Emergency care problems linked to poor relationships, finds south of England review

NHS South of England, the now abolished strategic health authority cluster, commissioned the King’s Fund to review urgent and emergency systems across the region.

Researchers analysed data from between September 2011 to August 2012 and interviewed key figures in several health economies, as well as members of the national emergency care intensive support team.

They found “significant” variation on a range of performance indicators but could not identify a consistent relationship with the characteristics of the health economy or provider.

For example, Devon, the area with the most GPs relative to population, had a third more A&E admissions than the Isle of Wight, which has the fewest GPs.

Researchers also found variation in the proportion of those attending A&E who were admitted, ranging from 14 per cent at Taunton and Somerset Foundation Trust to 46 per cent at Northern Devon Healthcare Trust, with an average of 22 per cent.

The review found that an average of around a fifth of emergency admissions were made between three-and-a-half and four hours of arrival – just within the national target.

The proportion admitted in this period ranged from 30 per cent at Royal United Hospital Bath to 6 per cent at Royal Bournemouth and Christchurch Foundation Trust and Northern Devon.

The report said some hospitals appeared to be “using this as a technique to hit the target”.

The report concluded there was an association between poor system relationships and reduced performance, but said it is “not clear which way the causality runs”. It criticised commissioners and providers in some areas for attempting to exploit “price differences between hospital and community setting that may have little relationship to the true cost”.

It said: “Too much stress may have been put on incentives, governance, contracts and the machinery of management to the detriment of the effective operation of the urgent care system. A more shared leadership model seems to be needed.”

The report also calls for a complete rethink of community services, basing them around the hospital footprint and moving away from the standard block contract to incentivise more flexibility of capacity and responsiveness.