Published: 14/10/2004, Volume II4, No. 5927 Page 9

Emergency care networks, set up to promote whole-system working, have yet to reach maturity and many lack power and influence, according to National Audit Office report Improving Emergency Care.

The report's survey of 28 strategic health authorities found 105 networks in existence. Four SHAs had eight networks on their patch, but North Central London and North East London had none.

And one in three acute trusts was not a member of a network.

Nor were two ambulance trusts, the NAO estimated.

Emergency care networks were proposed in the NHS plan and expected to bring together all the different agencies involved in emergency care to drive forward modernisation and joint working.

Of 157 acute and ambulance trust chief executives who responded to the survey, one in 10 thought joint working was ineffective, while eight in 10 believed it was quite effective but could be done better. Only five acute chief executives thought joint work in their area was 'extremely effective'.

The NAO surveyed 90 networks and found that many do not include participation from all relevant parties. For example, only 17 had actively engaged users. Also, attendance was variable, especially by mental health representatives.

And there was confusion about their role and responsibilities and where they fit with other groups such as winter planning. Few networks were truly cross-organisational, the report noted.

National director for emergency access Professor Sir George Alberti, a champion of the networks, said:

'They are still developing. People are focusing now on hitting [the accident and emergency 98 per cent target]. After that we will be moving into a broader arena.'