The Crisis in Accident & Emergency
The winter of 2016-17 demonstrated the pressures that hospital services, specifically A & E are currently under. Both The King's Fund and The Nuffield Trust have been analysing what's behind these problems.
A & E in the winter of 2016-17
January 2017 saw record delays in A & E responses with only approximately 82% of patients being seen within the recommended target time of 4 hours. Additionally, approximately 1,000 people who had been identified as needing to be admitted to hospital from A & E had to wait more than 12 hours before that could take place.
A & E departments were struggling to respond to demand.
The picture behind these statistics is, of course, complex and reflects a number of inter-related contributing factors.
Attendances numbers
- Since 2003 there has been an overall increase in the number of people attending A & E from 16.5 million to 22.9 million in 2016-17, creating significantly greater pressure on emergency services
- This increase not only relates to attendance at minor injury units but equally at major A & E units suggesting an increase in the number of serious, complex health issues which are likely to take longer to identify and resolve
- Waiting times in winter are further influenced by an increase in the number of complex conditions suffered by people at that time of year in comparison with often less complex injuries in the summer
Complex health conditions and hospital admittance
- A & E units are dependent on other hospital departments for services such as x-rays and blood test results which can lead to delays
- The number of A & E attendees who subsequently require hospital admission has also risen in recent years. This is often a more lengthy process than dealing with those patients who can be treated and sent home directly by A & E, thus adding to time delays.
- Although the bed occupancy rate in hospitals is recommended to be about 85% in order to allow for emergency requirements, bed occupancy during 2017 has reached over 90%, reducing a hospital's ability to admit new patients
External factors
- Access to GP surgeries is becoming harder and with news of GP surgeries closing and GPs leaving the profession, this is likely to get worse. Consequently, people are going to A & E with conditions that could perhaps be resolved through their local surgery
- At weekends when GP access is not available, there is a lack of clarity about where people should look for medical support so many turn to A & E in desperation
- The number of district nurses has been significantly reduced in recent years and so access to medical support within the community is harder to find, leading to greater pressure on existing services
- Reductions in provision by social care for elderly patients who require support after their hospital discharge has also added to the delays by forcing hospitals to keep patients who would otherwise have been discharged, thereby delaying the processing of A & E patients who need to be admitted to hospital
The Future
NHS Sustainability and Transformation Plans are looking at reducing capacity in some areas in an attempt to save money, and A & E departments are consequently threatened in many regions.
The A & E department has already been cut in some hospitals, such as High Wycombe, and emergency services are under threat in Staffordshire, Lincolnshire, Lancashire and Cheshire.
Underlying Factors
All these contributing factors seem to indicate three significant underlying issues - increasing demand, reduction in real-terms funding and an associated increase in pressures on NHS staff resulting in stretched services and difficulty with recruiting and retaining staff across the service.
The Times has recently reported an assurance by the Department of Health that it had planned ahead to combat similar A & E pressures over the coming winter with "an extra £100 million for A & E departments and £2 billion for the social care system to help improve discharging and free up beds in hospitals."
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