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Mondays are busiest time for A&E staff

Accident and emergency departments in England see the most attendances on a Monday morning – dealing with double the hourly average.

A&E departments collectively deal with about 4,000 cases per hour between 10am and 12 noon on a Monday, compared to the typical hourly average of 2,000, according to analysis of data for 2011-12 by the Health and Social Care Information Centre.

The Monday peak also occurred in 2010-11 – 3,700 arrivals per hour, compared to the typical hourly average of 1,900 – the HSCIC said.

While more attendances occur during the Monday peak, the attendee pattern within this period – age, gender and region – was broadly the same as the pattern at other times, the analysis found.

Overall 17.6 million attendances were recorded in 2011-12, compared to 16.2 million in 2010-11, major A&E departments, single specialty A&E departments, walk-in centres and minor injury units.

Nearly 45%, or 7.7 million, involved a patient aged 29 or under, and just over half of all attendances were for men.

Mark Newbold, chair of the NHS Confederation’s hospitals forum, said: “We know demand for urgent and emergency care services is rising, year on year, but a two-fold increase in A&E attendance on a Monday morning is a clear sign of a system not working at its best.”

Dr Newbold added: “Urgent illness, trauma and accidents don’t take a break over weekends and bank holidays, nor do they respect a 9-5 working day. It is essential that we look at all options for urgent and emergency care, and how it joins up with community and primary care, so patients know their health service will respond appropriately no matter what time they need care.”

A national review of how A&E and urgent care services are organised in England was announced last week by the NHS Commissioning Board.

Readers' comments (11)

  • It would be interesting to survey these patients attending on Monday mornings, as to whether they have tried and failed to get in to their GP's, or whether they were never going to access possibly more appropriate primary care options (GP, Walk In Centres, Pharmacists).

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  • There have been lots of studies on this, going back to the 90s. It's because of GP office hours. The cases are non emergencies due to inability to get an appointment in primary care and some MIUs being so under resourced that they are dressing stations. No X-ray, no medical cover, PGDs for Calpol, no emergency care practitioner in the community..... It is so unconnected and confusing for the frail elderly who just want timely care not an iPhone app. But the GPs were offered to lose their OOH for a loss of just 6k a year and to many working a one in two or three, getting a family life back was worth the loss of income. Since then we've made a dog's dinner of emergency care (managers not nurses) and I hope the national review makes a difference. But is is being led by a surgeon and taking "consultant present 7 days a week" as its starting point. There is strong evidence for this but I am worried that all this work is going on nationally and locally and nursing is not involved when it should be a key part of the planning for our future.

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  • michael stone

    The Manager | 24-Jan-2013 7:48 pm

    'But the GPs were offered to lose their OOH for a loss of just 6k a year and to many working a one in two or three, getting a family life back was worth the loss of income.'

    I seem to recall the consequences of that described (my phrasing here) as 'a surprise' - who exactly thinks out the consequences of proposals ! If anyone !

    There is quite a lot about this 'topic' in today's Guardian (page 1).

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  • Demand for urgent care is rising.

    This is not surprising !

    The population has risen and in many situations exacerbated by uncontrolled immigration, the social consequences of which were both ignored and left unfunded by politicians.

    Removing the GP's OOH obligations without ensuring adequate replacement is another example of political incompetence.

    So what is the answer?

    In my view it is not appropriate to splatter a variety of resource across a district - ie walk in centres, miu's, urgent care centres - the list is endless. All of these types of facility will be endowed with differing levels of resource and limitations.

    The general public will quickly learn or become very confused about the variety of provision, most of which fails to meet perceived patient need.

    The public do, however, understand what an A&E service is ! Such a service offers Drs, Nurses, X-rays and much more!

    Patients will out of sheer desperation gravitate towards A&E departments even if they have to endure long waiting times!

    In my opinion within urban areas a 24/7 GP type service should be associated with each A/E department. In addition to a reliable community based GP OOH service.

    The costs of a GP OOH illustrate another problem caused by "political" interference Each GP who opts out of providing an OOH service loses circa £6K of income.
    Re-provision of the service is variously quoted to be of the order of £9-!3K! (Ref National Audit Office). Is it surprising that a service of lesser provision/quality has emerged! Sorry I digress --

    Outside the urban areas provision of OOH services becomes more problematic because of a scattered population and the distances involved. However sufficient data should by now be available to permit a sensible and if necessary a pragmatic solution to be found which will avoid patients having to wait for extended periods of time in order to access care.

    There are of course no easy solutions!

    The problem is becoming more complex and small A&E departments are being questioned in terms of viability and clinical safety.

    Whatever the outcomes dont expect the solution to be cheap ! Money will have to be found from somewhere -----which of course is why we need managers ----go find the money !

