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 476.

    416. Sally
    When ended BA's monopoly, competition thrived.
    My previous occupation, the airline industry
    Nope - there was always competition. You could fly on 'grey market' tickets pretty much anywhere. It just wasn't fashionable to be 'anti British' before privatisation, there wasn't the internet, there were fewer 'reasonable' hotels at the other end.... many other reasons.

  • rate this

    Comment number 475.

    New NHS advert.

    If you ain't losing vast amounts of blood, feeling dizzy, fallen unconscious, had a nasty fall, or had a serious medical emergency stay away from A+E.

    Did you know that x% of people who visit A+E could have been treated at their GP or could have received Over The Counter treatment from their local pharmacist?

    A+E: For when there is a real emergency

  • rate this

    Comment number 474.

    If there is demand, business will meet it.
    For a incurable disease, demand for treatments is big, and would be more affordable in a competitive environment, lowering costs of treatment for you. Plus, in a free market innovation is far superior compared with government's. Advanced treatments would further assist in quality and affordability, possibly curing it altogether!

  • rate this

    Comment number 473.

    460. Sally
    My son has an incurable, but not life threatening condition. It hospitalises him every so often. Guess how interested your beloved private healthcare providers are in taking him on?

    Also, Private health providers DO NOT provide A&E facilities or maternity care. However, at least you know you can rely on the good ol' NHS to provide care at all levels to everyone.

  • rate this

    Comment number 472.

    Need more community based services - local minor injury units, enhanced GP out of hours services, and a change in public expectations....you don't need an emergency GP appointment for your athlete's foot which you have had for 4 weeks. If society wants 24 hour access to the best quality healthcare then great - but that has to be paid for somehow. We all have a part to play in this problem

  • rate this

    Comment number 471.

    The difference between an accident and an emergency.
    Look at the past to guide our future.
    Battlefields - Florence Nightingale

    Perhaps there should be separated entries into hospital / 24 hr. clinic.

    All that is needed is a proper triage test on patents entry.
    Modern electronics:
    Blood pressure, Pulse, Oxygen, inspection of ears eyes nose throat - you are an emergency - you are a clinic patent.

  • rate this

    Comment number 470.

    467. POB
    'Someone has to pick up the 70% tab. A&E pick up the tab and the public pick up the hassle.'

    You make the assumption that the 70% needed to be picked up is A & E business. This would be true only if GPs dealt with only accidents and emergencies. To be honest it would help if we had more patient patients who don't require instant treatment for minor issues.

  • rate this

    Comment number 469.

    A&E should be run by ATOS from the reports I have seen they can by a cursory look make the lame walk, the blind see and those with emphysema breathe just what we need to speed things up in our overcrowded hospitals and all for a fat fee without qualifications.

  • rate this

    Comment number 468.

    Class-warfare never works. View yourself as an individual, a person, not a "class". You'll find the group siege mentality evaporate. You're entitled to choice. The wealthy can afford choice. Many cannot. Demand choice of who your provider of care is, demand an end to monopoly. Then you’ll have the same freedom that the wealthy, the freedom to shun a bad, and reward a good, provider.

  • rate this

    Comment number 467.

    Lets do some simple maths:

    Total number of hours in a week 168
    Even if a GP's worked 10 hours / day for 5 days( I know they don't do this because many close their surgery 1 day per week) - that gives us 50 hours of medical cover out of 168 hours or 29% of the whole week!! Someone has to pick up the 70% tab. A&E pick up the tab and the public pick up the hassle.

  • rate this

    Comment number 466.

    460. Sally

    My son has an incurable, but not life threatening condition. It hospitalises him every so often. Guess how interested your beloved private healthcare providers are in taking him on?

  • rate this

    Comment number 465.

    To anyone advocating the use of private health care or the abolition of our NHS.

    How could paying a LOT more money for a LOT less cover ever possibly be in my best interests?

  • rate this

    Comment number 464.

    "These issues arise from the 2004 contracts which 'forced' most GPs to withdraw from out-of-hours working (because of the cost). John Reid (then Health Secretary) rolled out the "lowest bid cheapest provider" model of care we have today. In the absence of adequate alternatives the consequence is an increase in visits to A&E."

    Once again, GPs STILL WORK OUT OF HOURS.

  • rate this

    Comment number 463.

    The problem with this country, unlike others, is that we don't have complete, comprehensive 24hr cover. Our health service is literally open 'office hours'. If you fall sick outside of these hours then tough luck! If we had a 24hr health service this would solve most problems. GPs should work evenings and weekends and so should consultants in hospitals. Care homes run 24hrs a day on shift cover.

  • rate this

    Comment number 462.

    439.CURTAINS 2012
    'It can be an emergency when you find out that one of the seventeen pints of reassuringly expensive lager that you have just poured down your neck was "off" but you don't know which one'

    If you can down 17 pints of reassuringly expensive lager it won't be the NHS you need it'll be the local funeral director ;-)

  • rate this

    Comment number 461.

    These issues arise from the 2004 contracts which 'forced' most GPs to withdraw from out-of-hours working (because of the cost). John Reid (then Health Secretary) rolled out the "lowest bid cheapest provider" model of care we have today. In the absence of adequate alternatives the consequence is an increase in visits to A&E.

  • rate this

    Comment number 460.

    Even now, people in the UK attend fares where private hospitals offer what they need, on the spot and cheaply. Making a mockery of them being forced to pay £1,000s annually by force, if necessary to wait in line for a "free" procedure.

  • rate this

    Comment number 459.

    If there is someone in charge - please get Aggripa.

    Its obvious from me that it is not this government that do so many U Turns they are going round in circles. Nor is it Blairs Fiasco (Labour) who put everything onto the PFI (pay later tab) at the expense of nurses doctors and hospital beds.

    Too many chiefs does not save money.
    Lots of nurses trained ON JOB gives the care/attention to patents.

  • rate this

    Comment number 458.

    445. Sally
    'Have you seen the NHS's books?'

    The NHS books would be fine if it was funded properly through taxation of the undeserving rich (most of them) and locking up serial tax avoiders, evaders and their advisors (accountants again!)

    Or would you prefer a company like Unum Insurance who have been fined to death in the US to 'help' run our NHS?

  • rate this

    Comment number 457.

    I had raging toothache at a weekend & via the internet found there was an emergency dentist at my local hospital. I visited the hospital dentist only to be told at reception that I had to phone a central number & wait for a return call, in order to make an emergency appt! Even though in agony I duly complied but didn't get called back until 5 hours later by which time all the appts had gone!!


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