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
    +10

    Comment number 116.

    104. Sally

    "The NHS is the worlds 5th largest employer, swallowing up a huge chunk of our budget. How much larger and more money does it need until we realise socialism doesn't work?"

    It cost half as much per head than the US health system, that bastion of free market capitalism, and everyone in the country is covered!

    Seems like socialism is working to me when your biggest worry is a 4hr wait!

  • rate this
    +6

    Comment number 115.

    I remember the day the GP's couldn't believe their luck in reduced hours and pay awards given by the Labour Governments negotiation team many years ago and now we are paying the price. I had the miss fortune to visit an A&E department and like others have said I waited on a trolly queue in a corridor - it was like a major casualty incident happening every day. This can't go on and needs changing.

  • rate this
    +7

    Comment number 114.

    Since GP's no longer carry out or have out of hours duties the public look to their local hospital to get the care they need.
    Government incompetence in this area of work is spectacular, name any other PROFESSION where those engaged work a basic week, with no weekend or evening responsibilities!

  • rate this
    -1

    Comment number 113.

    71.John_from_Hendon

    John, I'm only asking the questions because in my area it's not A&E that arrange emergency hospital admissions from a GP's referral: it's the admissions clerks for the relevant departments (Orthopaedic, Paediatric, etc.) who would arrange to admit patients to hospital following a referral from a GP.

  • rate this
    +3

    Comment number 112.

    104. Sally
    Have you seen the budget? How much more of our money do you need invested publicly until you realise it doesn't work?

    ==

    The USA has 50 million people without health insurance. How well is that working?

    Keep your greedy privatization paws off the NHS...

  • rate this
    +1

    Comment number 111.

    Less and less people paying for more and more people, the problem bedeviling the NHS and every other service in this country.

  • rate this
    +24

    Comment number 110.

    The problem with all failing public services (Especially the NHS) is that policy and practice are dictated by some sycophantic buffoon who sits behind a desk miles from real work

    The untapped resource of frontline staff is where you'll find the real problems identified with practical solutions to overcome them.

    No viable solution has ever come from an executive only incompetence & greed !

  • rate this
    0

    Comment number 109.

    People's health problems are treated as separate from one another instead of as interconnected. Practically no one with a long term condition gets a care plan. Patient information is not shared between health professionals. GP surgeries are ridiculously over-subscribed. A big part of the problem is lack of preventative measures anywhere (NHS or private). It is illogical and unsustainable.

  • rate this
    +3

    Comment number 108.

    Cheap, cheaper, cheapest then becomes unfit for purpose (how many time do we hear that) = privatise. Either 3rd world public service standards or privatising everything they can make money from out of the public purse is the objective.

  • rate this
    +4

    Comment number 107.

    The sad thing is as very evident on here, we only read about the bad stories in the NHS, but you have to put it all into context.

    The NHS is a huge institution, of course you will see bad stories from time to time, but what you don't see in the media is lives that get saved every hour of every day. We have to embrace the NHS and be thankful for it, we would soon moan if it was not there.

  • rate this
    +6

    Comment number 106.

    Tell me,why were GP's given such a large increase in revenue and wages? Just how many of the people who turned up at A+E's actually needed nothing more than a review by a GP.

    Same old story

    The "business" does just enough and the state picks up the tab.

  • rate this
    +71

    Comment number 105.

    My girlfriend works as a nurse in A&E and she says that not even half of the patients they see actually need emergency treatment and often visit for mild colds etc. The general public need to be made more aware of what A&E departments are actually for and what they are able to diagnose and treat. Police also constantly bring in 'regulars' with no problems because there is nowhere else for them!

  • rate this
    -15

    Comment number 104.

    84.Exiledblade
    "invest in the community services FIRST and then watch the demands on A&E diminish."
    =
    Have you seen the budget? How much more of our money do you need invested publicly until you realise it doesn't work?

    The NHS is the worlds 5th largest employer, swallowing up a huge chunk of our budget. How much larger and more money does it need until we realise socialism doesn't work?

  • rate this
    +54

    Comment number 103.

    I have used A&E once recently regarding a sick baby because OoH service in Warwick was a call from someone who couldn't speak english, I couldn't understand him, nor him me. The service was clearly unsafe/non-existent & A&E was the only option available.

    NHSDirect worked well - give it back!

  • rate this
    +3

    Comment number 102.

    86. chris quartly

    The A&E target does exist; it was relaxed from 98% to 95% and called something different from a target to try and please the Tory voters. Lansley realised, as have all health secretaries left or right that if the target isn't in place performance drops dramatically (and that isn't due to fiddling the figures - that does happen but is at best guilding the lily in reality)

  • rate this
    0

    Comment number 101.

    The problems are too many to name in full here, but;

    GPs have to see you within 24 hours of you making an appointment = you can only book for that day.
    No out of hours GP service.
    A&Es closed down, ours is now a 40 minute drive away.
    Walk in centres manned exclusively by nurses so they either misdiagnose or send you to A&E.
    Too many people using too few services.
    Clueless NHS helpline.

    Etc.

  • rate this
    +3

    Comment number 100.

    I know from personal experience that part of the problem is that there are those who rush to A & E totally unnecessarily when a trip to the local medical centre is all that is required.

    There is also the usual problem in hospitals of there being 'too many chiefs and not enough indians', in other words, too top heavy with management.

  • rate this
    +1

    Comment number 99.

    Our local PCT closed A&E departments on most hospitals in our locality and designated one as the A&E Centre.
    Result, after Triage(which can take an indeterminate time) a case classed as Urgent has a 2 hr minimum wait time, non-urgent 4-8 hrs.
    Unless you are spouting blood on arrival forget it.
    Insufficient staff and resources.

  • rate this
    0

    Comment number 98.

    A. and E. Needs better organisation. Why does it take 3 hours to be seen. Quite often injuries are minor cuts, sprains etc... Why not have these seen immediately and dealt with in 10 minutes, sent to xray where needed. Instead they keep patients waiting for hours. As for drunks and bad behaviour get it sorted out by the cops. We pay through the nose in taxes so lets have a proper fast service.

  • Comment number 97.

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

 

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