A&E facing serious problem, health minister admits


Dr Peter Carter, of the Royal College of Nursing: "This is a system under huge strain"

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A&E departments are facing a "serious problem", a health minister has said, after NHS chiefs ordered urgent action to tackle growing pressures.

Rising attendances have meant A&E units in England have started struggling to hit the four-hour waiting time target.

The problem has got so bad that NHS England has pledged extra money to help hospitals that are struggling.

But Health Minister Anna Soubry warned there would be "no quick and easy solution".

She said: "We have a serious problem, we've had a problem for a while.

"If you look at the number of people presenting to A&E it's grown by a million in just the last year.

"And unfortunately unless we take urgent action, which we've been doing, it's a problem which will grow. It's very complicated. There is no quick and easy solution."

It has been clear for some time that pressures have been growing in A&E.

For the past decade the numbers attending the units have been rising year by year. There are now more than 21 million visits annually - up 50% in a decade.

There is a combination of reasons why they have grown, including a rise in number of people with chronic conditions, such as heart disease, that end up having emergencies; the ageing population; and problems accessing out-of-hours GP care. A&E units have also had problems recruiting middle-grade doctors, which creates staffing problems.

But until recently, hospitals had just about been coping. The harsh winter seems to have tipped A&E units over the edge.

In the past few months, the waits that patients face have reached their worst levels for a long time.

The four-hour target - 95% of patients have to be seen to in this time - started to be breached in many places. Since the start of last month, the NHS overall has missed it.

There are signs that, with the weather improving so have the waiting times, but not as much as many would have liked.

The problem is that A&E is the safety net of the NHS: the place people go when there is no other option. If it breaks there is a real problem.

In recent months reports have emerged of hospitals setting up temporary waiting areas in car parks and storerooms to cope with queues.

Ambulances have also been forced to wait to drop off patients.

'Market failure'

The situation prompted the Care Quality Commission to issue a stark warning about the future of A&E.

CQC chairman David Prior said: "Emergency admissions through accident and emergency are out of control in large parts of the country. That is totally unsustainable."

He added that there was no cast-iron guarantee that there would not be a repeat of the situation at Stafford Hospital.

Mr Prior is also reported to have suggested the large-scale closure of hospital beds and investment in community services.

He added: "The patient or resident is the weakest voice in the system. It is a classic market failure. The user doesn't know nearly as much as the professionals, even with the internet."

Mr Prior is not alone in proposing a radical shake-up of A&E services.

The College of Emergency Medicine, which represents casualty department doctors, believes that between 15% and 30% of patients admitted could be treated elsewhere.

Soon after the CQC warning was made, NHS England announced it was asking regional health bosses to work together to ensure plans are in place for each A&E in their patch by the end of the month.

Health Minister Anna Soubry says lack of access to GP surgeries is "one of many factors" putting pressure on A&E services

Extra money is being made available where problems are identified.

Prof Keith Willett, of NHS England, said: "When pressure builds across the health and social care system, the symptoms are usually found in the A&E department.

"We need the whole NHS system, in the community and hospitals, to recognise the problems and help to relieve the pressure on their colleagues in A&E."

A review, led by medical director Sir Bruce Keogh, is already under way to address the issues in the long term.


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  • rate this

    Comment number 684.

    I am a GP. Try considering why it is hard to get in to see your GP. We are not sitting around idly whilst all of our patients attend A+E. The demand on Primary Care is at least as bad as in A+E, but it is easier to blame GPs than look for solutions. Working in primary care and then reading the vitriol on here directed our way makes me want to pack it all in and emigrate now.

  • rate this

    Comment number 649.

    As an employee of an ooh Drs service we have problems of calls being held for 6 hours or more since the new 111 service was started and as people cannot get through or are offered ridiculous advice they go to A&E instead.Why fix something when it is not broken.This government does not listen and should get rid of the 111 system as it does not work and return to as it was before that did work

  • rate this

    Comment number 577.

    As an A&E doctor its quiote nice that the media is seeing fit to shine a torch on the issue. A&E attendances are rising very quickly, and I don't think it can all be blamed on GP hours. There are fundimental attitude issues. Hence why people are calling an ambulance at 3am because they have had 2 days of constipation, or their 3 year old has just vomited. once. What we need is common sense.

  • rate this

    Comment number 463.

    The problem with this country, unlike others, is that we don't have complete, comprehensive 24hr cover. Our health service is literally open 'office hours'. If you fall sick outside of these hours then tough luck! If we had a 24hr health service this would solve most problems. GPs should work evenings and weekends and so should consultants in hospitals. Care homes run 24hrs a day on shift cover.

  • rate this

    Comment number 268.

    The media always get it wrong about the 4 hour wait. It is not that people have to be seen within 4 hours. They have to either be admitted or discharged within 4 hours. There is a huge difference between the 2. The problem with the target is that A+E staff have become obsessed with not breaching it, instead of treating patients in order of priority. FYI I have worked in various A+E depts.


Comments 5 of 11


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