Comment / Emergency care ‘needs new funding solution’

By Seamus Ward


A new payment mechanism for emergency services must be found quickly to ensure trusts remain financially viable, according to the Foundation Trust Network.

The FTN said the new mechanism was needed after NHS England medical director Sir Bruce Keogh outlined a radical blueprint for changing emergency services over the next three to five years. His vision includes the creation of two levels of A&E departments, enhanced NHS 111 services and greater support for self care.

Sir Bruce said significant progress in developing new payment mechanisms for emergency and urgent care is expected over the next six months.

In a statement, the FTN said: ‘In the absence of this funding solution, some trusts will simply not be financially viable in the next three to five years.’

In the short term, the 30% emergency tariff should be dropped and patients with less serious conditions directed to the most appropriate care.

Sir Bruce insisted the proposals were not about creating super-centres that would lead to small emergency departments ‘withering on the vine’. He said there should be between 40 and 70 major emergency centres, connected to a network of smaller centres. Smaller centres would continue to receive most ambulances.

‘We now find ourselves in a place where, unwittingly, patients have gained false assurance that all A&Es are equally effective. This is simply not the case,’ he said.

The review has moved on to a second phase looking at workforce issues and costs. Pilot sites for the new emergency care and seven-day services models should be launched within six months.

The Academy of Medical Royal Colleges supports seven-day services, but it has warned that an initial financial impact is likely.

The academy’s report, Seven-day consultant present care: implementation considerations, said more consultants and workforce reorganisation were needed, together with additional resources to integrate primary and social care. Over time, service reorganisation and a reduction in morbidity may reduce overall costs.

Professor Norman Williams, steering group chair and president of the Royal College of Surgeons, said: ’Ensuring key staff and facilities are available to provide this support will come at a cost. However, this is crucial for the full benefit of seven-day consultant-led care to be realised.’