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 296.

    Its the only medical facility open 24/7 , so they have given control to GPs so lets see our surgeries open 14 hours a day and severn days a week . My local shopping centre opens over 64+ hours a week for customers , so surgeries should follow , as we must be customers to them .

  • rate this

    Comment number 295.

    @280 ovalball

    Are you suggesting that immigrants do not need hospitals and doctors?

    We require 30 to 200 new GPs to service the expected influx from Eastern Europe in 7 month time.

    Plus the hospitals, nurses and hospital doctors for the influx.

    It take 7 to 10 years to train a doctor and 10 years to build a hospital.

    We have to do all that in 7 months or service will suffer.

  • rate this

    Comment number 294.

    When my mother was recently ill on a Saturday, we waited nearly 7 hours for an 'out of hours' doctor to arrive. If the 'out of hours' services were speedier, fewer people would use A&E services.

  • rate this

    Comment number 293.


    "Pete - if you call the OOH number given by your doctor you'll be put through to an OOH doctor, via a 111 operator now of course!"

    No I wasn`t, i was put through to a non medical , then an hour later phoned by a nurse then another hour later by a doctor who had nothing to do with our GP practice , then visited by an agency doctor. You claimed that GPs had not opted out of OOH

  • rate this

    Comment number 292.

    If you think we have free competition in banking prior to 2008, you're dream'n! The big banks get the same deal the NHS does - special favours from politicians.

    We have almost copy & pasted the USSR's sytem into the UK. How can you champion such a system responsible for Stafford Hospital?

    274.CURTAINS 2012
    Is a TV show going to manage an NHS?!

  • rate this

    Comment number 291.

    The 2004 GP contract was a disaster for taxpayers. GPs became millionaires, worked fewer hours for more money,

    I seem to remember the argument being not enough GP's who were overstretched and under-paid for their required level of skill and knowledge. Seems like the policy has worked if they are now paid more and have a manageable workload.

  • rate this

    Comment number 290.

    267. Sally

    "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."

    You think the deficit is due to the NHS? Are you serious? You ACTUALLY think the NHS can't be efficient as the UK Government as a whole has a budget deficit?

    Wow. Again, look at the evidence!

  • rate this

    Comment number 289.

    266. Bluesybloo
    Now look at the state of Health care and Education in this country - no better and probably worse than many third world countries..


    Have you ever been to a third world country?

  • Comment number 288.

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

  • rate this

    Comment number 287.

    Why is the desire to make money and self interest the ONLY human attributes you value?
    Greed is good.
    The current system of socialism is failing and this upsets you, understandably.
    Sally we have NEVER had true socialism in this country except in the banking sector where all the losses were socialised.
    It was GREEDY CAPITALISM that failed in 2008 not SOCIALISM!!!

  • rate this

    Comment number 286.

    Reasons why A&E is under so much pressure:

    - Population growth (including immigration). Too many people seeking help, right now;

    - Education. People rocking up to A&E departments with cuts, bruises, colds;

    - Idiocy/Drink Culture. Prats getting drunk, falling over, fighting and having other miscellaneous drink-related injuries.

    Less Politcal Correctness and more self awarness needed.

  • rate this

    Comment number 285.

    Pete - if you call the OOH number given by your doctor you'll be put through to an OOH doctor, via a 111 operator now of course!

  • rate this

    Comment number 284.

    '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'

    So it wasn't an emergency if you were able to leave unseen?

    Is this part of the problem for A&E along with the inability to get a timely GP appointment nowadays? Maybe people need to man up a bit over minor ailments

  • rate this

    Comment number 283.

    I recently had to spend 7 hours in a & e at solihull hopital, getting home with my mum at 2.00.

    The treatment and assessment was superb'

    It was a long wait but you have to prioritise.

    However, Mums bloods had to be sent to another hospital, which was starnge; and some patients (elderly) were going to spend the night in a & e, which was not good (luckily more appropriate beds were brought down).

  • rate this

    Comment number 282.

    cont..Don’t insult very very hard working nurses and doctors by inferring that the crisis in the NHS is their fault.The fault is and always is the fault of the managers and the person at the top. Manage it!
    Mr Cameron.... It is time for some drastic action...bring back Gerry Robinson.

  • rate this

    Comment number 281.

    The NHS needs it's own police service. Every other large part of infrastructure such as rail, power, even the armed forces is policed. The NHS, a huge organisation with millions of human souls passing through it a year remains a vacuum with arrestable offences going under the radar. Why they have been exempt from policing is beyond me, abuse of staff and patient neglect could be ended.

  • Comment number 280.

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

  • rate this

    Comment number 279.

    What happened to common sense ? people attend A+E and Gp services having had a cold or sore throat for 6 hours and want emergency care. This overloads the system so people who actually need help are waiting longer eg those having heart attacks etc. If services weren't continually reduced and GP's were given more than 10min slots, time could be spent in health promotion and education.

  • rate this

    Comment number 278.

    As long as drunks are allowed to elbow their way to the front of the queue and immigrants are allowed free access to care having paid NOTHING into the pot this problem will never be resolved.

    Thirteen years of unabated, third world immigration has left our once great country bankrupt.

    If you voted Labour give yourselves a pat on the back with a pickaxe.
    YOU voted for it, YOU got it.

  • rate this

    Comment number 277.

    Inappropriate attenders are one aspect of the problem. But only one. The far larger problem is that after half a century of medical breakthroughs our chickens are coming home to roost in the form of a large, extremely elderly, extremely dependant, medically complex group of people who become very unwell, very quickly, and who no-one really knows what to with


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