NHS crisis needs to be treated as national emergency

It said the service model ‘no longer fits the reality of demand or clinical practice’ but there was ‘no sign that there is an adequate plan or the necessary leadership’ to deal with the crisis. Referral to COBR – the civil contingencies committee that deals with national emergencies or major disruptions – would secure cross-governmental attention, including that of the Treasury and the prime minister, it suggested, as ‘we lack any confidence in the existing structure to ensure the leadership this issue needs.’ 

In a hard-hitting report – Emergency healthcare: a national emergency – it called for more beds in hospitals, more use of NHS budgets to cover social care costs and speed up discharge, and a new model for primary care, saying ‘the current model for emergency health services is out of date and unfit for purpose.’

The committee – which took evidence last year – was clear that getting the right workforce in place is a crucial part of this and that retention was also a key issue.

Greater clinician input in both 999 and 111 would help direct patients to the right services, it said. But, more widely, capacity in hospitals and social care needed to be increased and patients needed to be able to get care in the community before they reached crisis point.

However, even the current planned increases in beds – which includes those in virtual wards – would leave the NHS 22,000 beds short of what it had in 2010, it pointed out, and any additional beds would need staffing. It also said that the interventions to boost capacity in social care ‘will not be sufficient to fully address the problem’ and have been criticised as being ‘too little, too late.’

It also questioned whether integrated care boards and systems ‘will be able to deliver on the high expectations placed on them’ without greater understanding of how they will function and who will be accountable for the delivery of services. More leadership from the centre than is currently envisaged is needed, it suggested, saying that there was no clear national steer on what was the common vision and purpose.

It also called for more data to be published – including the numbers of patients who wait more than 12 hours from arrival in A&E departments and the delayed transfer of care dataset, whose publication has been paused.

Committee chair Baroness Armstrong (pictured) said NHS pressures were not new but the committee could not have envisaged the severity of the current crisis when it launched its inquiry. ‘The problems have been widely discussed, and it is time for solutions,’ she said. ‘The models for community and primary care are broken, and a new approach is needed. Our recommendations are for both the immediate, and the longer term and are more relevant than ever.’

‘In the first instance we have called on the government to treat this crisis with the urgency it deserves and address it as a national emergency,’ she added.

NHS Providers’ director of policy and strategy Miriam Deakin said the committee’s analysis of the problems was ‘spot on’.

‘Our evidence to the committee highlighted many longstanding, pre-pandemic factors driving the current situation: the longest and deepest financial squeeze in NHS history; a growing mismatch between demand and capacity; severe staff shortages and the need for better workforce planning; and an underfunded social care system in need of reform,’ she said.

‘We need more capacity in social care, primary care and community settings, and a national urgent and emergency care strategy that looks at all the pressures on the health and care system beyond hospitals, as well as focussing more on prevention and reducing health inequalities.’