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 696.

    Yes I agree that the A&E crisis is the fault of the 2005 GP contract.

    It's about time we stopped regarding GPs as demigods.

    When asked at the start of the NHS how he got the GPs to join, Bevan said that he stuffed their mouths with gold.

    Well their mouths were stuffed with more gold in 2005, and for forfeiting a pittance their patients found out just how much they were held in contempt.

  • rate this

    Comment number 695.

    679.Doctorate Pending
    3 Minutes ago
    then had 3 massive heart attacks.gone was the company ..gone was his house..and gone was his wife with the money..and now on benefits..bupa gone as well ! so NHS is fine


    The boss at our company accountants gave up his pension and retirement to fund the tobacco industry.

  • rate this

    Comment number 694.


    You're a lawyer? Seriously? Correct me if I'm wrong but weren't you the person who claimed that if you don't pay your taxes police will turn up at your door with guns to take you to prison?

  • Comment number 693.

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

  • rate this

    Comment number 692.

    Hospital staff are useless! they walk around with stethoscopes, drinking tea/coffee and chatting among themselves whil patients are left hanging around waiting to be seen. Either that or they are on their break, they have no sense of urgency - proved by the fact that most of them are overweight! Why don't the management kick them up the backside and get them to fix the patients?

  • rate this

    Comment number 691.

    Sally sorry if I misread your post - the health nazis really wind me up on a subject close to me with their constant berating of smokers on health grounds.

    Not all libertarians oppose all taxes but let's not bicker over who is the most freedom loving given that we are already a tiny minority.

  • rate this

    Comment number 690.

    I have nothing but praise for the staff at our local A&E. In the last 3 years we have increasingly used A&E as an alternative to our GP surgey where usually we cannot be seen for several days. We don't go for colds and snuffles, but if our child is ill we invariable end up at A&E as the call to the GP will lead to "week, friday next". Maybe getting GPs sorted will help the A&E issues?

  • rate this

    Comment number 689.

    Anyone surprised when we have a GP service which suits GPs working hours preferences and not patients who pay their salaries. It's another example of the public sector tail wagging the tax payer dog.

  • rate this

    Comment number 688.

    Blair screwed up, (there's a surprise!) when he bought the out-of-hours cover off the GPs to appease them. No cover = A&E bedlam...
    made worse with the influx of health tourists, immigrants and their huge baby boom. My budgie could foresee that, but not Blair...

  • rate this

    Comment number 687.

    The problem here is the lack of flexibility with GP's and the lack of out of service they should be providing, which is compounding A&E departments with patients that need not be there. GP's are paid well for what they do which in my opinion should include out of service work.encompassing NHS direct. This on its own will relieve stress on A&E departments and us having to wait excessively in need.

  • rate this

    Comment number 686.

    Even enjoying the grand-kids while your kids take a breather from work and parenting is a form of productivity. A joyful form smokers often deny themselves, and whose lost benefits are felt by many loved ones.

    "Learn how law works"
    No need for attitude!
    I am a lawyer. Negligent driving occasioning death is criminal negligence and or manslaughter. If it's intentional, murder.

  • rate this

    Comment number 685.

    It's obvious from a multitude of comments here that one of the main problems is the inadequate GP service due to shorter hours in spite of massive pay increase. Until we get a 24 hr GP service back, A&E will be overburdened. I remember the days when you could "call the doctor" and he (mainly male in those days) would come round with his little black bag. Unheard of today. Now they say "Go to A&E"

  • rate this

    Comment number 684.

    I am a GP. Try considering why it is hard to get in to see your GP. We are not sitting around idly whilst all of our patients attend A+E. The demand on Primary Care is at least as bad as in A+E, but it is easier to blame GPs than look for solutions. Working in primary care and then reading the vitriol on here directed our way makes me want to pack it all in and emigrate now.

  • rate this

    Comment number 683.

    I have had to use the A&E department on various occasions with different members of my family both via ambulance and walk in...I couldn't fault any time.The staff work long hours and get little praise. GP's on the other hand should definitely sort their opening hours out to accommodate working shift patterns,some GP's also seem to favour the sick note culture as if they get paid a bonus for them!

  • rate this

    Comment number 682.

    While sat looking through a menu at a restaurant in a New York hospital, the heart surgeon who operated on my wife paid us a visit.
    He explained that they have such good facilities to try to encourage people from overseas coming in for operations as there is profit to be made there.
    Maybe, when it comes to oversea folk using our NHS, we need to also treat it more like a business!

  • rate this

    Comment number 681.

    I'm a staff nurse in A&E. The 4 hour breacher time is like ticking boxes, putting more pressure on already pressured staff and of course , more paper work. Our managers care more about the breacher times and care plans than the patients we're all supposed to be there for. Inappropriate use of A&E is one cause, cutting of beds is another.20% gone in Glasgow, where are we supposed to put our people?

  • rate this

    Comment number 680.

    I'm an A&E consultant. I work 48 hour weeks & nights and weekends, as do the most A&E consultants nationwide.

    People blame GPs, politicians for raising expectations but not funding

    truth is, the majority of people attending A&E do not need to be there, irrespective of day or time of attending. these people are stopping those that genuinely need help being seen properly and in time. wise up!

  • rate this

    Comment number 679.

    An old friend of mine hated the nhs and labour,,he and his wife thought that anyone that used the welfare state or the nhs were users..so he joined bupa.He .had a Multi Million pound company and a million pound house.. then had 3 massive heart attacks.gone was the company ..gone was his house..and gone was his wife with the money..and now on benefits..bupa gone as well ! so NHS is fine now !!!

  • rate this

    Comment number 678.

    671 If I understood what you were trying to say we could have a debate. Try punctuation, capital letters and joining words.

  • rate this

    Comment number 677.

    and what proportion of these time wasters are immigrants clogging up the system?


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