More than 80% of accident and emergency units do not have enough consultants on duty for the 16 hours a day that is regarded as necessary to give patients high-quality care, MPs say.
Emergency departments in hospitals have too few doctors to cope with their growing workload and face a recruitment crisis because young medics are increasingly put off working there by the stress and hours involved, the Commons health select committee says.
"Staffing levels in emergency departments are an area of considerable concern to the committee. They are not sufficient to meet demand, with only 17% of emergency departments managing to provide 16-hour consultant coverage during the working week," the MPs' report says. "The situation is even worse at weekends and consultant staffing levels are nowhere near meeting recommended best practice."
NHS England's plans to tackle the problems "lack sufficient urgency", the committee says.
The lack of consultants is compounding hospitals' difficulties in dealing with an increasingly complex caseload linked to the ageing population. Patients are being constantly assessed and reassessed by junior doctors, which delays what NHS England recently said should be early decisions by a senior doctor about whether they should be treated, transferred or discharged, the MPs add.
That leads to patients staying in longer than they need to and limits hospitals' ability to find beds for patients who need to be admitted.
Hospital trusts have to spend an average of £500,000 each to hire locum doctors to fill rotas in A&E units because there are so many unfilled vacancies, the report says.
"We think it is extraordinary that consultant coverage for a minimum of 16 hours a day during the working week is guaranteed in only 17% of designated A&E departments", said Stephen Dorrell, the former Conservative health secretary who chairs the committee. "The figure is even lower at weekends and there are high vacancy rates for senior staff and consultants leading, inevitably, to high locum costs."
The report says the new 111 telephone health advice service in England launched prematurely in April and has added to the problems facing hospitals as patients, unsatisfied with their experience of it, have gone to A&E rather than seeking treatment elsewhere.
It says hospitals have reduced bed numbers so much that they now cannot cope, or come close to not being able to cope, with the growing number of patients who need to be admitted. "Availability of a hospital bed when required is a fundamental part of an emergency care system," the MPs observe. Many hospitals regularly operate near 100% bed occupancy; 85% is regarded as the ideal level.
Patients get confused by the baffling array of alternatives to A&E such as walk-in clinics, 111, urgent care centres and out-of-hours GP services, and so make "the rational choice to go where the lights are on" – their local A&E – the report adds.
It castigates NHS England's creation of local urgent care boards as confusing, bureaucratic and inadequate. The MPs voice concern that an already worrying situation in England's A&Es may worsen next winter unless dramatic steps are taken.
"The committee is mindful of pressures which will build during next winter and is concerned that current plans lack sufficient urgency," Dorrell said. "We were concerned that witnesses disagreed about the nature of demand for urgent and emergency care. The system is 'flying blind' without adequate information about the nature of the demand being placed upon it."
The report also highlights "fragmented" care outside hospitals as problematic. General practice needs to do more to keep both the elderly and those with long-term conditions out of hospital, but is not well-placed to perform that role, so A&E units end up treating patients who could and should have been treated in their own homes.
The MPs recommend the creation of more urgent care centres beside existing A&Es to let emergency departments focus on the most seriously ill. Paramedics employed by ambulance services need to be able to treat more patients when they assess them, to relieve pressure on A&E.
The report sparked a political blame-game. Andy Burnham, the shadow health secretary, said: "This A&E crisis has developed on David Cameron's watch. The time for excuses and blame-shifting is over. Ministers tried to blame GPs but the select committee pins responsibility for the worst A&E crisis in a decade where it belongs – on the government. Job cuts, the collapse of social care and the failed 111 service have all combined to place our hospitals under intolerable pressure."
Earl Howe, the health minister, said the coalition's creation of a £3.8bn annual fund to drive better integration of health and social care services would help force the NHS to deliver services differently, in order to keep patients healthier and treat them closer to their own homes.
"We know A&E departments are under increasing pressure and it is testament to the hard work and commitment of NHS staff that there has been a marked and sustained improvement in A&E waiting times," he said. "We are absolutely clear that we must work differently to respond to the changing needs of our ageing population. Our immediate focus is on our most vulnerable and elderly and we have agreed a £3.8bn fund which will focus on joining up services, so that health and care services work more closely together, keeping people healthier and treating them closer to home."
Howe said Professor Sir Bruce Keogh, the NHS's medical director, was already investigating the state of A&E care and is due to report in the autumn.
It is also announced on Wednesday that foundation trust hospitals plan to spend £500m hiring 10,000 extra clinical staff in the next few months to improve the quality of care they offer. The hospitals, which are semi-independent of NHS control, intend to recruit 1,134 more consultants, 1,273 junior doctors and 4,133 extra nurses and midwives, according to Monitor, which regulates the sector