E attendances, hospitals fuller than at any point in their history and with thousands of beds taken up each day, in part, due to pressures in social care.

‘It is testament to the hard work of staff and results of our NHS winter plan – rolling out 800 new ambulances, 10,000 virtual ward beds and work towards 5,000 extra core beds – that waiting times for ambulances, 999 calls and in A&E have improved across the country during this financial year.

‘This progress has come as the NHS has committed to delivering £12bn of annualised savings by 2024/25 – all while dealing with more than a 100,000 staff posts being vacant.’

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