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”
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”
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.
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.