NHS leaders issue stark A&E warning
Sunday 8th September 2013, 12:10AM BST.
NHS leaders have issued a stark warning that A&E departments are likely to be brought to breaking point this winter unless the true causes of pressures on the service are faced up to and tackled.
A survey of senior health service leaders carried out by the NHS Confederation said that misleading and ill-informed debate about the reasons behind A&E pressures is preventing the health service from addressing the actual causes.
The results prompted shadow health secretary Andy Burnham to suggest David Cameron “get a grip” on the real issues behind the problem after leaving A&E services “on the brink of a serious crisis”.
The survey found that the majority of those questioned believe that the strain on the service is down to the r ising number of frail older people with multiple long term problems followed by the d ifficulty in discharging or transferring patients into appropriate further care and is not largely because of the problematic roll-out of NHS 111 services earlier this year as often suggested.
The results also gave an up-to-date prediction from the A&E front line about how well the NHS will cope during the coming winter.
“A prolonged period of cold, a rapid increase in the acuity of patients presenting in A&Es or a lengthy norovirus season would be all it would take to bring many departments to breaking point,” it said.
The survey found that less than half of respondents (45.7%) said their organisation is likely or very likely to meet the 95% four hour A&E waiting target for the next quarter (October to December). Across England, Type 1 A&Es have achieved the standard on only eight weeks so far this year.
Those questioned were asked to prioritise possible ways of easing A&E pressures in their organisation with more than half saying that giving them earlier notice about funding designed to ease winter pressures would be very helpful, followed by investing more in community, primary and social care.
Other popular solutions included raising public awareness to ensure patients are aware of alternatives to A&E and introducing more incentives for staff to work in the departments.
The new 111 phone service has come under intense pressure b ut the survey found that 79% of those asked said they did not think it a big cause of A&E pressures.
Yesterday Professor Keith Willett, the doctor leading the emergency services reform, warned that up to 6.5 million people a year are wrongly going to A&E when they could be treated by GPs, paramedics or even chemists.
Prof Willett, the national director for Acute Episodes of Care, told Sky News that 15% to 30% of people who turn up to be treated at A&E could have been treated in general practice.
He said many patients turn to A&E with routine medical problems because they are frustrated by out-of-hours services or because they cannot get quick enough appointments with their GP.
Mike Farrar, chief executive of the NHS Confederation, said: “We have known for some time that pressures on A&E are at their highest ever, and the honest picture is one of a service facing unprecedented demand.
“But as if the genuine rise in seriously ill, frail A&E attendees wasn’t putting enough strain on the system, the NHS is also struggling from ill-informed speculation about what is causing the pressures and what services they can rely on to meet their needs.
“The knock-on effect is that the public have so little confidence in alternative options for meeting their healthcare needs that they believe the only recourse is to turn up at A&E.
“It’s a vicious spiral.”
Mr Burnham said: “Warnings do not come more serious than this.
“David Cameron has left A&E on the brink of a serious crisis. We are already in the middle of the worst year in A&E for a decade and now it looks like the coming winter could be even worse.
“The Government’s response to date has been woefully inadequate to the scale of the problem.
“Labour has consistently said that the withdrawal of support from older people is the main reason and this report backs that up.
“David Cameron must now stop blaming everybody else, cut the spin and get a grip.”
The report Emergency care: an accident waiting to happen? is published today by the NHS Confederation.
The survey was carried out last month and involved questioning 125 senior leaders including chief executives, commissioners, chairmen, medical directors and chief nursing officers.
Health Minister Anna Soubry said: “We know A&E departments are under pressure. There are over one million more people visiting A&E compared to three years ago. This is why we are already making sure the NHS is ready for the additional pressures winter brings.
“We have provided A&E departments with an additional £500 million to make sure the best care is still available for every patient when they need it this winter and the next.
“We have also set aside an additional £3.8 billion – announced in the spending review – to help join up services, so that health and care services work more closely together, keeping people healthier and providing more support out of hospital.
“On Tuesday, we will be setting out exactly how we will be making sure services are fully equipped to deal with additional pressures this year and outlining longer-term changes for the future including how to better support those with the greatest need – vulnerable older people.”
Labour said the past year had been the worst in a decade for A&E waits – including “the first summer A&E crisis in living memory”.
Shadow health secretary Andy Burnham said figures showed almost a million patients had waited longer than the four-hour target in the last 12 months.
And England’s major A&E departments missed the target in 41 of the last 52 weeks.
Mr Burnham said: “Jeremy Hunt has been in post for one year, and we now have figures to show that those 12 months have been the worst in a decade in A&E.
“His failure to act on the winter A&E crisis has resulted in the first summer A&E crisis in living memory.
“These are the damning statistics on his watch: major A&Es have missed waiting time targets for 41 of Hunt’s 52 weeks in charge.
“Jeremy Hunt always tries to blame someone else for these problems. He scapegoats GPs and nurses, but it is he who botched the introduction of NHS 111 and has cut thousands of nursing posts.
“He has ignored repeated warnings about the fragile state of social care and sat on his hands while services collapse.
“He has left thousands of patients waiting for hours on end, stranded on trolleys in corridors and held in the back of ambulances.
“Patients and staff can’t go through another year of this. This Health Secretary is failing them and he needs to get a grip or go.”