The waiting game: resolving the crisis

Last month saw the highest number of patients who waited more than 4 hours in Type 1 A&E units (major A&E) before they were treated since figures began in 2010 (Campbell, 2014).

Figures from NHS England revealed that for the week ending 7 December, 35 373 patients waited more than 4 hours from arrival to admission, transfer or discharge at Type 1 A&E units (NHS England, 2014a). Of the total number of attendances, only 87.7% were treated in 4 hours or less. This is below the target set by the Government of 95%. This also marks a 66% increase on figures from the same week last year (NHS England, 2013). For the week ending 12 December, this rose to 44 153, which represented a drop in the number of patients treated within 4 hours to 84.7% (NHS England, 2014b).

The number of patients spending between 4 and 12 hours on a trolley from decision to admit to admission was similarly high: 7 760 patients for the week ending 7 December and 10 126 for the week ending 14 December, respectively (NHS England, 2014a; 2014b). This is more than double the numbers of 2013 (NHS England, 2013).

Following a decision made by health secretary Jeremy Hunt not to publish performance figures over the festive period, so as to give staff a break, data published on 6 January revealed that only 92.6% of patients were seen in 4 hours from October to December (Triggle, 2015b). This performance is the worst quarterly result in a decade.

It is undoubted that A&E departments are facing difficult times. At a King’s Fund conference in December, Prof Sir Bruce Keogh admitted that the health system is ‘creaking’ and ‘under pressure’ as a result of the strain brought on by increased attendances during winter months. The need for radical change within the urgent care system, therefore, has never been so apparent.

In England, an extra £700 million has been set aside to help the NHS, through the provision of additional staff. However, Dr Clifford Mann, president of the College of Emergency Medicine, has raised concerns that it has not gone through to all the places it should (Triggle, 2015a).

With major incidents being declared at a number of hospitals, new measures need to be implemented if targets are to be met. Keogh’s vision for a new urgent and emergency care system outlined in the Urgent and Emergency Care Review could present an answer, but it is expected to take 3–5 years to enact the major transformational changes. Although the Keogh Review wants to avoid risky ‘big bang’ change, that change is needed now. It is, therefore, a neverending waiting game.

References

Campbell D (2014) Record A&E waits show NHS is cracking under pressure—doctors’ chief. The Guardian. http://tinyurl.com/llm54sy (accessed 5 January 2015)

NHS England (2013) A&E weekly activity statistics, NHS and independent sector organisations in England. Week ending 8/12/2013. NHS England, London

NHS England (2014a) A&E weekly activity statistics, NHS and independent sector organisations in England. Week ending 7/12/2014. NHS England, London

NHS England (2014b) A&E weekly activity statistics, NHS and independent sector organisations in England. Week ending 14/12/2014. NHS England, London

Triggle N (2015a) A&E performance in England ‘likely to hit new low’. BBC. http://www.bbc.co.uk/news/health-30679949 (accessed 5 January 2015)

Triggle N (2015b) A&E waiting in England worst for a decade. BBC. http://www.bbc.co.uk/news/health-30679949 (accessed 6 January 2015)

Taken from Journal of Paramedic Practice, published 9 January 2015.

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