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National A&E crisis needs 'system-wide' solutions, warn nurses


A “whole system” approach is needed to tackle the issues behind the A&E crisis that took place this winter, and which saw patient safety compromised as hospitals struggled to deal with pressures, according to nurses at the Royal College of Nursing annual conference.

A shortage of community nurses, too little integration with social care leading to delayed discharge and a lack of training were all cited as contributing to the problems in accident and emergency departments across the country.

“The wider healthcare system is difficult to navigate and the public are confused”

Kathy Moore

District nurses play a “crucial” role in alleviating the crisis in helping to keep patients out of hospital, said one RCN member at the conference in Bournemouth.

But there must be more investment in leadership skills, training and opportunities for student nurses to carry out placements in this setting to ensure it is a more attractive career option, she added.

Meanwhile, some community practitioners – such as children’s nurses – are so rare they are “a bit like hen’s teeth”, according to Sarah Neill, from the RCN’s Joint Children and Young People Forum.

She said parents “must not be blamed” for taking their children to A&E and that the NHS needed more children’s nurses working in primary care.

Congress members voted overwhelmingly to pass a resolution calling for pressure to be put on the UK governments to address the A&E crisis.


Resolution on A&E pressures

That this meeting of RCN Congress requests Council to put pressure on the governments within the UK to address the crisi in the A&E service.


The resolution was proposed by Kathy Moore, from the RCN’s East Dorset branch. She pointed to figures that showed visits to emergency departments had risen by 50% in the past decade, to 21.7 million a year.

The general public are still unsure how to navigate the emergency system, despite campaigns to educate them on which illnesses and injuries are appropriate for A&E, she said.

“The wider healthcare system is difficult to navigate and the public are confused about telephone advice lines, minor injury units and walk-in centres,” said Ms Moore.

“Emergency departments are the easiest place to go when you are worried and asking people not to do this is counterintuitive,” she added.

“Children’s nurses working in primary care are a bit like hen’s teeth”

Sarah Neill

Despite nurses being “good, caring and heroic”, emergency departments are now a “terrifying” place for the elderly in particular, according to one clinical nurse specialist.

Initiatives to better integrate health and social care such as the NHS’s Better Care Fund have failed to reduce attendances and improve discharges, she said.

“Older, frail people are not service-savvy and they need to know the emergency department is a place they can trust,” she added.

Practice nurses are “part of the solution” to the A&E crisis, noted Karen Storey from the RCN’s Practice Nurse Forum.

But efforts were needed to make practice nursing as attractice as A&E to work in, she said. More placements in GP practices would help, she suggested.

Several speakers also laid part of the blame for the A&E pressures on the replacement of NHS Direct with NHS 111, which they argued was fragmented.

Others said that the public simply did not understand where they were meant to go, in terms of walk-in centres and urgent care centres.


Voting results on the A&E resolution

  • For – 99.49% (391)
  • Against – 051% (2)
  • Abstain – 3

Readers' comments (2)

  • Had an interesting conversation the other morning with an employee of my local council - he drives the truck which collects the domestic recycling refuse from around our town. He pointed out that the average "compliance" varied greatly between neighbourhoods - council estates being the worst by a long way.

    I believe A&E usage will follow the same pattern. However much one tries to educate and inform, there's a sector of our society that is not only disinterested but actually takes a defiant delight in non-compliance.

    Unsuitable or offensive? Report this comment

  • john warwick

    oour Population is ageing and there are less GPs so A&E is taking the hit keep closing A&Es

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