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A&E target missed for first time this winter

The health service has failed to meet the accident and emergency waiting target for seeing 95% of patients within four hours for the first week this winter.

The latest figures from NHS England, published today, show only 94.8% of all A&E patients were treated, discharged or admitted within the required four hours. In previous weeks this winter, the 95% target has been met.

The figures for type 1 A&E incidents – the category for serious incidents - show a fall-off from 94% during last month to 92.2% in the latest week’s data.

Several trusts’ type 1 performance has fallen below 80%, with University Hospitals of Leicester Trust seeing only 73% of patients within four hours and Southend University Hospital Foundation Trust only 78.4%.

Mid Staffordshire Hospital University Trust’s performance has improved from 76.8% to 85.7% in the most recent figures, which cover last week.

NHS England deputy chief executive Dame Barbara Hakin attributed the drop in performance to an increase in attendances and emergency admissions. She said: “It is of course disappointing that any patient has to wait longer than they should in A&E however we are now seeing many more patients than ever before.

“Last week was the busiest so far this year, with 415,400 attendances and 105,800 emergency admissions - the highest number of emergency admissions since we started collecting data in November 2010.”

Dame Barbara added: “Every year we see a dip in the figures for December, with week on week variations which is why we fully assess how local systems are coping with winter pressures over a longer period.

“The number of emergency admissions has been consistently high now for the past three weeks, and is in line with the emerging trend which has seen a 31% rise in number of people needing emergency admission to hospital over the last 10 years.”

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Readers' comments (26)

  • Concerning, but not unexpected. Until the GPs have been sorted out and we have decent OOHs primary care provision the picture will stay the same.

    Once people have an option other than attending A&E, I believe things will improve dramatically.

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  • Anonymous | 16-Dec-2013 3:06 pm

    but will the issue of offering alternative facilities really be resolved or just continue to be talked about in the media? It seems more severe in some locations than others.

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  • Anonymous | 16-Dec-2013 9:00

    I dislike this this culture of almost blaming people for attending A&E when often, people quite literally have nowhere else to go. It's like blaming people for travelling by car in areas where there is no bus service. It's pointless until you sort the underlying problem out. Until we create that second option, A&E attendances will continue to rise.

    With dynamic changes to the GP contract -using a 'carrot and stick' approach to funding - I believe GPs could take a significant amount of traffic from A&E departments.

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  • I thought the NHS were dropping this silly managerial notion of targets to focus on the patients and meeting their presenting needs instead. With all the government and media attention, isn't it now time for a meaningful cultural change?

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  • Anonymous | 23-Dec-2013 3:00 pm

    my GP advised me to go to A&E Christmas Day or Boxing Day if I had any worries or exacerbation of a minor current problem he is investigating. It should not be the case but it is good to know there is an alternative when his group practice is closed on these two days as there seems nowhere else to go.

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  • Anonymous | 23-Dec-2013 3:00 pm

    Anonymous | 16-Dec-2013 9:00

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  • continued from post above.

    I made no suggestion of blaming anybody. I merely asked if the issue would really be resolved. it is the responsibility of the government and the NHS to do so, not the patients needing medical services!

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  • Anonymous | 23-Dec-2013 5:24 pm

    Sorry, I think my earlier post wasn't too clear: I wasn't suggesting that you were blaming patients, rather the government appears to be or it's proxy through childish adverts advising people to go to chemists if they're unwell etc.

    I think the problems in the NHS will be sorted out, I believe the government is committed to a having a joined-up NHS.

    Sorting-out the ludicrous Labour GP contract by mandating extended opening hours and weekend working will offer patients a real alternative to attending A&E. I'd go further and get rid of all the OOHs services, NHS 111 and the like and use the money to build 24/7 walk-in centres where patients can physically go and be seen if their GP is closed or can't see them that day. Financial penalties for poorly performing GP practices would concentrate their focus on seeing their patients in a timely manner and help pay for the WICs.

    Moving toward a full 24/7 NHS with consultants working shifts will make a huge difference to patient experiences. That coupled with access to around-the-clock diagnostic imaging will mean patients can be seen, have a senior Doctor review them - having had whatever tests they required - and being discharged in a timely manner. The money saved on overnight stays and unnecessary admissions will be phenomenal and will help Trusts offset increased wage costs.