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  • Jenny Jones | 27-Jan-2013 4:44 am

    Your post is 100% spot on! I would love to work for you. Bizarrely, when you cost out all the different disconnected services and add them together, it's actually LESS than what it would cost to make a serious investment in A&E as you describe. But the idiotic rules that have been created around PbR and only paying 30% of a trust's costs if a patient is re-admitted (often because of lack of social care package or family dynamics and unrelated to what the hospital may or may not have done) is punitive and doesn't help a health system work together effectively. Or the CCG designs "demand management" plans that don't work. Roy Lilley wrote a brilliant piece about patients wanting to go somewhere where the lights were on. Bruce Keaogh is the Chief Medical Officer and is leading a review of urgent care using the "consultant present 24/7" report that the RCP wrote but this needs to be multi professional and across organisations, and not used to shut units unless they are dangerous.

    We are using risk stratification and working with practices whose patients have the most risk of admission, and trying to wrap social services and community nursing around those areas.

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  • michael stone

    Jenny Jones | 27-Jan-2013 4:44 am

    The Manager | 27-Jan-2013 10:05 am

    Jenny might be spot on, but from my brief perusal of something about this in last week's press, the current plan involves reducing the number of A&E departments that deal with major issues (on the grounds of concentration of expertise and capability) and also leaving 'less-capable' local services for less complex immediate care.

    But it is confusing to lots of different options, for 'emergency' treatment - until you've seen someone, as a patient you are probably unsure of how much of an emergency your problem is !

    By the way, the Manager mentioned CCGs - is it just me, or a while ago were there not CCGs (the group of GP Practices) and CCBs (the board doing the purchasing for the CCGs) ? These days, people seem to be using CCG for both - and the two things are not the same. Whether this is because people are now talking about the NHS Commissioning Board, and do not want to use 'board' in CCB I'm not sure - but it strikes me they keep renaming bits of this new 'system' !

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  • DH Agent - as if ! | 27-Jan-2013 2:07 pm

    Oh, don't start me off - my turn for a rant! Instead of spending time and money on integrating health and social care or improving care of the elderly services or whatever, Andrew Lansley spent the last couple of years completely dismantling the planning system. We used to have 3 layers. Dept of Health, Strategic Health Authority (10 across the country) and 151 PCTs. GPs, practice nurses and community pharmacists etc sat on the Professional Executive Committee or PEC, which was part of the PCT. It wasn't perfect but I knew who to ring if I had a question.
    Now we have one NHS Commissioning Board, which has 4 regions and 27 area teams, then 212 CCGs (which are the GP led clinical commissioning groups), 27 Commissioning Support Units, 12 Clinical Senates, 16 Academic Health Science Networks, don't know how many Health and Wellbeing Boards, something called Health Education England which has goodness knows how many regions.... I know I've forgotten some layers. Google images of NHS structures, the Guardian did a hilarious diagram. Something like 30-40% of managers lost their jobs, and the redundancy payouts were several billion. Some have come back, but many of my friends (mostly nurses) took early retirement or decided to do something completely different like run a cattery or emigrate, they'd had enough.
    My mum asked me once how this was going to help prevent things like Mid Staffs and I said it wouldn't. It was a very expensive deck chair shuffling on the Titanic and I have no idea why every Government tinkers so much with structures.
    It reminds me of a time when I went to my GP to discover that the builders they'd got in to do some refurbishment had drilled through all the cables, so no phone, Internet, electricity or running water. Some of the (male!) GPs were rushing round bashing things with hammers and trying to find a torch and shouting at things, but the practice nurse doing my tests was humming calmly as we went into the clinic room. She said she was just carrying on seeing her patients, ignoring the chaos outside......

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  • Sorry, forgot to say, there are different strands of work going on re out of hours care. It might be that the one you'd read about Mike was the other one, about major trauma units, which is for huge RTAs (road traffic accidents) or major incidents, so has to be in a place where there is good theatre cover, ITU capacity and so on. Tends to be centred in a teaching hospital.
    But yes, I do worry that the other review is a way of making more closures, just look at Lewisham.

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  • michael stone

    The Nobody | 27-Jan-2013 3:10 pm

    It strikes me - I don't really follow this closely - that for every layer of the old system they removed, they inserted a replacement layer at the very least. This 'new system' looks like a mess, to simple little me. I think I was referring to an open letter published by Bruce Keaogh et al in one of the papers last week (perhaps the Guardian).

    But we (public) were sold this new system as 'you and your GP will control the decisions' and that isn't true, when CCGs are now almost the same size as PCTs were !

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  • michael stone

    PS Preferred The Manager to The Nobody !

    Mind you, I can hardly talk - my posts invite replies to any of DH Agent, Mike Stone, Dr Stone or Thicko (there are historical reasons, from this NT site, why I set those options up: disappointingly, nobody has yet started one with 'Thicko, your post was ill-informed rubbish, because ...').

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  • Yes But

    I really like The Manager/The Nobody's posts.

    But, what is going on here?

    The tag has changed to 'The Nobody' - not to 'a nobody': am I missing something important!

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