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 56.

    A&E should be user pays! It's for emergencies, not a free repair shop for every drunk who feels like getting into a biff on a Friday night.

    If you use A&E, heaven forbid, you should pay for it, not strangers. We have enough expenses without having to pay for your repair. Get some savings, get some insurance, or get some charity - Why should we subsidise other people by force, if necessary?

  • rate this

    Comment number 55.

    "up 50% in a decade..."

    Yep - and no suprise that is the time that under Labour's open door immigration policy we have an extra 4 million people in this country including the new EU states.

  • rate this

    Comment number 54.

    41's -ve score.

    Apparently the TRUTH is unacceptable to bloggers today!

    The truth of A&E turning patient's away rather than TREATING them is a REALITY. The same patients come in again & again and sicker!

    'Push off and die' is an unacceptable response from A&E - worst of all it is entirely counter productive.

    (I can't name the hospitals concerned as they are subject to legal proceedings.)

  • Comment number 53.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 52.

    Here we go again. This story will keep cropping up until the public are convinced that charging people for 'self inflicted' injuries is a good idea. It'll never affect them as the perception is that it's just drunks & drug OD's. Ever been in A&E on a Sunday morning when it's packed with football & rugby players? Be careful what you wish for.

  • rate this

    Comment number 51.


    Isn't the point of a GP referring a patient to A&E for A&E to diagnose the problem? As such, the GP can't know if an admission to hospital is necessary. If the GP knew what the problem was then they would have referred your relative to a consultant, not to A&E. Was the fact that this relative later broke a leg directly related to the condition or not?

  • rate this

    Comment number 50.

    I'm a paediatric nurse and I see so many kids admitted to the ward unnecessarily. Parents need more guidance about treating simple conditions at home. I am also seeing a lot of parents who aren't getting adequate access to their GPs. Accident and emergency means accident and emergency, not bronchiolitis! More knowledge and common sense is the solution.

  • rate this

    Comment number 49.


    Hospital the patient is in has a patient notes system that is best described as 'write once read never' Consultant's plans are ignored by the ward for a couple of weeks as it is either illegible or more than a couple of sheets in the file. Ward staff waste huge amounts of time trying to find out the current info, or just don't bother!.

    Management knows their systems are unfit for purpose!

  • rate this

    Comment number 48.

    Part of the solution is in the hands of the patients

    THINK before you turn up - minor ailments are neither Accident nor Emergency, and shouldn't be there; most people know if they have just a cold or a very minor injury - after all, we've all had them before

    And keep your routine appointments, so you don't turn into an emergency unnecessarily

  • rate this

    Comment number 47.

    The govt are letting this happen to strengthen the case for privatisation.
    Yawn ...
    Gordo Clown didn't help when he changed the GP's contracts part of which was limiting their out of hours responsibilties & nearly doubling their pay @ the same time

  • rate this

    Comment number 46.

    The problem is not that the NHS is underfunded, it is that the UK is overpopulated.

    We need to do something drastic immediately about the UK's exploding population or we will soon find things are far worse than they are now.

    No amount of money sent to the NHS will solve this problem.

  • rate this

    Comment number 45.

    27. Little Plum -Except that its not drunks who are the cause of the pressure on the NHS (its no help either), we are an ageing population and that puts pressures on services. Unless we pay more tax and are willing to take a massive hit in incomes we will see the decline of what we used to take for granted. Simple economics, either pay for it and stop people abusing the system or watch it die.

  • rate this

    Comment number 44.

    I worked in the NHS for 25yrs, and left in 1994, a year after the tories introduced 'NHS Trusts'. Morale of staff, even then, was horrendous because all the money was going to boardroom wages instead of frontline services. I have no reason to believe things are any better now.

  • rate this

    Comment number 43.

    27. Little Plum
    Anyone accessing A&E with alcohol related injuries should be charged a fee to cover the cost of their care.


    I agree.

    But then you get the people who say - well what about people who get injured playing sports.

    (To which I'd reply - well what about people who are just clumsy or stupid)

    We'd just end up charging everyone in the sake of fairness.

  • rate this

    Comment number 42.

    When you have an open house people tend to take advantage.

  • rate this

    Comment number 41.

    If A&E TREATED the people who came, then they would not have to turn up repeatedly & seem like an overwhelming crowd!

    [This comes from experience. A relation (age 100) was sent away from A&E twice despite a GP saying 'admit this person' - then the patient broke a leg, due to reacting to medication, and has been in hospital for nearly 10 weeks - due to botched treatment in this other hospital!]

  • rate this

    Comment number 40.

    This is totally traceable back to the disastrous GP contracts agreed by Labour in 2005. For only £6000 loss of income paid out of a big salary increase, GPs could opt out of weekend and out of hours patient care - and guess what? They nearly all did. The result is a botch job of expensive unaccountable locums. Little wonder people go off to A&E. It's not A&E, it's a GP replacement.

  • rate this

    Comment number 39.

    The A&E at Lewisham is to be downgraded & made smaller as part of cost-cutting measures. Jeremy Hunt also said the maternity unit at Lewisham would be replaced with a midwife-led facility. Jeremy Hunt is taking this action because he cannot close the A&E in the Queen Elizabeth Hospital with debts of £150m because it is a PPP and has a 30 year contract to provide services for this Hospital trust.

  • rate this

    Comment number 38.

    Two words: GP contract

    Messed everything up for the NHS and now we're seeing the consequences.

  • rate this

    Comment number 37.

    I agree with respondent Michael Griffin that the A&E department needs to sort out their priorities. There are FAR TO MANY PEOPLE THAT SHOULD NOT BE AT A&E DEPARTMENTS! ACCIDENT & EMERGENCY IS WHAT IT MEANS, not people who are DRUNK of suffering from CUTS & GRAZES!


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