    It's not going to be easy, but with the two big changes described I think will make a huge difference to the patient experience.

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  • I'm sorry, but some of the lunacy being spouted here cannot go unremarked!

    The current government promised no top/down reorganisation of the NHS and proceeded to go about doing just that! So they lied to the electorate. Nothing less. And before the right wing extremists start accusing Labour, socialists, tinky winky and God knows who all of being entirely to blame for the state of the NHS, I support no political party. THEY ARE ALL TO BLAME.

    Oh and I think the GPs, who are much more powerful and much smarter than the dumb politicians you seem to worship, would have quite a lot to say about some of the idiocy punted as 'solutions'. When you so clearly don't understand/acknowledge the problems, you are obviously ill-placed to posset the answers.

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  • Oh and my comment above is addressed to Anonymous | 24-Dec-2013 12:08 pm, in particular.

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  • The Tories are committed to nothing other than the fragmentation and privatisation of the NHS in England. This process was started by Thatcher and her gang of thugs, progressed by sellout Blair and his nit-wits and now self-serving Cameron who has told lies to this country about his cobbled government's plans for the NHS, is finishing the job. There are fewer nurses than ever (and the panic has started over the shortages). These nurses have had their pay frozen for years, their terms and conditions attacked illegally and their pensions plundered. And the clueless blame the GPs!!!!

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  • Anonymous | 30-Dec-2013 11:42 pm

    I remember when Gordon Brown said he'd ended boom and bust, but I digress. All politicians lie, I wouldn't trust any party with the NHS or anything else for that matter.

    Putting it simply: the problem with the NHS is that for years we've tried to cram in 24/7 care into an eight-hour working day, five days each week. I'm sure the left-leaning among us would say we need to build one hundred more hospitals and a thousand more GP practices all working in the same antiquated way, but eventually we'd hit capacity again.

    Surely it makes sense to make best use of what we've got? I don't see the problem in telling extremely well-paid GPs that they have to stay open late and work weekends so that their patients can actually get an appointment; similarly I don't see the problem in making hospital consultants work shifts so that patients can have access to expert care, is this really too much to ask?

    Think of all those expensive CAT, MRI, PET scanners (and goodness knows what else) standing idle for more hours than they'r used. Is it so bad that we should expect them to be working around the clock including weekends too?

    I genuinely believe that by extending GP opening hours, having consultants working 24/7 and patients having access to diagnostic imaging when they need it, will save money and will reduce A&E attendances. Surely it's worth a try?

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  • Anonymous | 1-Jan-2014 1:27 pm

    Unfortunately, you've fallen into the government trap of believing the bilge they leak out through the press office via the nudge unit. The blame for A&E issues does not singly lie at the feet of GPs, neither does the solution.

    You "...don't see the problem in telling extremely well-paid GPs that they have to stay open late and work weekends...". Your first mistake is thinking that you have the right to "tell" anyone to do anything. GPs are private practitioners. The problem with this government, and its apologists, is that they think that no one has a right to negotiate terms and conditions and that legally binding contracts should not be honoured. (Unless of course they are "extremely well-paid" bankers. In which case, they are untouchable because "telling" bankers to behave themselves or threatening to change their contracts without consent or agreement apparently runs the risk of them taking umbrage and moving themselves and their "talents" abroad! As if it would be a problem to be rid of these incompetent leeches!)

    The hipprocracy of this government is breathtaking and I am sick to the back teeth of the treachery and lies peddled out to the people of this country day after day.

    Yes, the NHS is in trouble. However, it is not the fault of GPs, Nurses, Consultants or any other frontline staff who are continually being portrayed as uncaring, selfish, money grabbing criminals, who appear to have no right to demand that the legally agreed contracts should be honoured for all the hard work they put in day after day. I note that no mention has been made of the thousands of unpaid hours spent carrying out onerous, government mandated and pointless administration and audits.

    No more money is needed. Get rid of several layers of management, get rid of the ridiculous paperwork, give control back to clinicians and stop thinking that villifying staff and that an incompetent government "telling" them what to do is going to solve anything.

