A&E consultants: Hospitals in Wales at 'meltdown point'

Ambulances queue outside Wrexham Maelor hospital These ambulances were queuing outside Wrexham's Maelor Hospital

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Hospital consultants have spoken out to warn that A&E departments are at the point of meltdown and patients are dying as a result.

Almost half of the Wales' A&E consultants have signed a joint letter to new Health Minister Mark Drakeford.

It says pressure to meet financial targets has meant the loss of beds "at the expense of quality care".

Earlier this month A&E units were under intense pressure with record numbers of patients.

The Welsh government said one of Mr Drakeford's priorities was to look at ways of easing the pressures on unscheduled healthcare.

Start Quote

Each of us has seen standards of care slipping in our departments”

End Quote Consultants' letter to health minister

Meanwhile, the consultants warn that a lack of beds means serious overcrowding is almost a daily occurrence.

The letter, sent by the College of Emergency Medicine, reads: "Our emergency departments are at the point of meltdown. Most days, they are seriously overcrowded.

"This jeopardises safety and puts patients at risk: there is clear evidence that death rates go up if patients requiring admission remain in emergency departments for hours whilst they wait for ward beds to become available.

"Each of us has seen standards of care slipping in our departments, as we struggle to look after a dozen or more patients stuck in the emergency departments whilst waiting for ward beds, in addition to our normal workload."

They point to examples of patients coming to harm because of overcrowding:

  • A patient with chest pain having a cardiac arrest whilst being seen in the eye examination room (as there was no room in the resuscitation bay)
  • No space in the resuscitation bay to accommodate a baby having a severe seizure
  • These pressures, they say, have a knock-on effect on the Welsh Ambulance service which is unable to respond to emergencies "when scores of ambulances are queuing outside gridlocked emergency departments".
'Speak out'

Mark Poulden, chair of the Welsh National Board of the College of Emergency Medicine, and one of the signatories to the letter, said many factors played a role in their concerns.

He told BBC Radio Wales: "We have seen this deterioration. We're all working in a very complex system. We just see the system continuing to deteriorate. We felt that we had to speak out.

"There's obviously a lot of change in the NHS but that all takes time and what we see, because of the financial squeeze, is that beds have been closed but the system is not ready for that yet.

"Whatever we need to keep those beds open is what we need. It needs to change."

Wales' ambulances have missed a response time target for life-threatening calls for the ninth consecutive month.

Start Quote

This is a dire warning from Welsh NHS emergency consultants that patient safety is being dangerously compromised as a result of financial pressures”

End Quote Darren Millar AM Conservative health spokesperson

Statistics from February show 60.8% of emergency responses arrived within eight minutes, missing the Welsh Ambulance Service target of 65%.

A Welsh government spokesperson said: "The newly appointed minister for health and social services, Mark Drakeford, has stated that one of his priorities over the next 12 months is to look at ways of easing the pressures on unscheduled healthcare - this includes out of hours services, emergency departments and ambulance services."

The consultants warn that creating a culture whereby health boards are required to achieve financial balance could lead to the same result as the Mid Staffordshire scandal.

A public inquiry report found that neglect and abuse at Stafford Hospital between 2005 and 2008 had led to needless deaths.

Published at the start of February, the Francis report accused the NHS of putting corporate self-interest ahead of patients.

The consultants say: "The motive behind the financial squeeze affecting hospitals in Wales is different to that underpinning the Mid Staffordshire scandal, but from our perspective, the result is the same: the pursuit of targets and financial balance at the expense of quality of care."

Wales' seven health boards are currently in the process of trying to balance their books before the end of the financial year.

The largest, Betsi Cadwaladr, predicts it may be £3.9m in debt by the end of the financial year, despite £15m of extra funding from the Welsh government.

Analysis by BBC Wales indicates other health boards are also facing similar challenges, but some are predicting they will succeed to stay within budget.

Darren Millar AM, Conservative health spokesperson, said: "This is a dire warning from Welsh NHS emergency consultants that patient safety is being dangerously compromised as a result of financial pressures.

"Axing inpatient bed numbers to save money is leading to overcrowded A&E departments, which cause ambulance queues outside our hospitals and delay them from being able to get back on the road to emergencies."

Plaid Cymru's health spokeswoman Elin Jones said: "Labour health ministers have failed to take a strong hold of the NHS and ensure that it is delivering safe services for the people of Wales.

"Clinicians, health organisations and patients have been telling us for many months that there are serious failings in the current system, and it seems that key NHS targets are routinely missed."


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  • rate this

    Comment number 317.

    My Sister sat in A & E for 12 hours waiting for a bed yesterday at Withybush Hospital! She is 77, has a heart condition, has been diagnosed with Myeloma and had a Chest infection, shortness of breath and a huge swelling in her face. I don't know if she was offered food and drink. Why are GP's sending patients up to A & E with letters of admission instead of arranging admission with a Consultant

  • rate this

    Comment number 316.

    Dr's and Nurses pay attention to this:-
    If you are under 45 years of age apply for emigration to Australia
    Yes, you work a 37 hour week.
    You have more holiday entitlements
    on average the Dr's & Nurses are paid 25 to 33% higher salaries than in the UK. you are treated with respect, too.
    When you go into hospital in Australia you are treated as a human being not a statistic of the Gov't

  • rate this

    Comment number 315.

