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 276.

    Smacks of GP's sitting on comfortable contracts while junior doctors pull 100 hour weeks for a pittance. I see that an A&E proffesional elsewhere says half the people should not be there - either non-urgent or ooh not working.

  • rate this

    Comment number 275.

    If, as the article suggests A&E are over-run with booze victims, then why the hell aren't the drinks industry paying for A&E ?

    It well never happen of course, as the breweries are too close to politicians.

  • rate this

    Comment number 274.

    1 Minute ago

    I beg to differ:
    If the NHS was efficient, we wouldn't be deficit spending to fund it, running a £1Trillion national debt, and NHS Trusts wouldn't be going insolvent requiring bailouts left right and centre.


    Not all are insolvent. Engaging "The Apprentice" rejects to manage trusts is bound to end in tears.

  • rate this

    Comment number 273.


    "The GP OOH service is run by GPs - they havn't opted out of anything!"

    So how come when my 86 year old mother needed help out of hours , my call to her doctor was redirected to NHS direct and 5 hours later a german doctor with no knowledge of her medical history who worked for an agency turned up?

  • rate this

    Comment number 272.

    Whilst this article focuses on A&E, it represents problems that pervade throughout the NHS.
    The NHS is very well funded. Unfortunately huge chunks of it never go anywhere near anything that has any bearing on care or treatment.
    The four assistants to the NHS chief exec receive £250k pa salaries!!
    And don't get me started on the nepotistic carousel that is NHS chief execs....

  • rate this

    Comment number 271.

    Until my last visit to the local A&E the care has always been exceptional.
    But last time it took 2 hours to see the triage nurse, we left after five hours unseen.
    Yes A&E 's are feeling the pressure, mostly due to Government Policy.
    But I saw with my own eyes just how low staff moral had dropped, just how resigned to not being to cope they had become.
    Ripe for saving by privatization Dave? George?

  • rate this

    Comment number 270.

    The 2004 GP contract was a disaster for taxpayers. GPs became millionaires, worked fewer hours for more money, and abandoned evening and weekend cover. That's why a flood of sick patients now wait on trolleys in A&E.

    GP pay in England on the medical services contract rose by 46% between 2002-3 and 2009-10. The average number of patients per GP in England fell from 1780 in 2001 to 1562 in 2011.

  • rate this

    Comment number 269.

    The BBC analysis outlined by Nick Triggle does not include rapid population growth due to high levels of immigration

    Surely more immigrants means more requirements on hospitals

    Current levels of immigration require a massive hospital building program just to service the new arrivals, but it isn’t happening.

    We are expecting between 50,000 and 300,000 new arrivals from Eastern Europe next year

  • rate this

    Comment number 268.

    The media always get it wrong about the 4 hour wait. It is not that people have to be seen within 4 hours. They have to either be admitted or discharged within 4 hours. There is a huge difference between the 2. The problem with the target is that A+E staff have become obsessed with not breaching it, instead of treating patients in order of priority. FYI I have worked in various A+E depts.

  • rate this

    Comment number 267.

    This way, people will use it for what it meant for, emergencies.
    Plus, binge drinking will be discouraged as they won't get bailed out by all of us.

    I beg to differ:
    If the NHS was efficient, we wouldn't be deficit spending to fund it, running a £1Trillion national debt, and NHS Trusts wouldn't be going insolvent requiring bailouts left right and centre.

  • rate this

    Comment number 266.

    Blame Tony Blair and his idiotic approval to give millions of foreigners a British passport and NI number. He was warned that public services would not be able to sustain the inordinate strain. Now look at the state of Health care and Education in this country - no better and probably worse than many third world countries

  • rate this

    Comment number 265.

    The GP OOH service is run by GPs - they havn't opted out of anything!

  • rate this

    Comment number 264.

    There are three major reason why A&E departments can't cope. The biggest one is the fact that there are simply not enough doctors and nurses. Second is public abuse - using A&E when all the problem is finger-ache or a cold and third is migrants coming to the UK to get free health care. If A&Es were staffed properly, abusers fined and migrants charged, the problems would eventually ease.

  • rate this

    Comment number 263.

    If so called patients were assessed immediately on arrival at A & E instead of just being booked in and stuck in the queue it woulld ease the workload. The time wasters etc. could then be sent on their merry way.

  • rate this

    Comment number 262.

    There is something drastically wrong with out A&E system.
    Drunks are served FIRST to get rid of them.

    On one visit after a 7 hour wait I was given strong pain killers after suffering a slipped disk. I was STAGGERED to receive a bill for them.

    It would seem that there is an endless pit of money for free-loaders but somebody who has been paying in for 40 years is charged for treatment.

  • rate this

    Comment number 261.

    NHS safe in our hands?After all we've put our best man on it...good old Jeremy.

  • rate this

    Comment number 260.

    cont..Allow the nursing staff to nurse. The managers of the hospitals are too concerned about being sued, that is why the nursing staff spend all their time doing paper work. I have heard nurses say just that...stop the paperwork and let me nurse my patients. cont..

  • rate this

    Comment number 259.

    @255 Well said, could not agree more!!

  • rate this

    Comment number 258.

    Last time I took my toddler the Paeds area in A&E was packed. The mum next to me with her primary school age child was there because her daughter had been constipated for 2 days (yes! Really!!) She got a ticking off from the doctor but didn't seem to care!

  • rate this

    Comment number 257.

    Lets look at this, GPs opt out of Out-of-Hours provision. NHS Direct staffed by medically qualified practitioners replaced with shambolic NHS 111 script-based call centres. And in my area, Mid-Yorkshire, the Trust will be left with only one fully-functioning A&E out of the the three it runs at present if it gets its way. Looks like I'm running out of reliable options.


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