NHS faces repeat of A&E winter crisis if plans not drawn up, hospitals warn

NHS faces repeat of A&E winter crisis if plans not drawn up, hospitals warn The NHS faces a repeat of last winter's crisis in accident and emergency units because health officials have yet to draw up plans to cope with rising patient admissions and find the money to help struggling hospitals, it has emerged.

The Foundation Trust Network (FTN), which represents hospitals, says almost a third of "urgent care boards" – established across England in response to concern about waiting times – had not produced "local recovery plans" for each A&E department in their area.

In a survey of NHS hospitals, the network said six out of 10 trusts said that even when there were proposals from the urgent care boards they are underfunded. The boards were supposed to have produced schemes to fund extra GP out-of-hours services, faster inpatient assessment and improved discharge arrangements, especially for elderly people.

With 45 trusts responding this month, the FTN says there is a strong possibility there will be a winter crisis in emergency wards. It points out that the urgent care boards were meant to have workable plans by the end of May.

"We do not believe that the current approach will deliver the improvements required and we face a repetition or worsening of the position next winter," said the network. This year the pressure on A&E wards was so great that patients were being abandoned on trolleys in other parts of hospitals without nursing supervision because there was nowhere else to put them.

The study reveals that NHS trusts are gearing up for problems. It says recent work by the network showed 62% of trusts expect this winter to be more severe than 2012-13 and 72% believe the A&E system is at a tipping point.

The FTN said to avert a crisis the health service had to quickly determine which urgent care board plans have insufficient funding and find the cash to fund them. It also called on the health secretary, Jeremy Hunt, to give a public assurance that the process would deliver.

"Failure to deliver adequately funded plans will risk the provision of safe, effective and accessible urgent and emergency care for patients, as last winter showed," the network said.

In the survey, health officials warn of widespread confusion over the issue. In one instance a hospital trust said: "We have not been made aware of any additional funding that will be allocated to support winter planning. Colleagues in social care are also concerned that no funding has yet been identified to support demands being placed on them."

At the root of problem is an argument over cash between the health secretary and the newly created independent quango NHS England, which oversees health spending. The urgent care boards were supposed to collect cash from existing payments to NHS trusts that are withheld when hospital admissions rise above a maximum agreed level. Hospital trusts where emergency admissions rise above a base level established in 2009 receive only 30% of the NHS tariff – the national cash payment to doctors – to deter unnecessary admissions.

The remaining 70% was originally earmarked for GPs, but was diverted to urgent care boards in response to the crisis in emergency care. Hunt had hoped this would amount to £400m, but NHS England said it was closer to a 10th of that figure.

NHS England said "plans for all areas have been received and are being reviewed". The Department of Health did not respond to a request for comment. The Guardian