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  • Anonymous | 2-Jan-2014 9:09 pm

    Agree with your comments on government and bankers, but had both governments not 'backed the bankers' and people had not been able to access their money, the country would've gone into meltdown - Greece being an prime example of what we could've faced.

    I agree with getting rid of layers of management, but that alone won't deal with the rising numbers of patients presenting at A&E departments.

    I think sometimes we need to remind ourselves that the NHS is there not for the benefit of its staff, but for its customers - our patients. Labours GP contract may have been acceptable in the 00's, but with the failings of OOHs services it certainly isn't acceptable anymore. GPs may well have negotiated an excellent package for themselves, but when it is in direct conflict with the interests of the people they're supposed to serve, radical change is required.

    It strikes me that I can go shopping, book a holiday - do all manner of things on a Sunday, yet I can't see my GP; how can that be an acceptable state of affairs in 2014?

    Other posters have commented on the government being hellbent on 'fragmentation and privatisation of the NHS' - they're certainly comfortable with privatisation, but if we don't get our house in order, it won't be the Tories demanding privatisation, it will be the general public!

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  • Anonymous | 3-Jan-2014 10:15 am

    I'm a nurse and I look after patients (recipients of health care services). If I wanted to look after customers, I would work in a shop. You don't NEED to shop or book a holiday on a Sunday. They are only available on a Sunday because someone stands to make a good deal of money from you. They don't care about you and, if it wasn't lucrative for the multinationals, then it just wouldn't be an option for you. Simple.

    If you need to access a doctor on a Sunday, then there are OOH services available which are perfectly fine. Unless of course they have been underfunded then closed. I am able to see my GP in the evening of a weekday. If I need to see anyone at the weekend, my local OOH GP service is great. I don't need that to change.

    If you want a good quality service and good quality staff, then you are going to have to remember that your staff are people who have a right to have the terms of their contracts honoured. That means NO MORE unpaid, extra hours, NO MORE missed meals, breaks, staying on after shifts are ended, NO MORE reneging on legally agreed contracts, NO MORE plundering of staff pensions, NO MORE villification of staff to disguise or excuse the imposition of deliberately destructive policies. But that's the trouble isn't it, in spite of their best efforts, any shortcomings will continue to be the fault of the staff?!

    After years of working punishing shifts and suiting the needs of everyone but myself or my family, I found a job where I no longer work weekends. No one will ever make me work weekends again and I will not accept the dismantling of perfectly OOH good services being used as an excuse to deny anyone else.

    Ask nicely, and treat staff with respect and decent conditions, and you may find that some will happily adjust their hours and take a more flexible approach. However, using the approach that GPs "...have negotiated an excellent package for themselves..." (they didn't negotiate with themselves!) and making accusations that the hard work they put in "..... is in direct conflict with the interests of the people they're supposed to serve......" is erroneous, damaging and typical of current political ideology. Next they'll be getting called scroungers! Making them the enemy is exactly what has already been done to silly nurses, who have readily accepted the mantle of "uncaring" and come up with the daft 6Cs to prove to everyone that they do care! Now try to get decent pay and conditions when you have been labelled as the cause of all the problems with the NHS.

    With regard to the defence of the the bankers, if both governments had not 'backed the bankers', with their criminal practices which played fast and loose with peoples' money and has ruined lives, businesses and brought our economy to its knees, then we wouldn't be in the current mess!! How can anyone defend that?!

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  • This government has blatantly lied to the public (as I write this, the news is reporting on the documented evidence that Thatcher's government lied and lied again about their plans to close 75 mines in the 1980s whilst they publicly denied it. Scargill has been proved to have been right all along!) and set about the privatisation of the NHS with thuggish intent. I don't know one person (other than government policy makers) who wishes the NHS to be privatised. Not a single soul. Our local community services were privatised, staff were made redundant and those who stayed made to reapply for their jobs which were paid less. Now the company are not making enough profit, have found that they cannot provide acceptable services and the NHS has had to step in!! People should be going to jail for this treachery. Oh, but it must be the fault of the GPs!!

