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 676.

    Not me. I try to show more class than that person.

    Petty insults only reveal yourself... and you were doing so well beforehand.

    I was pointing out the shortsightedness of the IEA report on that topic, agreeing with you. But hey, when you're done displaying your class, feel free to join the debate.

    We libertarians oppose taxes as aggression anyway, you should too

  • rate this

    Comment number 675.

    You know, if they start charging for people to use A&E then I suppose we're all in for a rebate on our NI since that's what we pay it for in the first place. I already get charged to use the NHS, A&E included, through my taxes, why should I be charged again to use A&E?

  • rate this

    Comment number 674.

    Arrest Drunks and put them in a police cell not an A&E bed?

  • rate this

    Comment number 673.

    What most people are saying comes from personal experience not what any surveys show. We can all quote experience but what we need to know is the percentage of how many contacts in A+E are "appropriate " and how many are not. That's the only way we can judge whether there is enough provision or too much expectation.

  • rate this

    Comment number 672.

    Bring back cottage hospitals, matrons & common sense. Get rid of middle management, bean counters & excess paperwork. Late night clinics in local surgeries run by nurses. Time wasters & drunks at A&E's should be charged for services rendered or have medical Asbo's & be educated on what an A&E is for. I was a porter at A&E and saw so many timewasters taking away from genuine patients.

  • rate this

    Comment number 671.

    659. Sally
    661. Libert_arian
    creating multiple identities does not enhance your argument unless you have insured you both for accidental damage and do not have an emergency that the private sector cannot cope with and shove you over to the NHS, warts and all..

  • rate this

    Comment number 670.

    Start charging.

    If it is serious, then anyone would be more than willing to pay for being attended to.

    Those who abuse the service...especially at weekends, will only suffer through their pockets.

  • rate this

    Comment number 669.

    "This government does not listen and should get rid of the 111 system as it does not work and return to as it was before that did work"

    As an NHS Direct call-handler, I agree! 111 may even out over time, but right now it's disastrous.

    I can't believe the editor here is 'picking' ignorant comments that are claiming there is no OOH service in the UK.... what on Earth?

  • rate this

    Comment number 668.


    Noone who dies of old age having lived what you may consider a virtuous life is "productive" all the way to the end (and neither should they be). Smokers have an accelerated decline, non usually have a longer (monetarily more costly) downward trend.

    Also, failing to cough up for an accident like you described earlier would be a civil matter, not criminal. Learn how law works.

  • rate this

    Comment number 667.

    I blame our parents. How very dare they create a post-war baby boom.
    It's clearly now our fault for living so long - and for being so healthy.
    How frustrating it must be for the NHS Staff when we occasionally get sick and require treatment. OK - we've paid for our health care in advance - but that's no reason to claim on the National Insurance. That money is allocated for wages, not treatment!

  • rate this

    Comment number 666.

    A good solution is to turn the whole A&E over to user pays, and reduce everyone's tax burden correspondingly.
    What could be more fair than that.

    This way, those that minimise risk, perhaps get a policy (or not) and make responsible choices will use it much less and will reap the savings. Conversely, those that make poor choices, increasing the likelihood of an A&E visit will bear its costs.

  • Comment number 665.

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

  • rate this

    Comment number 664.


    I know, isn't it? I was wondering why no one thought of it myself... Sarcasm meets sarcasm for a duel to the death. But seriously now, do you want to talk about it? Building new hospitals will require construction workers and all the related industries involved, boosting the economy... Well that's what they say about building new houses, right? 1 stone 2 birds.

  • rate this

    Comment number 663.

    May I propose a radical solution: let GPs run hospitals, and own them.
    The artificial distinction between "hospital care" and "community care" will disappear overnight.
    First, impress on all in the localities, that hospital beds are their local resources, to be used well or not, for the benefit of all.
    Then impose severe corporate & personal sanctions for clinical failures on those who run them.

  • rate this

    Comment number 662.

    Make an appointment for your GP 24 hours (if your very lucky) go to A&E 4 hours! Hmmm see the problem. Think what part of your condition is an Accident or Emergency!

  • rate this

    Comment number 661.

    Sally I think you are a loser trying to claim smokers do not pay their way. As someone who has lost a number of relatives to lung cancer I can state that by the time they have to go to hospital they do not last very long.

  • rate this

    Comment number 660.

    Try getting a GPs appointment in under two weeks and then you will see why A and E is over burdened in many areas. GPs only work "office hours" people get sick 24/7 but having said that we are becoming a nation of big girls blouses. Minor ailments are just that and do not need A and E and alcohol is now a major factor in using up NHS resources. We need public education!

  • rate this

    Comment number 659.

    Does the IEA report consider what that smoker may of contributed had they simply quit and remained a productive member of society for the remaining 50% of their lives?

    I wonder if 2nd-hand smoke victims factor in the report also?

    640.Machiavellian Hamster
    You're "long-term solution" is to expand the worlds 5th largest employer, while our country is grossly insolvent. Brilliant.

  • rate this

    Comment number 658.

    651.Al Gore

    And so with available facts we find out that they're closing A&E departments down whilst at the same time complaining that they're not meeting targets. Sounds like someone is tageting the NHS and manufacturing problems to complain about...

  • rate this

    Comment number 657.

    Please please please ....can I and my family have the same health care plan that is given to the Royal family..??? because my dear old dad would still be alive now..and my daughter wouldn't have nearly died because the NHS couldn't look after her like the Hospital that they the Royals always make VERY OLD BONES IN !!!


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