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A&E 'crisis' caused by systemic failures, say emergency nurses


Accident and emergency nurses warn that patient safety is increasingly being compromised by growing pressures impacting across the healthcare system this winter.

Widespread problems in hospitals and across the whole health and social care system have combined to create the so-called “A&E crisis”, nurses told Nursing Times.

Trusts have been forced to make financial savings resulting in decreased bed capacity, while cuts to adult social care budgets have left hospitals with limited options for patient discharge, they said.

Addition seasonal factors, such as a four-day Christmas weekend – when social services are “minimal” – and an increase in people with respiratory problems, have also caused a surge in A&E demand across England, Scotland, Wales and Northern Ireland.

“If you ask any A&E nurse what they really would need, it’s extra resources to have extra wards and more nurses on those wards”

Janet Youd

Emergency nurses across the UK told Nursing Times they were becoming increasingly frustrated at being forced to care for patients in corridors or alongside other duties because wards are full.

“Last week I had a shift in triage and I was looking after patients who had been referred from a GP – one who was a really poorly sick young girl and there was nowhere for her to go to in the department. I had to care for her in a wheelchair outside triage for two and a half hours,” said Ema Hughes, a deputy sister at Betsi Cadwaladr health board.

Ms Hughes told Nursing Times that patients were also being kept in ambulances for treatment when wards were full. She said: “It’s been called an A&E crisis, but it’s not – we are not in crisis – it’s the hospital that is in crisis because we can’t move anyone to wards.”

Janet Youd, chair of the Royal College of Nursing’s Emergency Care Association, said nurses were “extremely frustrated and disheartened” by having to nurse patients on corridors. “It’s not dignified and they don’t have the resources to give the care to patients that they need,” she said.

She added that staff were seeing more aggression from people who were having to wait for treatment, and that nurses were having to make increasingly difficult decisions about which patients to prioritise for care.

“Patient safety is being compromised. Emergency nurses always have to prioritise – such as with triage systems – but they’re now having to make decisions about which patients can be in resus and which patients should be in resus but are the least sick of the ones they’ve got.

“They’re not easy decisions to make – it’s a decision about who is in the next cubicle. Is it the man in agony because he needs catheterising or the woman who is miscarrying her baby?” she said.

Ms Youd claimed the pressure on hospitals could have been predicted in October, as many trusts were missing the four-hour A&E waiting target at that point.

“What a lot of trusts have done is pared back the bed base to meet cost improvement programmes,” she said. This also meant that, when additional nurses were needed to brought in to reopen beds, it had been difficult for them to find the right amount, or those with the appropriate skills, she said.

“If you ask any A&E nurse what they really would need, it’s extra resources to have extra wards and more nurses on those wards. What’s happening now is hospitals are opening wards, but don’t have the staff available so the nurse to patient ratio is a bit dangerous in some places,” she said.

“It’s been called an A&E crisis, but it’s not – we are not in crisis – it’s the hospital that is in crisis because we can’t move anyone to wards”

Ema Hughes

As was widely reported in the media earlier this week, quarterly performance figures for October to December showed that, for the first time in a decade, A&E departments missed the four-hour waiting target for 95% of patients from arrival to admission, transfer or discharge, with 92.6% of patients seen within the target timeframe.

These were followed today by the latest weekly statistics – covering the week ending 4 January – suggested the situation had worsened, with 86.7% of patients waiting four hours or less from arrival to admission, transfer or discharge.

In addition, hospitals in Staffordshire, Gloucestershire, Cambridgeshire, London and Surrey have all declared “major incidents” in recent weeks due to high A&E demand.

University College London Hospital

Accident and emergency

A Department of Health spokesman said: “We know the NHS is busier than ever before, which is why we’ve given the NHS a record £700m this winter for more doctors, nurses and beds. The NHS has ensured there are plans in every area to manage the extra demand.”

But Ms Youd claimed that while the government’s injection of £700m to help with NHS winter pressures was welcome, its benefit had not been felt within acute trusts or social care services. She said: “Patients waiting for social services beds or increased packages of care – that £700m isn’t going to touch that.

“Funding the frontline is going to have no effect on the emergency department. Even opening GPs will go some way. But nowhere near as much as freeing the back end of the hospital to discharge patients,” she said.


Readers' comments (18)

  • And not opening it to the world!

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  • It's just like the last time the Tories were in power... a lot of nurses may be too young to remember that, but a quick trawl through the archives will show you how history repeats itself.

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  • Our cottage hospital of 17 beds was closed couple of years ago . Trained staff, local G.P,s ,post -op care following surgery at major hospital, respiratory and medical problems, cardiac assessment plus minor injury clinic . What a tragedy to close these little centres of excellence close to home . In this area 4 have closed with loss of nearly 80 beds and now the powers that be wonder why they can't cope . I am retired but I feel for those poor nurses trying to cope

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  • They cut staffing by 25% on our ward, call us incompetent when we can't deal with this long term extra workload, moan when it takes 3 weeks to transfer a patient to hospice because no-one has had time to fill in the referral, give us a pay cut, talk about abolishing un sociable hours pay, give us disciplinary action when we use the word busy... Truth is they are trying to get the nhs to collapse so they can privatise it all. My trust is already run by a banking group... Wake up England and demand realistic funding for the best service in the world...

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  • I think it is so sad that Nurses are Not left to focus on the essential tasks of Nursing/all the focus on audits and fabricating risks that are not there / defensive practice all this consumes money value the staff/ value the NHS / increase taxes for those earning high wages to help pay for the NHS / Tories stop trying to privatise a public service and setting as all up too compete for business/ exploiting ill health is not a business for obtaining profit

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  • Maybe block booking local hotels to put medically fit to discharge but awaiting social support patients. Far cheaper than staying in a hospital bed.

    In London, there's a few near the Palaces of Westminster, that can house non-London MPs. Saves on a 2nd home, travelling + other expenses. Walking from there to 'work' will help to keep them fit too.

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  • john warwick

    closing hospitals and A&Es and letting every idiot who cannt be bothered to get a gp appointment turning up and being reguired to see and treat with in 4 hours all help contribute to the socalled crisis, Having a small fee for minor A&E attendence will eliminate alot of these useless patients many nights people who coundnt sleep or had a headache for 3 months choose to attend along with parents of children with fever who had no money for calpol but had money for fags would come in along with the drunks that the old bill didnt want and forget about the policy of no treatment of pts who abused NHS staff, matron was more concerned about covering her a.. than that of the A&E staff. social services not discharging pts because theres no stable enviorment or care homes the list goes on and on in NYC they have closed 8 major hospitals in the last 5 years yet there is no crisis there. if the A&E attendance is judged not medically necessary then the cost is deducted from the people on benefits dole so after not having money to buy fags and beer they learn to go to their GP instead of the Emergency Room and people who over use their insurance get problems from their bosses as the companys rates go up. we can learn alot from north america

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  • When the NHS policy makers refuse to comprehend the needs and demands placed upon the NHS departments, sadly, it will go further into decline.

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  • i was doing emergency assessments for potential thrombolysis of strokes in the back of ambulances last night because there was no room in a+e.

    Read Jeremy Hunts wiki. no healthcare experience, failed marmalade exporter, expenses cheat, and we wonder why its going to pot. the tippy top of the NHS chain doesnt have a clue.

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  • Well John Warwick, your comment is exactly why we can not learn anything from North America. You sound really uncaring, people need help, not punishment. Sometimes symptoms are serious. Your response is sad actually, it is what happens when people are under pressure, turning anger towards the wrong people. This is a definite result of government policy - don't confuse it with anything else!

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