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 36.

    I am aware of three factors here.

    The first was the Labour government of 2004 allowing GPs to have third parties cover out of hours.

    The second was the Coalition government working behind the scenes to encourage larger commercial companies to buy out the various local out-of-hours services which had been set up.

    The third was the needless replacement of NHS Direct by the shambolic 111 system.

  • rate this

    Comment number 35.

    #11 sassles said - "Some people attend A&E with some very trivial things that could be treated with a first aid box at home."

    And they would know that? Or you would know that? Are you qualified to make that decision? One of the worst things this government has done is close down Walk-in centres. The were extremely valuable to the community, and obviously valuable in taking the heat off A&E.

  • rate this

    Comment number 34.

    Changes of provision in the NHS are constant and confusing. If I have a medical problem I can now ring/go to: my GP's surgery, GP unit at local hospital, Urgent Care Centre, A and E 12 miles away, or ring Out of Hours Service, 111 or 999.

    You have to be smart and fit to be ill. No wonder people go straight to A and E - if they are well enough to get there

  • rate this

    Comment number 33.

    One visit to any A+E in Uk on a weekend even 25 years ago and you would be convinced it needed a major change to cope with demand, 25 years later and it is 25 years worse as it has been neglected of the much needed maintenance or any sort of improvements. There is more chance of being assaulted from the drunken fools swamping the place than getting any medical assistance in any sort of emergency.

  • rate this

    Comment number 32.

    Our Doctors, Nurses, and affiliated workers deserve better!
    They deserve better than the Politburo maintaining their monopoly over their services. We need a system where merit, innovation and competition in encouraged and rewarded. Our current system is bloated (5th largest employer in the world!), takes up a huge chunk of the budget, and still it is fails. When will we learn?

  • rate this

    Comment number 31.

    For as long as I can remember, the NHS is always on the brink of collapse.

    So now when I see stories like this I just think "Really ? Just like the last time". There are only so many times you can cry wolf.

  • rate this

    Comment number 30.

    All wrong ! I know of 2 recent cases where a 90yr old man was rushed to hospital..once by helicopter.. the other by ambulance..just cos he was prince Philip made no difference to his treatment !!!??? yeah we know..go to my local a & E at his age and you would be on the Liverpool pathway before you managed to get a bed after 14 hrs on a trolley..NHS the PLEBS health service !!!!!

  • rate this

    Comment number 29.

    A&E problems are predictable and demonstrate the political as opposed to planning influences on NHS. The Blair contract enabled GP’s to opt out of out of hours care with no loss of money. The solution - locate primary care centres at/near hospitals and employ NHS salaried primary care doctors to run a 24hr primary care service. It will give the service the public require and save money.

  • rate this

    Comment number 28.

    Whilst people use the A&E for non-emergencies it is inevitable that the NHS will not cope. I took my 2 year old to A&E as he had fallen off his slide and after a 6 hr wait eventually diagnosed with a broken arm. A mum sitting beside me came because her 3 year old was constipated for 3 days and she wasnt happy with what GP advised - a complete waste of valuable resources!

  • rate this

    Comment number 27.

    Anyone accessing A&E with alcohol related injuries should be charged a fee to cover the cost of their care. Many people would start thinking twice then.

  • rate this

    Comment number 26.

    What about the drunks?

  • rate this

    Comment number 25.

    The government are letting this happen deliberately to strengthen the case for privatisation. You just don't get the modern world if you think the possibility of thousands of preventable deaths is more important than some toff buying their third yacht.

  • rate this

    Comment number 24.

    In Crewe, the after-hours service is co-located with the local A&E - if your phone call to the service warrants asking you to come in, you can be fast-tracked through A&E if they decide you need to be admitted. This seems to work quite well - except the after-hours service is poorly advertised so lots of people do not know who to call & go to A&E anyway!

  • rate this

    Comment number 23.

    So what's it goind to be like when 1,000,000 Romanians arrive?

  • rate this

    Comment number 22.

    7. JamesStGeorge
    Surely the problem is GPs?
    Totally agree. GP's provided a 24 hour community healthcare service. They no longer wish to do this and have in effect removed the need for their existence. The NHS should terminate their contracts and introduce a new doctor's service based around existing hospitals, staffed by doctor's employed on new, realistic (lower) salaries.

  • rate this

    Comment number 21.

    If I want an appointment with my GP I'm offered a date 2-3 weeks in advance or I have to try by phone at 0830 when you can't ever get through. No wonder people go to A&E.
    However I do think the triage at A&E should refuse to treat many of the visitors. I went a few years ago for an eye injury and was appalled at the number of non emergency patients who simply should not have been in the queue.

  • rate this

    Comment number 20.

    Just as well then that the government are planning to put huge amounts of the NHS's budget into the hands of GPs? Whilst planned treatments might improve(?), I suspect A&E will fair even worse than it seems to be doing at present.

  • rate this

    Comment number 19.

    Jeremy Hunt, the Minister for NHS Privatisation, cannot wait to sell off the family silver to his corporate pals.

  • rate this

    Comment number 18.

    Hardly surprising when the populaiton continues to increase at the rate it does due to uncontrolled immigration.

  • rate this

    Comment number 17.

    The last government gave GP's a massive pay rise whilst allowing them to work fewer hours, including delegating out-of-hours services. It is time to make these people work hard for their high salaries by practice members being on rota for out-of-hours work and having late evening / weekend surgeries.


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