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 496.

    As a GP it's incredibly frustrating having all the blame laid on our doors all the time. At my surgery absolutely everyone who asks to be seen on the day is seen. This is the same at the last 3 surgeries I worked at where nobody was turned away.
    Patients often take little responsibility and we get a lot of people not showing up for appointments and many turning up at A&E with a sore throat.

  • rate this

    Comment number 495.

    "All A&Es have triage. This should sort out the wheat from the chaff." Good in theory but not in practice. A field mouse took a chunk out of my finger, was told to go to an A&E for a tetanus injection. Waited hours to see the traige nurse who took me into a room and told me I needed an injection. Had to wait another few hours for a doctor. Pointless waste of time for all.

  • rate this

    Comment number 494.

    'This binge drinking culture which takes place on weekends needs to be stopped by increasing tax on alcohol'

    I'm not advocating binge drinking but in the same respect should we not slap a big tax on fatty foods as obesity is also a big burden on the NHS? However, unlike drinking and smoking there is no direct tax associated with it

  • rate this

    Comment number 493.

    If we didnt have such a high level of immigrancy over the last few years we wouldnt be under pressure.
    Many foreigners will queue up in A&E to get a free prescription instead of going through the proper channels.

  • rate this

    Comment number 492.


    You're welcome, it was well deserved.

    I assume you meant Craig Venter, not Craig Ventor. You could at least spell the name of your poster boy correctly, even if you don't actually understand how his research fits in with huge amounts of other work over the decades that only public sector institutes were willing to touch.

  • rate this

    Comment number 491.

    I have used A&E twice this year. Both times I had to wait >4 hours, once with a child having a temperature of 40C.
    Compared with my experience over the previous 5 years NHS services have declined. Recently I took my child to A&E because he smashed his face falling off his bike. Neck and head were checked, but they said, "Sorry, we don't fix teeth". We had to pay private to save his front tooth.

  • rate this

    Comment number 490.

    It's laughable really, they cut staff, reduce funding and threaten to close hospital A&Es... then are surprised when the figures show that there's a crisis and the A&E departments can't cope.

    They're thinking about closing our local city A&E... yep that will solve all the issues alright, the nearest hospital 25 miles away will have a fit though.

    More GPs working evenings / weekends will help

  • rate this

    Comment number 489.

    If you end the NHS, you must abolish the taxes that funded it, returning the wages to the people.

    Nope. The FDA in USA, and our MHRA, regulate competition out of existence - keeping a happy cartel in place.

    I feel as long as the current monopoly remains, @474 will not materialise, to all of our (& to your family's) detriment I am afraid.

  • rate this

    Comment number 488.

    @483 You can't run a system which prioritises different groups of patients otherwise middle aged and young people will be waiting for the rest of their lives. It has to be based on the severity of the condition.

  • rate this

    Comment number 487.

    486. lfchater

    'This binge drinking culture which takes place on weekends needs to be stopped by increasing tax on alcohol.'

    True. Notice anything about alcohol pricing in the Queens' Speech? Now who is of more concern to the Chancellor? A & E units under pressure at weekends or big business Tory donors? No prizes.

  • rate this

    Comment number 486.

    @481 But we shouldn't privatise healthcare because its an extra cost for everyone which many people are going to struggle to afford.

    This binge drinking culture which takes place on weekends needs to be stopped by increasing tax on alcohol. Binge drinking causes majority of hospitalisations on weekends which people mostly inflict on themselves because they aren't aware of what they are doing

  • rate this

    Comment number 485.

    The Torys they despise the NHS they cant wait to get their friends and families sticky fingers very wealthy by getting private providers firmly embedded in the NHS draining more money for profit from front line care soon we will have dying people being escorted from private A&E and thrown on the street but by then ministers will have no legal responsibility thus were not to blame ching ching

  • rate this

    Comment number 484.

    So the pharma companies don't already operate under a free market model?

  • rate this

    Comment number 483.


    Same day. The person in change of A&E came out twice in a 4 hour wait to be seen begging people to leave and go somewhere else.

    Problem is if you leave for a walk-in-centre or another A&E you start at the end of perhaps an even longer queue!

    Live queue times should be made available on the web for all A&E's (with a note that babies and the really sick will be seen first!)

  • rate this

    Comment number 482.

    I do think A&E gets bogged down by people who should not be there because you just can not get into see the doctor. I called Tuesday morning have been ill all weekend. Was told first appointment they had was Friday morning. And also said if I wanted to ring to see if they had any cancelations I could. I have rang twice a day to see if they had and got nothing.

  • rate this

    Comment number 481.

    you can rely on the good ol' NHS to provide care to everyone.
    Just wait, in agony, for treatment in 40+ weeks!

    If there was no monopoly, and a user pays for A&E, we'd see businesses set up to met this demand. You could set up an ambulance business, billing, treating and delivering patients (customers) to hospital.

    Thanks for the insult.
    Google Craig Ventor. Xx

  • rate this

    Comment number 480.

    meanwhile the solution seems to be close A&E units and they won't have a problem just the open ones picking up the slack.

    I can just see hunt claiming he has reduced the number of units in crisis

  • rate this

    Comment number 479.

    474. Sally

    'If there is demand, business will meet it.'

    Absolute piffle. My son takes expensive medication every day, spends time in hospital from time to time usually as an emergency patient and has a regular regime of blood tests and consultant examinations. You let me know which of your wonderful private providers will take him on and I'll give them a call.

  • rate this

    Comment number 478.

    All A&Es have triage. This should sort out the wheat from the chaff.

    If you get past triage you need to be seen in A&E.

    What you don't want is not to be treated and get stupid remarks like 'you are the healthiest 100 year old I've seen in A&E' - when what the fools means is that you are the only 100 year old he has seen! True story - trust being sued for medical negligence causing actual harm!

  • rate this

    Comment number 477.


    The fact that you believe that a "free market" would miraculously generate cures for complex diseases, never mind provide cover for them, just proves how much of a fantasy land you live in. You obviously understand nothing about medical research and are making a fool of yourself.


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