    @ 306. Decisionbyscience.
    I suppose it could have nothing to do with Blair opening the flood gates of immigration for 13 years. Putting everything, NHS, education, housing, transport, jobs and social services under intolerable pressure. And he did it on the cynical basis he thought immigrants would be more likely to vote Labour in elections.
    And now...... he's left others to sort it out!

  • rate this

    Comment number 314.

    I really do not understand this anymore. You can vote my last comment down. But out of a class of 25 Civil Engineering students 15 are contemplating leaving because we see with these ideology based decisions to cut everything , except politicians salary, subsidised meals and bar etc. They champion banks and slag the young and infirm. Wake Up people the corruption is everywhere and we are losing

  • rate this

    Comment number 313.

    It does not do to need A & E . Try keep healthy, hospitals are not much use now.

  • Comment number 312.

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

  • rate this

    Comment number 311.

    303.Fred Bloggs
    ..but would you really suggest one of the most expensive govt departments should be run with NO consideration to cost?"

    Absolutely. I agree with having the NHS but sadly it has been put under extreme pressure due to lack of funding keeping up with a rapid population growth and "health tourism".

    The lack of effective controls in the UK are staggering.

  • rate this

    Comment number 310.

    We don't need more resources for the NHS! We need the existing resource to be managed efficiently and for the public to understand what the words ACCIDENT and EMERGENCY mean.

  • rate this

    Comment number 309.


    I believe what I see with my own eyes.

    I see people in dire need having their benefits cut, not the rate of increase slowed.

    I know a woman who has to use the one remaining working element on her cooker to cook a meal for her family.

    Not Sky, 60" TV, Sun holidays - Just raw survival on a pittance now being cut

    These are the facts I go by, not political BS

  • rate this

    Comment number 308.

    Unfortunately the UK has a long standing reputation that demonstrates that there's a lot of people who like to voice their complaints but are reluctant to actually do anything tangible about it like protest in meaningful ways as an organised group of force that can't be ignored! The result is the political class know this & therefore don't really care about complaints & ride roughshod over us all!

  • rate this

    Comment number 307.

    There are more inpatients awaiting discharge plans to come to fruition than patients waiting for beds in A+E. The general population is ageing. Where are all these placements??? We need more resources in general ie staffing to process these patients through the system and respite/residential/nursing home beds. This is the problem.

  • rate this

    Comment number 306.

    This constant bombardment of the NHS is shocking. Only half of these consultants signed this. What do the other half say? The reason its straining is most likely due to greedy politicians and their "pals" setting it up for the only option they will then give us - Full privatisation. I'm only 23 and angry....very angry. They cut my services, not theirs, Well when i get my Masters im gone. ENOUGH!

  • rate this

    Comment number 305.

    Meltdown yes - it would only take a flu pandemic to push the 999 system over the tipping point. Or maybe the new 111 system might just do it?

    GPs should be taking more of the load that is true. Surgeries should supply their own out of hours services and that would cut a real load off the ambulances and A+Es.

    More of an issue is that we are becoming wimps!!

  • rate this

    Comment number 304.

    Re295 FredBloggs. Even if you are right about spending/cuts. Even if spending stood still, costs and expenditure keep rising so the gap automatically gets larger. If costs increase and you don't have the same amount of money to meet that expenditure, you are at a loss. The semantics can be dressed up as much as you like, but the reality is what counts - there is less real money in the pot.

  • rate this

    Comment number 303.


    "When you run a health service according to financial targets rather than clinical need, then needless deaths are the inevitable outcome. There simply is no way of escaping that basic truth."

    It's a lovely progressive fluffy leftist sentiment but would you really suggest one of the most expensive govt departments should be run with NO consideration to cost?

    (Then YOU pay for it!)

  • rate this

    Comment number 302.

    GP appointment ...................2 weeks wait and thats not for a particular one you might want to see. Thats for the first one available.
    Wales again

  • rate this

    Comment number 301.

    295.Fred Bloggs
    "Austerity" is a joke, real terms spending is UP. Not Cuts. There ARE NO CUTS"

    Yes, spending is up. eg Billion £ contracts for expenditure on 2 unusable aircraft carriers because Labour signed a contract where it would be more expensive to cancel it. But cut backs have and continue to happen eg: Police & UK Border Agency etc etc

  • rate this

    Comment number 300.

    Whilst I completely accept that we should all use our GPs for non-urgent care, what about out-of-hours?
    GPs in my experience give good care, as do Hospitals (in general), - but OOH services seem fragmented and unlikely to do much other than refer you back to your GP.

    Also, it is genuinely difficult in many cases to tell whether something is an emergency or routine. On which side would you err?

  • rate this

    Comment number 299.



    Yes as you may have guessed I get all my facts from the The Junior Encyclopedia of Space. It's the only one which has pictures. ;-)

  • rate this

    Comment number 298.

    A+E is often used as a default for those unable to see their GPs. This is the problem. People also won't help themselves. There are some things an A+E Dept is NOT required for. Pregnancy testing, emergency prescriptions because someone forgot to order it before the weekend and holidays , for plasters because you cut your hand cooking! We don't need more beds. Accident and Emergency people!


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