The Public Accounts Committee wants the Department for Health to get a better grip on the governance of Accident and Emergency services which are struggling to cope with increasing demand.

When officials of ?the Department of Health and NHS England appeared before the Committee they struggled to explain who is ultimately accountable for the efficient delivery of local A&E services and for intervening when there are problems.??The Committee believes that without clear accountability and responsibility it is much more difficult to achieve the changes needed to improve the situation.

Emergency admissions to hospitals have increased by 47% over the last 15 years at a time when budgets are under pressure. Bed occupancy rates across hospitals continue to rise year-on-year and the ambulance service is also under stress. ??Hospitals, GPs and community health services all have a role to play in reducing emergency admissions – but financial incentives to make this happen are not in place. Attempts to ensure patients are treated without coming to A&E are not working. ??While hospitals get no money if patients are readmitted within 30 days, there are no financial incentives for community and social care services to reduce emergency admissions.?

In 2012-13, there were 5.3 million emergency admissions to hospitals. Two thirds of hospital beds are occupied by people admitted as emergencies and the cost is approximately £12.5 billion. NHS trusts and NHS foundation trusts, primary, community and social care and ambulance services work together to deliver urgent care services.

Since April 2013, A&E services have been commissioned by clinical commissioning groups, which are overseen by NHS England. However, it is the Department of Health that is ultimately responsible for securing value for money for this spending.? ?It is not clear who is accountable for the performance of local urgent and emergency care systems, and for intervening when local provision is not working effectively.

Delivery is fragmented, and the health sector does not consistently work together in a cohesive way to secure savings, better value and a better service for patients.

The Committee has called on the Department to confirm that it is responsible for the overall performance of urgent and emergency care and to set out how it will challenge local performance, step in when this performance is substandard and enforce beneficial local changes to save money and provide a better service when local agreement cannot be reached.??