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UK A&Es failing to meet waiting time targets


Accident and emergency services have “deteriorated significantly”, NHS officials have conceded as they set out plans to improve the service.

Launching its “national recovery and improvement plan”, NHS England said the number of organisations failing to meet waiting time targets has doubled over the last year.

The organisation said that many factors have contributed to the decline of the service including the increasing numbers of patients, seasonal illnesses such as the winter vomiting bug and delays in admittance and discharge of patients.

The problems could have been exacerbated by the introduction of the NHS 111 service and pressure on social care budgets, an NHS England document suggests.

“A&E performance has deteriorated significantly over the last six months,” the document says.

“Long waiting times in A&E departments (often experienced by those awaiting admission and hence ill patients) not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness.”

In the last quarter of 2011/12 a third of hospitals did not meet the target of having 95% of A&E patients seen and discharged or admitted within four hours. For the last quarter of 2012/13, two thirds of of hospitals failed to meet the target, figures show.

NHS England has ordered local health authorities to form “urgent care boards” which will create plans to improve the service in place by the end of the month.

It is also ensuring that NHS money is “feed up” to help the improvement of A&E services.

“When pressure builds across the health and social care system, the symptoms are usually found in the A&E department,” said NHS England’s national director for acute episodes of care Professor Keith Willett.

“I’ve lived that environment for 30 years and I know just how tough it can be. What we all want is great service for patients that meets and often exceeds the minimum standards. To get there, we need the whole NHS system, in the community and hospitals, to recognise the problems and help to relieve the pressure on their colleagues in A&E.

“In the longer term we need to combine all the expertise in the NHS to determine how best to organise emergency care in future so that people get appropriate, effective and rapid care whenever and wherever it is needed.”

The organisation has already launched a review to try and get to the root of the problems, and NHS England medical director Professor Sir Bruce Keogh is looking into the urgent and emergency care system across the country.

The news comes after the health and social care regulator warned that demand on NHS accident and emergency departments is “out of control” and “totally unsustainable”.

David Prior, chairman of the CQC, said there should be widespread closures of hospital beds and investment in community care to tackle the increasing burden on emergency care.

Mr Prior said that far too many patients were arriving at hospital as emergency cases - a crisis which could be averted by earlier intervention through care in the community.

This has put such pressure on the health care system that it is at the brink of collapse, he said, meaning regulators cannot guarantee that there will never be another care disaster such as that in Mid Staffordshire.

Hundreds of patients may have died needlessly at Mid Staffordshire Trust - many patients were left lying in their own urine and excrement for days, forced to drink water from vases or given the wrong medication.

Robert Francis QC, chairman of the public inquiry into the ”disaster” at Stafford Hospital, highlighted ”appalling and unnecessary suffering of hundreds of people” at the trust between 2005 and 2009.

Health minister Anna Soubry said there was no quick solution to the “serious” problem.

“We have a serious problem, we’ve had a problem for a while,” she told the BBC.

“If you look at the number of people presenting at A&E it’s grown by one million in just the last year.

“Unfortunately, unless we take urgent action, which is what we have been doing, it’s a problem that will grow and it’s very complicated and there is no quick and easy solution.”



Readers' comments (13)

  • Hmmm could lack of nurses be contributing to this probelm?Surely not I hear the politicians say

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  • The problem is that there aren't enough medical and elderly care beds in the hospitals for these patients to be admitted, so they're stuck in A&E or the CDU for 12-24 hours at a time and A&E take the flack for it. Plus, if you bleep an orthopaedic doctor, you'll be waiting several hours for them to appear, so again A&E gets all the blame.

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  • The demand in A&E is partly due to people using the service as a GP service. Much is non acute and non life threatening. Lack of first aid knowledge and common sense also appears to compound attendance unnecessarily too. An all systems review is needed. If we are to provide a 24 hour service then we need24 hour support to do this. All too commonly support services are reduced at night when demand increases.

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  • this target culture needs to be abolished. patients need to be triaged in A&E and seen according to clinicial need, clinical priority and degree of urgency. those whose condition is life threatening first, those who are in pain, bleeding or at high risk from deterioration, those who are infectious need to be isolated. those who are not urgent should be triaged within 20 minutes and nobody who has been triaged should then should have a further wait more than an hour, which can be extended to two but only in exceptional circumstances. those under observation or pending a hospital bed should be transferred to a bed within four hours and much less if possible. after four hours, and normally considerably less, no patient should be left lying on a trolley or in a corridor. these are intended and designed for transport purposes and initial examination only!!!!!!

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  • I am sick of hearing patients, medical staff and Nursing staff blamed for this mess.

