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 96.

    If all A&E departments had a 24 hour walk in and wait GP clinic next door they would not see half as many cases. GP practices are taking the money and not doing the job-too many managers and receptionists. When I was a kid the GPs came out day or night-no one much had cars back then. Plus we knew they would be a proper GP not a locum with no English straight off a plane. A&E picks up the pieces

  • rate this

    Comment number 95.

    If GP surgeries were paid a suitable extra fee to stay open 24 hours or at least until 1 am, many people would visit their own doctor's surgery for minor problems rather than clog up A&E.

    Someone should look at the economics, this might be a cheaper and better answer to the problem.

  • rate this

    Comment number 94.

    "There are now more than 21 million visits a year - 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 93.

    All about priorities and population control.

    Government finds zillions to bail out banks, build HS2, Trident and put on the Olympic/Jubilee - but cant find the cash for walk in centers or more GP's to take the pressure off A&E's.

    Your health is way down the priority list.

    The Economy is all that matters in 21st Century Britain.

  • rate this

    Comment number 92.

  • rate this

    Comment number 91.

    As a frequent visitor to New Zealand and an occasional user of their health services, every major town (and a major town in NZ is ~40,000 people) has a town health centre open 24/7, you pay a fee (about £60) and get to see a doctor and/or specialist, obtain prescriptions and have small emergency care (eg stitching) and get referred directly to a hospital if necessary. Why can't we do this?

  • rate this

    Comment number 90.

    Will someone please give us back our wonderful NHS? It's NOT a business and should not be treated as one. I would be more than willing to pay more tax to fund it - ring-fenced so the money could not be wasted bribing foreign countries, showered on banks and wars etc. This WOULD be a vote winner.

  • rate this

    Comment number 89.

    66: With JSA at £71 per week, £20 is a significant chunk of an employed person's income that week.

    The NHS should remain free at the point of use - to lower A&E use we need better provision of GP services. Having to wait weeks to see the supposed family doctor is absolutely ridiculous.

  • rate this

    Comment number 88.

    The root cause of this problem can be traced back to the new contracts negotiated by Labour in 2003 where they allowed GPs to opt out of providing 24 hour care.

    Don't be fooled, the NHS isn't safe in any politicians hands.

  • rate this

    Comment number 87.

    I don't think we can comprehend how lucky we are in having resources like A & E and 111 which are free and available 24 hours a day.

    111 has been getting lots of bad press, which for a newly-started service is inevitable. However, try talking to people who have used it - it also receives a lot of praise.

    Ultimately, use of these services requires common sense - something lacking all-too-often !

  • rate this

    Comment number 86.

    This 4 hours a/e breach time I believe does not currently exist

    Andrew Lansley about a year ago was reported that this 4 hour target was to be abolished.

    Therefore any patient can wait hoyrs, days, years in a/e and there would be no repercussions

  • rate this

    Comment number 85.

    Is this the result of more past Labour incompetence ?
    "We didn't see it coming" was the cry when the banks went boom & bust

    In future maybe they should consult some of the guys down 'the pub' on policies (Oh thats another Labour failure we wont go into), before implementing them because they did.

    All our taxes flushed away from this to global warming (which its not either)

  • rate this

    Comment number 84.

    There is a simple solution that even Mr Prior can agree with - invest in the community services FIRST and then watch the demands on A&E diminish.

  • rate this

    Comment number 83.

    54's -ve score

    Some true imbeciles on this blog apparently thing that 'push off and die' is an acceptable response from A&E.

    Remember that when you are left on a trolley to die in a draughty corridor. This is your choice.

    You idiots might like to carry a 'do not treat card' in your pocket so paramedics can leave you in the road when you are run over.

  • rate this

    Comment number 82.

    A new specialist emergency care hospital is currently being built near where I live. This will relieve pressure from surrounding general hospitals.

    The two gen hospitals in the area, will no longer receive 999 admissions, therefore, coping better with less serious a&e patients.

    So, some Trusts have planned well, while others have failed.

  • rate this

    Comment number 81.

    The answer is simple, fund the NHS as a public service and not as a profit provider for private healthcare companies

    The current bunch of clowns do not want a National Health Service, they want and are putting in place a privatised profit driven health care industry, hence its increasing desire to underfund our A&E departments.

    If we want an A&E department it has to be funded properly

  • rate this

    Comment number 80.

    Levels of demand on ALL NHS staff are unsustainable!

    My sister-in-law is a fantastic nurse, but is worked to the bone. Not only her own work load, but the workload of useless agency staff who are not fit for purpose.

    She's been a fully qualified nurse for nearly a year, but may have to quit on health grounds due to stress of the job. Madness, utter madness.

  • rate this

    Comment number 79.

    If GPs actually offered the service they ought to be doing as the 'first port of call' for everything that isn't so life-threatening that you need to dial 999 there wouldn't be this problem. Yet even during office hours you cannot get in to see them and outside of them, forget it. Ditch the ridiculous overpaid contracts, bring them back into proper employment.

  • rate this

    Comment number 78.

    64. shillo - We are living beyond our means, really is that simple. Blame the Tories all you want but all 3 parties are to blame for mismanagement of the UK and its services and assets. Short term politics and failure to plan for the future. PS it did not help when Gordon Brown gave a blank cheque to the banks and the city who have caused Financial Terrorism. Let the Banks Fail!

  • rate this

    Comment number 77.

    What do we expect!How many people and their children who havn't paid into the system use this service,4/5/6 million people?There are just far to many people in the country for our infrastructure to cope,If we want a better service then we have to pay the taxes needed to fill the hole.Do people want to pay for the people who fleece the system?I don't!


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