A&E units ‘facing worst winter yet’
Tuesday 5th November 2013, 8:00AM GMT.
Accident & Emergency departments in the NHS are facing what may be “our worst winter yet” due to a combination of soaring demand, a shortage of doctors and “toxic” overcrowding on hospital wards, a senior consultant has warned.
Bernadette Garrihy, a member of the board of the College of Emergency Medicine, said Government measures to ease the pressure on A&E amounted to “a drop in the ocean” and warned that doctors were concerned about their ability to provide “a safe and quality service” this winter. Patients should only attend casualty departments “as a last resort”, she said.
She said that “sweeping changes” were needed and called on all parts of the NHS and social services to consider seven-day operations, to provide out-of-hours care for patients in the evenings and at weekends.
Dr Garrihy told the BBC Radio 4 Today programme: “We are getting ready for what may be our worst winter yet, and we have been warning about this for a number of months.
“As we have had data last week from the National Audit Office, we know that our attendances are going up, we know that our rate of admission is going up, we know that the complexity of the cases we are seeing is increasing.
“Now that we are heading into winter, when we have got severe weather problems on the way, increased incidence of respiratory tract infections – things like winter vomiting bugs – we know that this puts our departments under huge pressure.
Dr Garrihy said part of the problem was caused by patients going to casualty departments with problems that could be dealt with elsewhere, such as in a GP surgery.
“Certainly we are finding that our increased attendances – particularly out of hours, in the evening and night and at weekends – seem to be because patients aren’t able to access any other sources of care,” she said.
“They are either unaware of them or they believe that they are not available to them, so they are coming to the emergency departments at a time when we have great issues around staffing, particularly senior medical staff, and significant issues as well about flow in our departments because we have toxic overcrowding in our departments due to bed-blocking in our hospitals.
“This, in the face of rising demand is a real issue for us. We are concerned about providing a safe and quality service this winter.”
Asked whether Government measures to ease the pressure on A&E were enough, Dr Garrihy said: “It is far from enough. It is a drop in the ocean really.
“We are very much looking forward to the results of the urgent care review, because we hope that this will recommend some sweeping changes.
“We need to address our staffing shortage urgently. We have got a real problem with senior doctors in A&E.
“We also need other parts of the health service to be working on a seven-day basis the way we are, providing out-of-hours cover too. The whole health service needs to be looking at seven-day working, and indeed the social services as well, because a lot of our patients have interlinked health and social demands.”
Dr Garrihy urged patients to consider other options before heading to A&E this winter.
“People should look after themselves this winter, they should keep warm, they should look after the elderly and keep them warm,” she said.
“They should keep simple remedies in the house, they should try to talk to their GP if they can, they should use the 111 service and then only as a last resort if any of these fail, access the emergency departments.”
NHS national medical director Sir Bruce Keogh, who will publish a report next week on the long-term vision for A&E, said there was “a feeling that this year is worse” in terms of the winter pressures on casualty departments.
Sir Bruce said a second report, which he will produce before the end of the year, will include “some thoughts on how we can move more closely to a seven-day service in the NHS”.
And he said the NHS had already taken action to deal with the expected pressures this winter, including the establishment of 147 urgent care working groups and the distribution of £250 million in September to enable hospitals to prepare.
Planning started earlier than usual this year in May, and the NHS is aiming to “decongest” hospitals by moving some services during winter into the private sector.
“We are going to be utterly transparent about what we do,” Sir Bruce told the Today programme. “Every week on a Friday we will release figures so everybody can see how we are performing.”
Sir Bruce said: “We have some immediate winter pressures. Winter doesn’t come as a surprise.
“It comes every year and every year we plan for winter and we focus on three areas.
“One is to try and reduce the number of people attending A&E, the second is to help hospitals function in a more efficient way, and the third is to reduce the congestion in hospitals by trying to help hospitals get their patients home.
“There is a feeling that this year is worse.”
He added: “We are seeing increasing demand and have been for some years for our accident and emergency departments. We see in our A&Es about 16 million patients a year. That’s climbed by two million over the last decade.
“You could argue that just means an extra four patients a day per A&E but it still represents an inexorable climb.
“We also are seeing increased demand for our urgent care centres, walk-in centres. They are up at about seven million a year and climbing by 12% a year.
“We are also seeing seasonal variations, so in the winter although the numbers tend to be down, we see much sicker and older patients.”
Sir Bruce said: “We know that of the five million admissions that come in through A&E, just over one million of those are avoidable if we could offer better services in the community – going to their GPs or GPs going to them or ambulance services helping them at the scene.
“We know that 50% of 999 calls could result in people being treated at home. We know that of the 20 million people who attend our urgent care services a year, 40% of those people leave without any form of treatment.
“So there is a big educational exercise…
“One of the things we will be considering in our strategy is that we need a better offer outside hospitals. What we are really seeing, although this is manifest in A&E, this is a problem of the whole system.
“Winter is going to be a particular issue. We have to address the problems coming up this winter and we have to address the longer-term problem.”