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  • tinkerbell

    there is always room for improvement. Personally and in no particular order I would like to remove 4 layers of the bureaucratic onion

    *zombie tick boxes

    *suits who LBDN (look busy doing nothing)
    talk a good talk but never take any action but always attending endless meetings. (the more people involved in a decision usually means the less likely a decision will be made).

    *funding panels (who ask me to present a patient for funding and then tell me after months of preparation and filling out their 200 plus pages of assessment they are not the funders but someone else. I am inclined to think none of them actually know themselves because it's totally unintelligible but still they keep up the pretence and tell me 'we're sorry you're finding this difficult to understand'.

    *Political interference and continual re-disorganisation by corrupt spivs. (Actually make that number 1 improvement)

    4 suggestions just to start with.

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  • Anonymous | 3-Jan-2014 2:25 pm

    "If you need to access a doctor on a Sunday, then there are OOH services available which are perfectly fine. Unless of course they have been underfunded then closed. I am able to see my GP in the evening of a weekday. If I need to see anyone at the weekend, my local OOH GP service is great. I don't need that to change"

    You're very fortunate, an elderly friend of mine waited almost 8 hours not so long ago on a Saturday for a home visit by the OOHs service GP. If you think that level of service is acceptable, then you're absolutely right: everything is fine and dandy.

    If you work Monday to Friday, do you not need to shop at weekends?

    tinkerbell | 3-Jan-2014 6:35 pm

    Agree with everything.

    Anonymous | 3-Jan-2014 6:26 pm

    That wouldn't be the same Mr Scargill who called a miners strike in the hottest summer for decades would it - when nobody was burning coal?

    I worked for a service that was privatised so believe me I'm no fan of private healthcare companies, but if the NHS doesn't sort itself out, I think that is likely to lead to more private companies being involved not less.

    These are just my opinions.

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  • Anonymous | 3-Jan-2014 10:52 pm

    No. I never go near a shop at the weekends. Too full of people. Am I supposed to only shop at the weekends because I work during the week? Or is it okay to organise my life in a way that works for me?

    With regard to your unfortunate, elderly friend, obviously you forgot to mention any details whatsoever. In October, my elderly father was seen by the OOH GP within an hour for a pyrexial illness which turned out to be a chest infection. His treatment was started promptly and a hospital admission was avoided. If you don't think that's acceptable, then you are irrationally hard to please. If you are unhappy with the services in your area, then start a campaign.

    "... if the NHS doesn't sort itself out..."

    "sort itself out"? Seriously? Constant interference from governments, disenfranchised clinicians and the imposition of business managers, a top down reorganisation which is decimating the NHS is precisely why the NHS can't 'sort itself out'. I couldn't believe that line when I read it. Are people really so unaware of what is going on? The government has completely planned the removal of its own responsibility (the Tories have changed the constitution of the NHS and the Department of Health is no longer RESPONSIBLE for the National Health Service in one is!! Fact.) and opened the door for your care to be provided by private companies whose first responsibility is to their shareholders, NOT you the patient. Cut price services, cut price staff and you're unfortunate, elderly friend will have to find an A&E next time. (there will be no OOH service). If you think that level of service and accountability is acceptable, then you're absolutely right: everything is fine and dandy.

    I would recommend to anyone living in Scotland or Wales or NI to vote for independence or increased devolved powers. Do what you can to get as far as possible from the cancer at the heart of the NHS in England. Learn from the mistakes made in England. Protect your own precious NHS. We are finished here.

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  • tinkerbell

    Anonymous | 3-Jan-2014 11:47 pm

    'Learn from the mistakes made in England. Protect your own precious NHS. We are finished here'

    Sadly I agree. I started out in 2010 angry but hopeful that we could stop this destruction but it appears we are 'done for'.

    Yesterday at work after spending 7 1/2 hours at my computer screen ticking boxes to make my 'stats' go from red to amber to green on the BI report(British Intelligence - oxymoron) I stood up put some Christmas decorations in my hair and announced 'I can't take any of this seriously anymore'. It's just an hysterical coping mechanism I know, none of my colleagues batted an eyelid and then I made them all a nice cup of tea. Keep Calm, Carry on.

    Would the last one to leave please turn out the lights.

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