Paul Corrigan: Commissioners must lead on A&E crisis

Since 2004, an extra 4m people a year have been attending A&E services. The target that means nearly all of these patients must be seen within four hours was originally called politically motivated by the coalition government and was abandoned in its first few months in office.

However, the target was reinstated within the year because in reality, this is a publicly owned target, one which matters a great deal to patients (and therefore voters).

The success of hitting the four-hour target assures the public that they can always see a doctor within four hours if they go to A&E. This is speedier access than other parts of the NHS can guarantee. In 2013, it appears that more and more members of the public only trust the A&E services of their local hospital to deal with their anxiety about urgent care.

At the moment, the crisis in emergency care is only a problem for those hospitals which have an A&E department, but increasingly, unless the NHS as a whole provides much better urgent care than it does at the moment, this will quickly become a problem for the rest of the NHS.

Nye Bevan had an interesting word to describe what he wanted the British public to feel about NHS services. He wanted them to feel more than secure - he wanted them to feel serene. And the fact that 4m extra people a year are prepared to take their chances in A&E demonstrates that the NHS has failed to create that serenity for people who need urgent care.

The messy jigsaw of urgent care services does not create an experience that patients understand, or feel they can depend on. Developing an urgent care service on which these and millions of others can depend is one of the most important matters for the NHS to address.

GP-led commissioners have the opportunity to develop contracts that ensure a secure, clear pathway for urgent care. To achieve this, they need to ensure the public for whom they are commissioning can understand and depend on these services.

Paul Corrigan is a management consultant and former adviser to Tony Blair. He is a regular contributor to our new Inside Commissioning website at

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