Emergency in A&E Services

3 June 2013

According to NHS doctors and managers, Accident & Emergency services have “deteriorated significantly” and the entire A&E system could collapse without urgent change.

One of the key reasons for this concern is increased patient waiting times. A&E departments aim to see patients within 4 hours of arrival. In 2012, the number of A&E departments failing to meet waiting time targets doubled. By the start of 2013, two thirds of A&E departments failed to meet this 4 hour target.

Increased waiting times can compromise both patient safety and clinical effectiveness. In some circumstances, this can result in clinical negligence claims.

Although by no means a new issue, the recent spike in patient waiting times has again focused the spotlight on the NHS’ ability to function effectively in the modern era.

Over the past decade the number of people attending A&E has risen 50%. In Birmingham, the Queen Elizabeth Hospital has seen a 65% growth in recent A&E admissions. It will come as no surprise that this particular hospital has an excellent reputation. Patients are understandably influenced by this.

Leaving aside short-term explanations (seasonal illnesses and the well-publicised teething problems with the new non-emergency 111 phone line (the successor to NHS Direct)), there appears to be a growing trend for patients to prefer to attend A&E.

Whatever the reason for this change (the fact that busy working and family lives do not easily fit in to limited GP practice hours, for instance), it poses significant difficulties to the structure of NHS healthcare and, more specifically, hospital A&E departments.

For example, the former head of the NHS, Sir David Nicholson, devised a policy to discourage unnecessary A&E admissions by only paying the hospital 30% of the normal fee for each additional patient once a specific level of A&E admissions has been reached. The result is that busy A&E departments are actually losing money which, in turn, has an adverse effect on staffing levels and services within the A&E department and the hospital generally.

Considerable thought needs to be given to the statistic that 15-30% of patients attending A&E do not need emergency care; however, the current regime of financially penalising busy hospital A&E departments seems un-workable. If this is a shift in the type of medical treatment that patients want, should we be penalising the A&E departments that provide it?

The Chief Executive of the Foundation Trust Network, Chris Hopson, has said that: ‘Unless we can change the funding structure, the A&E system is going to fall over. We simply cannot carry on’.

NHS England has launched its National Recovery and Improvement Plan asking local health authorities to form urgent care boards to improve A&E service whilst the Health Secretary, Jeremy Hunt, is reported to have asked for an extra £400 million for A&E services.

One solution may be to streamline our healthcare services and bring GP practices on to main hospital sites. This integrated approach has been used in other countries such as Spain and America. From a patient's perspective, a connected, time-efficient medical system where all services are on one site may look attractive.

Whatever the solution to this healthcare conundrum, the traditional NHS healthcare structure needs to evolve better to meet the demands of the modern patient. Change is required. 


The Sunday Times: Exit Stalin. Now let the little people rescue the NHS

BBC: NHS A&E departments 'left unsafe by political meddling'

BBC: A&E must change or face collapse, NHS warned

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