    There are not enough staff or hospital beds it's as simple as that. Cutting more beds as David prior suggests is frankly laughable. he goes on about more "community care" to solve the problem - nice and vague chum, how will community care help the acutely ill? Anyway all the community hospitals were closed years ago.

    Stop thinking about doing it on the cheap.

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  • well said Sarah.

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  • this is all a government problem by introducing waiting times and other stupid rules. my own experience ,i am nurse and took my 4 yr old son to a+e, however when i looked at the screen his time was manipulated as being seen when we we 1.5 hours post triage. this rule of penalty and finance is sploiling our NHS. why does'n the governemnet let those who deal with sick people do their job. if they want to bring rules ask those who work in the service how to implement them instead of dictating or bringinging solutions from other countries such as the states or others which do not apply to the uk. the NHS is not a one fit all. each area has its demand and care need to be provided accordingly. this is not only in a+e but all other areas in the NHS are feeling the same be it in the community or outpatients. what starts at the A+ E has a ripple effect ,just like the tsunami. it is just a matter of time before the tsunami causes massive damage.

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  • The problems with ED attendances are multi factoral, just injecting more nurses will not solve the problem. The public also need to play their part and stop and think whether an emergency Department visit is absolutely necessary. The vast majority certainly are not. 3 week old sprains, coughs, toothache, persistent headaches, "second" opinons on leg ulcers, chest infections (especially when they are already on AB's), D&V, torti collis, are not reasons for attendance. Neither is it acceptable to attend ED if they cannot get an appointment with their GP at a moments notice (believe me, many lie about the 'dificulty' of appointments, and when I have rang the GP on their behalf, surgeries often deny they have had a call from the patient in the first place, or the 'patient' has refused a reasonable appointment time or wants to see a particular doctor who is unavailable.)
    20 years ago we had few walk in centres, barely any nurse led minor injury units, and ED had no silly targets until within the last 10 years or so. We did not have the problems that we have now, and - notwithstanding the increase in population - the question is why is the Emergency Department inundated today?
    Firstly,I have spent some time in ED signposting - that is catching people at triage that do not need an Emergency Department. But why only at triage? Why not BEFORE they book into the front desk? The reason is simple. For every person who books in, whether they stay for 6 hours or whether they walk straight out of the door before they are even triaged, is that the GP/PCT is billed £54 on average for the privilege whether they wait for treatment or not. A nice little earner for the Emergency Department.
    Secondly, the silly 4 hour targets should be relaxed. Why should people who turn up as a convenience with long standing, minor ailments be subject to a 4 hour target, especially when the department is busy with serious, life threatening injuries? Why should someone with constipation be treated with the same amount of urgency as a CVA/AMI/#NOF? Years ago people knew that their attendance was minor and non urgent and most had the sense to leave knowing that there was little a SHO in the emergency department could do, so it was pointless waiting around for 6 hours.

    Thirdly, the public are bombarded with conflicting advice from the media/magazines/newspapers/TV and stupid programmes such as casualty and holby , which give an unrealistic view of exactly how much time a nurse has to chat/sort out their social problems/run across car parks chasing someone to talk them into returning to their family, etc etc. They are convinced every rash is meningitis, every cold is flu/every headache is a haemorrhage etc.
    Emergency Departments vary on the standard of their triage. At busy times experienced nurse practitioners or doctors should be on triage to filter the patients needing emergency treatment and advising and discharging those who can wait to see a GP quickly. But many do not do this.

    Of course, community support is essential, but this Government is hell bent on making the poor, the vulnerable and the sick pay for the excesses of the bankers who are responsible for this world recession and are now hiding out in tax havens. Services are cut to the bone, or non existent.
    And whilst different disciplines of medicine, nursing and community care are busy blaming each other (ie ED's blaming GP's, GP's blaming lack of hospital back up, all blaming lack of care in community, management blaming "bad" nurses, etc etc;) all are missing where the blame should really be aimed, and that is this Government's creeping privitisation of the NHS.

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  • As a nurse myself I felt very vulnerable during a recent episode of illness, when I could not get a GP appointment, despite phoning from 8 am as requested. I did sometimes manage to get an "emergency appointment" and saw a different GP on each occasion - not very satisfactory, where is the quality and continuity of care - and being advised "if you don't like it go to A & E". Surely the Government approach to deal with most problems swiftly in primary care can be reinforced, rather than forcing surgeries to fiddle the figures by not offering bookable appoinments.

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  • Anonymous | 12-May-2013 4:49 pm

    it is very sad and frustrating for those feeling unwell or anxious that they have to try and negotiate their way through such a dysfunctional and unnecessarily complex system and then deal with people who do not know the patient and are unfamiliar with their concerns. such conditions should not be accepted.

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