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 596.

    A visit to A&E can alos be seen as far more attractive with its attendant drama than a simple trip to a 24hr pharmacy that can advise on a lot of the minor stuff.

  • rate this

    Comment number 595.

    To CladinBack's - There's 24hr cover from surgeries + OOHGPs. Practices on call for just their patients mostly went 30+yrs ago. Before 2004, surgeries formed co-ops because of burnout + unmanageable workloads-1 GP was oncall for 100,000+patients. Now, my local GPs still do OOHs, but safety's better - there's governance, more GPs available +shifts are chosen so GPs don't work 48hrs straight.

  • Comment number 594.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 593.

    I note that someone has said on here that N H S DIRECT worked well,, yes,, it did.. Why have this government, or if it be N H S responsible,, got rid of it. Can someone genuinely tell me why.

  • rate this

    Comment number 592.

    Doctors get their mortgages paid for when they buy a property for a practice - they either sell it on or own the property in retirement, they are paid ridiculously and unjust wages for the few hours they do, they also make profits from pharmaceuticals. A & E nurses are paid much less but take on the burden. Time doctors started earning their pay and truly looked more widely at patient care.

  • rate this

    Comment number 591.

    Yes, the country's population is increasing so more staff etc are needed in A&E's, but what would would really help solve the problem of overstretching is education of the public so they don't turn up with trivial ailments that could be treated elsewhere.

  • rate this

    Comment number 590.

    587. Sally
    They'd treat you, then bill you. A few can't pay, this could be factored into the costs of us all.
    Sounds a lot like national insurance, but at the moment more are taking out than are paying in, not sure if I am arguing against you, or with you now!

  • rate this

    Comment number 589.

    Some Gps seen to keep people ages before referring them to hospital. My father was so ill, that i took him to A & E out of frustration with the doctor. Apologised to triage nurse for using it, but she was so supportive and admitted him to hosp immediately as he needed intraveneous antibiotics to survive!

  • rate this

    Comment number 588.

    How coincidental - while my Mother was being taken to A & E having fallen, unable to get up, hallucinating and talking to people that weren't there. I asked the paramedics how often they had calls for this and to my surprise it was 90% of calls. 17 days in hospital and hence this

  • rate this

    Comment number 587.

    They'd treat you, then bill you. A few can't pay, this could be factored into the costs of us all.

    574. Libert_arian
    I identify with your name sake (ok, biases declared).
    You are 100% correct, just as government welfare only spends £0.33 in every £1 it receives on the intended recipient, the remainder goes to the middle class public worker. The same is most certainly true of the NHS.

  • rate this

    Comment number 586.

    A visit to A&E is more a drop-in to a social service/substance misuse centre than a medical emergency.Societys undesirables gravitate to them.Assessment at the door coupled with an increased hospital security presence would mean those through the doors would be there with a very real need.Not because theyve nutted someone in a drunken rage,want a methadone top-up or doss somewhere warm overnight

  • rate this

    Comment number 585.

    578. Sally
    If A&E was user pays, we'd see a swift decrease in admissions:
    Of course you would, if you don't pass the credit check, your feet wouldn't touch the floor.

  • rate this

    Comment number 584.

    privatisation shouldn't be seen as a problem. there are many parts of the NHS that use or are privatised. All GP's & dentists are privatised (self employed), the NHS uses many private hospital wards for example.
    it shouldn't matter who gives the service as long as its FREE AT THE POINT OF USE.

  • rate this

    Comment number 583.

    There are several reasons why A&E can't cope. The well known rise in health tourism, the fact that in general immigrants are less healthy (lack of vaccination, higher rates of TB etc) the drunks etc, but also the fact that normal doctors' surgeries are overloaded. Anybody with a severe pain who gets a doctor's appointment for 2 weeks down the line is unlikely to grit their teeth and carry on.

  • rate this

    Comment number 582.

    Its simple. We cannot afford to do everything. Eg

    The NHS, good social care, good public transport, flood defences, libraries etc or

    Buy trident, HS2, invade a country, spend billions in the EU, have a "defence" force etc

    We cant do it all BUT our leaders keep borrowing against the future without really addressing the real issues.

    Where can I vote for and against ANY of the key issues?

  • rate this

    Comment number 581.

    #572 its not only the tories that have wrecked the nhs but labour as well with their mass immigration policies..we see the damage thats doing dont we.

  • rate this

    Comment number 580.

    My daughter was 'diagnosed' over the phone by an out of hours service doctor as having tonsillitis. The next day she was critical in a high dependancy unit with pneumonia and a clot on the lung. As a resuly of that experience if I now have any doubt if something may require urgent treatment then its A&E as a first point of call.

    Perhaps loss of trust in out of hours care has overwhelmed A&E.

  • rate this

    Comment number 579.

    I suppose we are lucky not to have had to make use of A&E services, other than the odd accident with the kids when they were smaller, and we have a small hospital which offers 9-7pm service.
    I believe the problems have been worse since the GPs were offered these fantastic opt out and now you can't get an appt for love nor money.
    Unpopular as it may be, I see privatisation as the only option.

  • rate this

    Comment number 578.

    If A&E was user pays, we'd see a swift decrease in admissions:

    Frequent weekend users, binge drinkers, upon receiving a bill for their stay in the "hotel of healing" would quickly realise that their lifestyle choices, encouraging visits, aren't conducive to a balanced bank account.
    Apply this lesson (personal responsibility) to us all = job done.

    Can u elaborate on smoking plz? Xx

  • rate this

    Comment number 577.

    As an A&E doctor its quiote nice that the media is seeing fit to shine a torch on the issue. A&E attendances are rising very quickly, and I don't think it can all be blamed on GP hours. There are fundimental attitude issues. Hence why people are calling an ambulance at 3am because they have had 2 days of constipation, or their 3 year old has just vomited. once. What we need is common sense.


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