Analysis: Emergency care reforms delayed pending answers on social care

An announcement on a package of measures including setting out how a new high profile indicator for the accident and emergency system would work, a shake-up of 111 and out of hours services, and changes to ambulance response time measures, had been widely expected in recent weeks.

However, officials realise the recent major failings in A&E are closely linked to adult social care because of the impact on delayed transfers and bed capacity. This argument has rightly gained traction in the media, and ministers are now widely rumoured to be considering an intervention on social care.

There is speculation that ministers are preparing to announce some form of funding boost

HSJ understands system leaders felt announcing new emergency care targets, without also addressing social care or delayed transfers would (at best) go unnoticed and, at worst, be viewed by both the public and NHS staff as missing the point; a rearranging of the deck chairs with the iceberg looming.

The proposed emergency care package itself, though, is still on the table, and is still expected to prove significant when it arrives.

The centrepiece is likely to be the detail of the new A&E standard, which NHS Improvement is developing to combine the waiting time target with clinical standards and data on staff and patient experience.

As reported by HSJ in December, system leaders said they would retain the four hour target as the headline measure for A&E performance but the new metric would help “broaden oversight of A&E” and drive “greater focus” on the sickest patients.

HSJ understands that a drive to get more 111 calls answered by clinicians and make more efficient use of out of hours doctors has also been discussed; while the next steps may be taken to introduce more flexibility to ambulance service response targets.

Any messing with these high profile emergency targets will be sensitive – and tinkering with ambulance responses in particular will need to be done with care in light of the controversies which similar moves have attracted.

Little optimism

Meanwhile, what might we expect from a social care intervention, if it arrives? There is sustained speculation that ministers are preparing to announce some form of funding boost.

There is little optimism this will represent entirely new money injected into the system, but it could mean bringing forward some of an additional £1.5bn due to go into the better care fund later this Parliament.

Any funds are likely to come with strings attached from the Treasury

This is a move NHS England chief executive Simon Stevens and others have proposed for some time, so it would be welcomed, though not sufficient to solve the system’s ills.

The prime minister has stressed she believes the system of commissioning and providing social care needs more than money, however, and pointed to big performance variation between local authorities. So any funds are likely to come with strings attached from the Treasury, and new scrutiny from the centre. There will also be questions about how the funds might be distributed – past routes have proven clunky and bureaucratic.

The sector’s leaders hope they might get some clarity – and funding – from the spring budget on 8 March. The national better care fund policy framework for 2017-19, a document delayed since before Christmas, may also provide some clues if it arrives sooner.

Once the government makes its plans known, NHS England, with the Department of Health and NHS Improvement, will want to press on with their A&E reforms – but this is no guarantee of timing.

They could be made public at the time of the budget, in the Five Year Forward View “delivery plan” announcement scheduled later in March, or even shelved until the summer or autumn.