A&E: The straw that broke the camel's back

Patients waiting to see a doctor A&E waits have risen in recent years

It is often said visits to A&E units are rising rapidly. That is true, but it does not tell the whole story - as a new report shows.

Over the last four years the numbers attending A&E in England have risen by 11% to nearly 22m last year.

However, this has largely been driven by patients going to minor injury units and walk-in clinics, which are included in the national figures.

If you look at the 140 major A&E hospital trusts the numbers have been pretty steady.

So why have many hospitals been missing their waiting time target and, hence, said to be in crisis?

A new analysis by the Health and Social Care Information Centre sheds light on this.

Its report shows that there has been a small, but significant increase in the number of over-65s attending the major A&E units.

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As a proportion of overall attendances they now account for 21% of the total - up from 19% four years ago.

This is likely to be largely driven by the ageing population, although some have suggested cuts in community health and social care budgets have made it harder to keep elderly people well,

In numbers terms it amounts to a surprisingly small amount of patients, about 150,000.

However, these people are more likely to need tests and monitoring and, therefore, take longer to see in A&E.

The change - described as a "subtle shift" by information centre chair Kingsley Manning - has meant standards have dropped.

Performance is measured by the proportion of patients who wait longer than four hours to be seen.

In 2008-9, just under 3% did, but by last year this had risen to just over 6% for major A&E units.

The NHS is meant to keep it below 5%.

The growth in older patients is, in effect, the straw that has broken the camel's back.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 261.

    The NHS was broken at conception. All the problems we see with the NHS is the system running its logical course, even the people themselves complaining about the elderly being a burden is the logical end result of socialized health care.

  • rate this

    Comment number 260.

    There are two distinct problems.
    The fact we live longer is only of marginal effect, because we also work longer, if the jobs are available.
    The demographic of baby bulges is more pronounced. However, importing young immigrants to reduce the average age of the population is a Ponzi scheme that makes the first problem worse as well.
    We need investment and productivity.
    Nationalise the banks!

  • rate this

    Comment number 259.

    232.scottish astronomer
    3rd December 2013 - 21:58
    'You want GPs to work until 10pm'

    'Due to the vast amounts of paperwork... GPs are still working 12 hours or more per day, five days a week.'

    Would it be possible for some GPs to do their paperwork in the morning or afternoon and run an evening surgery instead? No more hours but a chance for working people to get to see them.

  • rate this

    Comment number 258.

    The problem with many hospitals, including the one I work at is that the government will give us a budget for the year but we can not spend it all as the government want us to return some of that budget as 'savings' This year alone, my hospital has to save £8m and save £50m over the next 10 years.

  • rate this

    Comment number 257.

    The NHS needs to start using its budget, available staff and modern technology much more wisely and effectively. It may mean a big turnaround in the way it provides patient care but if the police and the teachers can do it then the NHS can and a bit quicker. If the staff are the problem then maybe they either need to commit to team playing or move on.

  • rate this

    Comment number 256.

    If you clear inpatient beds then people who need to be inpatients will move through A+E faster.

    Staff need to be faster with TTOs etc in hospital, but social care is a primary reason stay in hospital. This means community services need more of this mythical money made avaliable in the HSCA 2012 and district nursing!

    + significant number of a+e admissions are still inappropriate.

  • rate this

    Comment number 255.

    It's not being vindictive to the elderly, it's just simple maths.

    When they were young there were less old people and more young people - now it's the other way around and the gap is widening.

    This has affected government revenue as they're taking in less tax while spending more on pensions and the NHS, which has affected the NHS budget.

    Unfortunately we can't magic money out of thin air.

  • rate this

    Comment number 254.

    253 SeaQuinn
    we usually do know these things are going to happen. The pension problem was forcast in the 1980's - we spent north sea oil on the dole queues and tax giveaways. The baby boom - but Gove will only allow 'free' schools, which are rarely the primary one needed. Elderly? No one in power 1980's till now has planned a thing

  • rate this

    Comment number 253.

    It's not as if more elderly are suddenly being dropped out of the sky. Population rolls have known this was coming along since the moment these people were born.

    If the 2% more elderly patients whom we've known about for 65+ years are single-handedly causing a "crisis", then there is something deeply flawed within the system itself.

  • rate this

    Comment number 252.

    The many informal groups of pensioners who indulge in binge drinking are well-intentioned but misguided.
    Far from fast-tracking themselves to an early 'money-saving' grave they are costing our nation dearly. The government must weed out these wasted wrinklies.

  • rate this

    Comment number 251.

    People over 75 should only receive palitive care. We aren't immortal. Nature has a solution and its much like Logan's run.

    Who wants to be 95 and so senile they don't even remember what they ate through a straw at lunchtime?

  • rate this

    Comment number 250.

    248 phil bunting
    It's not degenerate binge drinking youth if its the Bullingdon Club, or Druggies when it was 160+ bankers on a cocaine dealers list on the Isle of Dogs.

  • rate this

    Comment number 249.

    I would like Mr Hunt to let us know how many hospitals with problems have the PFI finance damaging their cash flow, and how many elderly people are in hospital because their local councils can't provide the care packages needed. Then I will remember the £35 billion unpaid tax last year.

  • Comment number 248.

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

  • rate this

    Comment number 247.

    Only because we are not innovating and using new technology, report's I get from the NHS is they only do what's necessary to keep the old in the same condition they are already in. However I believe more can be done the is an extra mile to go.

  • rate this

    Comment number 246.

    This is all about nudging, problem, cause, solution. Blame the aged who have been paying National Insurance & Tax to the government all their lives. Then come up with the solution, euthanasia. After all, they are considered to be useless eaters. World de-population is the name of the game.

  • rate this

    Comment number 245.

    No.There are two main causes. First is that the population have lost faith in the service provided by GP's. For many the appointment is too far ahead,or the GP is simply unavailable for long enough hours and the out of hours services are rightly discredited. So people go to A&E instead. Then we have loads of immigrants not registered to a GP practice so have no choice. Not hard to understand

  • rate this

    Comment number 244.

    I wonder if royalty or rich have to queue over 4 hours to been seen in A&E. The money that should be going into hospitals is being used to line the pockets of the fat cat bankers. We need to exit Europe, take control of our monetary system and kick out the members of parliament who are being financed by the big corporations.

  • rate this

    Comment number 243.

    Come on, be reasonable. You can't have a funded and functional NHS AND zero tax for Google and Starbucks. Which do you really want?

  • rate this

    Comment number 242.

    I was admitted to hospital earlier this year as an emergency case. All the staff in A&E (plus elsewhere) were rushed off their feet. As I observed all the various emergencies being admitted around me, I couldn't fathom out how on earth they all coped, but they did, professionally, efficiently and swiftly. In my experience, the only "problem with A&E" seems to lie with politicians and the managers.


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