• Clifford Mann says extra social care cash needs to go on DTOCs or NHS won’t meet A&E goal
  • NHS England A&E lead says huge boost in emergency staff needed
  • Mann urges HEE to extend emergency medicine recuitment programme

NHS bosses must persuade councils to spend £100m of new social care cash this year on reducing delayed discharges or acute trusts will fail to meet the emergency waiting time target, a national leader has warned.

NHS England clinical lead for accident and emergency Clifford Mann also raised concerns about accident and emergency staffing numbers and urged Health Education England to extend its emergency medicine recruitment programme.

Dr Mann was speaking to HSJ in his first interview since being appointed joint clinical lead for emergency medicine under the Getting It Right First Time programme, announced last week.

He said NHS England’s key pledge to hit the four hour waiting time target system-wide by next year was “realistic” – but he warned it was contingent on support from council run social care services and addressing major staffing issues.

Dr Mann said: “It’s said that when social care gets a cold the NHS gets pneumonia… This relatively small proportion [of the overall £1bn fund] towards delayed transfers of care could produce a significant impact. If [that does not happen and] there is not a reduction in DTOCs, it will not be possible to hit the A&E target as planned.”

He added: “Across the system we need about 2,000 to 3,000 extra beds compared to last year. We probably need of the order of 15 to 20 patients per hospital which were the subject of social care related DTOCs [last winter] to not be subject this year. That [would cost] around £100m of the £1bn allocated.”

The extra £2bn of social care funding was allocated in the spring budget, £1bn for this year and the same next year.

However, as it is under local government control, there is no guarantee it will be spent on speeding up hospital discharges, as hoped by the NHS. There have been concerns it will instead be used to plug holes in existing services.

Dr Mann said he did not know how much progress had been made on the matter to date. HSJ has been told system leaders are aiming to persuade councils to spend over three times that amount on DTOCs and that negotiations are ongoing ahead of the critical winter period.

The other major challenges facing A&E were largely around staffing, he said. The existing £150m locum bill – “enough to double the number of consultants” – was a huge issue, as was the overall shortage of consultants and other emergency medicine staff.

He said “at a conservative estimate we are 50 per cent short of the [consultant] numbers” the NHS needs. He urged Health Education England to extend its emergency medicine recruitment programme.

He said NHS A&Es had an average of about six consultants per department but there was wide variation. However, “at an absolute minimum, you need 10 to run a [full] rota, or more if you have a big department or major trauma centre”, he added.

He said HEE’s recruitment programme, originally funded for three years from 2013 to 2016, had been “extremely successful” in boosting numbers of emergency medicine trainees from 225 to 300 a year.

Dr Mann said ending the programme now would be “premature”. It would need to run for “at least six [more] years” at the current rate to get to the required levels, he said. Asked about NHS England’s system-wide audit on bed capacity, he said it was a “really good idea” because there was a lack of “lack sufficient granularity” around the existing data.

He added: “We need better bed availability [but that does not definitely mean more beds]. We have good data to suggest that 30 to 40 patients in winter in an average hospital don’t need to be there. So, we either have to build more beds, or do the right thing, and move those people out of hospital, in which case we don’t need more beds.”

Dr Mann, who is also an emergency medicine consultant at Taunton and Somerset Foundation Trust, said the new GIRFT A&E work would focus on measuring staffing resource and outcomes. Alongside co-lead Chris Moulton, vice president of the Royal College of Emergency Medicine, he will visit all 184 type one A&Es as part of the study into efficiency and unwarranted variation.