‘Disjointed’ emergency care wasting time and creating confusion

EMERGENCY care in the Welsh NHS is “disjointed and confusing”, according to a damning report published today.

Too many people who have urgent reasons to access the NHS or social services encounter inefficiency, uncertainty and delays, says the report by the Wales Audit Office.

The report into so-called “unscheduled care” – which covers all NHS care above and beyond routine appointments – identifies a “fundamental weakness” in a failure to plan for demand on services.

One solution to the problem, according to Auditor-General Jeremy Colman, is to show people how they can have their needs met more effectively elsewhere, rather than heading straight to hospital A&E departments.

It recommends that Wales’ new Local Health Boards (LHBs) should take the lead in redesigning the system of “unscheduled care”.

This covers incidents ranging from emergency hospital treatment, 999 ambulance services or urgent appointments with a GP.

The report says: “The emergency department is commonly a bottleneck where people can face delays but only some of the delays are due to the management of the department itself.

“Very often, the delays in emergency departments are because of problems elsewhere in the hospital or at the interface between the hospital and community-based health and social care services.”

But at present, there are not enough community-based services for people to have genuine alternatives to acute care.

The authors are concerned that the unnecessary use of acute services leads to “avoidable hospital admissions” which put people at risk of infections which can result in loss of independence.

The report insists LHBs must match their staffing to meet demand.

It also calls on the Assembly Government to develop a national communication strategy to help the public understand how best to access the services they need. There is the further demand that health and local government organisations should join up their information systems across health and social care.

The Wales Audit Office warns there is a “disjointed pattern” to services.

It claims: “The system is complex so that people are uncertain about how and where to seek help, often resulting in people unnecessarily calling 999 or attending a hospital emergency department… For example, a person suffering a minor injury may have a choice of attending an emergency department or minor injury unit, going to see their GP, phoning NHS Direct Wales or caring for themselves.”

Particular problems take place during out-of-hours periods.

It states: “The range of services can even be confusing for professionals.”

However, the authors of the report found user surveys showed high satisfaction levels for hospital emergency departments, surgeries and ambulance services.

Nevertheless, they also highlight there is little understanding of the cost of running the system in its present form.

The report claims: “We estimate that the absolute minimum annual cost of providing unscheduled care in Wales is £256m.”

It warns that the lack of progress on calculating changes in costs “is especially serious in the current and projected fiscal climate” and calls for “radically new models” to deliver care.

The authors are concerned that when ambulance crews are delayed at emergency departments, fewer crews are available to respond to 999 calls.

In the 12 months leading up to July 31 this year, ambulance crews spent 38,536 hours waiting at hospital emergency departments beyond the 20-minute target to complete the handover.

These delays have an estimated direct cost of more than £2.9m.

Mr Colman added that providing care outside of normal surgery hours would not improve unless it was planned as a complete system.

The health service needed to be made easier for the public to understand and use by linking up different services effectively.

This was more important than considering access to particular parts of a unco-ordinated system.

Richard Jones, deputy director of nursing organisation RCN Wales, welcomed the report and hoped it would create the momentum for change.

He said: “Emergency care has for a long time been a source of concern for us. Obviously, it’s a highly-pressured role that members find themselves in.

“With the NHS reorganisation, there is a great and unparalleled opportunity to improve emergency care across Wales.”

He said he had genuine hopes long-standing problems could be addressed and solved, saying: “I hope it will be taken by the LHBs as a whole to move forward.

“They should be developing their own action plans to implement this. I think, with perseverance, we will get it much more right than we have got it at the moment, to be honest.”

Jonathan Morgan, the chairman of the National Assembly’s public accounts committee, said: “There are valuable lessons to be learned from this report. Delivery of unscheduled care will not improve unless it is seen and planned as a whole system.

“Making the system easier for the public to use and linking up the current services more effectively are more important than focusing on access to particular parts.”

Andrew RT Davies, the Conservative Shadow Health Minister, said: “The report tells us what every good organisation should already understand – that good communication is vital to service delivery. Regrettably, in the Welsh NHS this has not always been the case and patients and health professionals have very often found themselves working in a void when providing emergency health care services.”