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 76.

    Perhaps the coalition put A&E to outside providers and pay by results. Seems to be the way of these days!

  • rate this

    Comment number 75.

    Try getting an appointment with your doctor and your confronted with we have no appointments until two week next Thursday.
    I gave up a long time ago and now I go straight to A+E if am truly unwell
    Sign of the times am afraid.

  • rate this

    Comment number 74.

    This is an issue which will never go away. Whenever my son or anyone in my family is sick, we have to wait for 3 days to see the GP. So what's our solution, go to walk in clinic or A&E! The doctors in the walk in clinic or A&E are more willing to listen, more empathy while the GPs are those I find it difficult to speak to. GPs services in UK is like a third world service!

  • rate this

    Comment number 73.

    The problem is the public I am afraid, not all obviously but huge amounts of our population are unfit, overweight and don't take health seriously. We have the highest heart disease, obesity is on the rise and we have to change and exercise more.

    It's no good blaming Doctors and the NHS the public need to start looking after themselves instead of being in hospital in the first place.

  • rate this

    Comment number 72.

    Just stop the ridiculous system we have now;

    Can't get in go see your GP.
    Wait 2 hours in nurse-led walk in centre, staff either misdiagnose you or they can't treat you so send you to A&E.
    Local A&E closed down, go to the nearest a 40 minute drive away.
    Wait 4 hours in A&E.
    Skip GP and walk in centre next time only to be told off like a child in A&E even though you'd be sent there anyway!

  • rate this

    Comment number 71.


    GP wrote 'admit this person' - told the patient that the patient needed an emergency admission and having asked which hospital they would prefer.

    The patient was suffering from a medical emergency and apparently in this area the procedure is to send them along to A&E with a written instruction to admit.

    Medical negligence proceedings are in progress.

    Broken leg related to A&E treatment!

  • rate this

    Comment number 70.

    In order to reduce the pressure on A+E there needs to better out of hours GP cover. If you become unwell on Friday night people do not want to wait until Monday morning so may go to A+E for something simple such as a urine infection.

    There also needs to be better education for what A+E and the ambulance service are for. People still think a 5 year old vomiting or a broken toe require a 999 call.

  • rate this

    Comment number 69.

    Click the up arrow if you have confidence that the Tories really care about the NHS.

    I expect to receive lotsa down arrows !!

  • rate this

    Comment number 68.

    If the reasons are obvious to us why not to Prior? GP services failing to provide out of hours service in line with past provision, GP day services poor-we need walk in and wait, patients sent home too early relapsing, cottage hospital and convalescent home beds a thing of the past so the sick at home go to A&E if they relapse and no GP comes out, and the migrants do not register with a GP

  • rate this

    Comment number 67.

    Go into any of our A&E's on a Friday or Saturday night and see the relentless drunkiness, blood and abuse and then try blaming the doctors and nurses.

  • rate this

    Comment number 66.

    Make A&E attention chargeable.

    Make it nominal, maybe £20 fixed rate not paid at the time but through the GP surgery. Obviously some will not pay, but they can then be struck off their GPs lists. In practice most would pay.

    If GP services remained free that would stop the trivial complaints clogging up the A&E departments.

    Also it's a self financing answer!

  • rate this

    Comment number 65.

    As nurse of 20 yrs exp I have seen hospital services deteriorate regardless of govt policy, the service needs fundamental overhaul and changes that users need not what new politicians in the job feel necessary, GP's (Generally Pointless we call them) are the weak link that need most reform, power to them will worsen this situation, watch and wait, speak to an NHS worker, they know the solutions.

  • rate this

    Comment number 64.

    Comments on here try to make this an immigration issue.
    The situation would be much worse if expat Brits were forced to return. If others applied the same rules to Brits abroad as some wish to apply to immigrants.
    Every problem with the NHS is exacerbated by every policy decision made by this Government.
    The Tories will hand the NHS to their sponsors.
    Name a privatisation that hasn't cost jobs?

  • rate this

    Comment number 63.

    People go to A&E because they can't see a GP outside normal office hours.

    There are about a dozen GPs at the surgery I go to - surely it isn't beyond the wit of one of them to make up a rota so that the surgery is open 6am - 8pm every day, not just Mon-Fri.

    Police, nurses, hospital doctors, fire service, paramedics etc etc all work shifts - why should GPs be any different?

  • rate this

    Comment number 62.

    We can all say what we want, but until the government starts listening, which they seem to have a habbit of not doing, things will only worsen.

    Lets start with - No National Insurance number no medical care !

    I dont pay N.I. contributions for tourist care.

  • rate this

    Comment number 61.

    Mr Prior's suggestion for wholesale closure of hospital beds and invest in community services displays a worrying (but not unexpected) lack of understanding of the real problems. Patients are kept waiting in A&E because there are insufficient hospital beds to admit them into - closing more beds will just make it worse. Community initiatives have been proven not to work in practice

  • rate this

    Comment number 60.

    Lets stop treating being too drunk to stand up and too old to properly care for yourself as an emergency medical situation, that would practically empty A&E departments from what I've seen. Both of those situations could generally be handled much better in other ways such as providing a "drunk tank" and decent home help.

  • rate this

    Comment number 59.

    Blame the immigrants eh? how about the 25% of drink related A&E admissions? the A&E departments are full of drunken people at weekends, often abusing the NHS staff in the process.

  • rate this

    Comment number 58.

    New Labour were tactically brilliant. Have disastrous polices which will take time to unravel and then dump the problems on the next government! Whether it's the banking crisis, the deficit, social care for the elderly, or out of hours GP cover (the big cause of higher A&E usage), use voters' short memories to ensure the Tories get the blame when in reality they are trying to sort out the mess.

  • rate this

    Comment number 57.

    I listened to a GP the other day talking about the new 111 service and he said that the reason for the service was because he was unable to run out of hours services because the majority of his time available for patient care had been replaced by form filling, dotting I’s and crossing T’s exactly the same problem with schools and other public services. This is why the A&E's are over stretched.


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