Revealed: How NHS targets make the A&E crisis far worse

Hospitals struggling to cope after government cuts to care services, says Labour

Doctors in casualty units are admitting patients into hospitals unnecessarily for fear of breaching government waiting-time targets, using up much-needed bed space and slowing down admissions procedures, a report suggests.

In a comprehensive analysis of the ever-increasing pressure on England’s accident and emergency (A&E) wards and its impact on the wider NHS, the Government’s spending watchdog, the National Audit Office (NAO), identified the Department of Health’s key  four-hour waiting-time target as “one of the main reasons for the increase in short-stay emergency admissions”.

The target, introduced by Labour in 2003-04, requires 95 per cent of patients attending casualty units to be seen, treated and either admitted or discharged in less than four hours. Although the NAO found the target had reduced waiting times, it also said nearly a quarter of all admissions from A&E took place in the 10 minutes before the four-hour limit was breached.

The watchdog did not rule out the theory that some hospitals might be admitting patients simply to avoid missing targets.

Unnecessary admissions are a major source of concern for the NHS. There were 5.3 million emergency hospital admissions in 2012-13, at a cost of £12.5bn to the NHS. The number of such admissions has rocketed by 47 per cent in the past 15 years. Every admission raises costs, increases pressure on the system and denies a bed to another patient. The NAO report also identified an increase in the frail elderly population and a lack of 24/7 social-care provision as a major cause of increased admissions to hospital.

Health chiefs are under increasing pressure to both diagnose and solve the mounting problems in emergency care ahead of the busy winter period.

Last winter saw unprecedented pressure on A&E wards and there are fears that the health service would struggle to cope with a major flu pandemic this year. The Government has pumped £250m into emergency care to shore up hospitals expected to struggle.


Among the reasons given for increased attendances at A&E, the NAO report identified widespread “confusion” among patients about where to go in the event of a health problem, a situation that may have been exacerbated by the expanding number of  out-of-hours care providers and new “layers” of NHS urgent-care services, including walk-in centres and polyclinics. GPs, who used to be responsible for out-of-hours care, were allowed to opt out by their 2004 contract, leading to a diversification in the number of providers.

“Faced with such a confusing myriad of services many commentators have suggested that patients may be bypassing primary-care services and defaulting to A&E services for consultation and treatment,” the report said.

The Health Secretary Jeremy Hunt said that the Government was aware of the pressures on A&E and was addressing “both the short and long-term problems”. He said the NHS had “never been more prepared” for the coming winter. “[We are] transforming out of hospital care by reversing the disastrous changes to the 2004 GP contract, joining up the health and social care system, and backing A&Es with £250m.”

But Labour said that government cuts to council care services had exacerbated shortages in social-care provision, leaving hospitals to pick up the pieces. “Sadly, it is patients who are paying the price,” the shadow Health Secretary Andy Burnham said. “Elderly people are drifting towards hospital in such numbers that many have to wait hours on a trolley just to get a bed. And when they do get a bed, they end up being trapped there because of delays in arranging discharge.”

The report came as Mr Hunt gave the go-ahead to a major reorganisations of NHS services in north-west London. The changes will see the A&E wards at Hammersmith and Central Middlesex hospitals downgraded next year to become urgent care centres treating more minor injuries. Five other hospitals in the local area will be redesigned to provide more advanced, comprehensive emergency care. The plans were backed by the medical directors of all nine hospitals in the area.

Life and Style
ebookNow available in paperback
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
The data shows that the number of “unlawfully” large infant classes has doubled in the last 12 months alone
i100Mike Stuchbery, a teacher in Great Yarmouth, said he received abuse
Arts and Entertainment
The starship in Star Wars: The Force Awakens
filmsThe first glimpse of JJ Abrams' new film has been released online
Rio Ferdinand returns for QPR
sportRio Ferdinand returns from his three-game suspension today
The Speaker of the House will takes his turn as guest editor of the Today programme
arts + ents

Watch the spoof Thanksgiving segment filmed for Live!
Billy Twelvetrees will start for England against Australia tomorrow with Owen Farrell dropping to the bench
rugbyEngland need a victory against Australia today
Arts and Entertainment
The cover of The Guest Cat – expect to see it everywhere
Tyson Fury poses outside the Imperial War Museum in south London ahead of his fight against Dereck Chisora
All British heavyweight clash gets underway on Saturday night
i100 Charity collates series of videos that show acts of kindness to animals
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Opilio Recruitment: QA Automation Engineer

    £30k - 38k per year + Benefits: Opilio Recruitment: An award-winning consume...

    Opilio Recruitment: UX & Design Specialist

    £40k - 45k per year + Benefits: Opilio Recruitment: A fantastic opportunity ...

    Opilio Recruitment: Publishing Application Support Analyst

    £30k - 35k per year + Benefits: Opilio Recruitment: We’re currently re...

    Opilio Recruitment: Digital Marketing Manager

    £35k - 45k per year + benefits: Opilio Recruitment: A fantastic opportunity ...

    Day In a Page

    Homeless Veterans Christmas Appeal: ‘We give them hope. They come to us when no one else can help’

    Christmas Appeal

    Meet the charity giving homeless veterans hope – and who they turn to when no one else can help
    Should doctors and patients learn to plan humane, happier endings rather than trying to prolong life?

    Is it always right to try to prolong life?

    Most of us would prefer to die in our own beds, with our families beside us. But, as a GP, Margaret McCartney sees too many end their days in a medicalised battle
    Thomas Cook's outgoing boss Harriet Green got by on four hours sleep a night - is that what it takes for women to get to the top?

    What does it take for women to get to the top?

    Thomas Cook's outgoing boss Harriet Green got by on four hours sleep a night and told women they had to do more if they wanted to get on
    Christmas jumper craze: Inside the UK factory behind this year's multicultural must-have

    Knitting pretty: British Christmas Jumpers

    Simmy Richman visits Jack Masters, the company behind this year's multicultural must-have
    French chefs have launched a campaign to end violence in kitchens - should British restaurants follow suit?

    French chefs campaign against bullying

    A group of top chefs signed a manifesto against violence in kitchens following the sacking of a chef at a Paris restaurant for scalding his kitchen assistant with a white-hot spoon
    Radio 4 to broadcast 10-hour War and Peace on New Year's Day as Controller warns of cuts

    Just what you need on a New Year hangover...

    Radio 4 to broadcast 10-hour adaptation of War and Peace on first day of 2015
    Cuba set to stage its first US musical in 50 years

    Cuba to stage first US musical in 50 years

    Claire Allfree finds out if the new production of Rent will hit the right note in Havana
    Christmas 2014: 10 best educational toys

    Learn and play: 10 best educational toys

    Of course you want them to have fun, but even better if they can learn at the same time
    Paul Scholes column: I like Brendan Rodgers as a manager but Liverpool seem to be going backwards not forwards this season

    Paul Scholes column

    I like Brendan Rodgers as a manager but Liverpool seem to be going backwards not forwards this season
    Lewis Moody column: Stuart Lancaster has made all the right calls – now England must deliver

    Lewis Moody: Lancaster has made all the right calls – now England must deliver

    So what must the red-rose do differently? They have to take the points on offer 
    Cameron, Miliband and Clegg join forces for Homeless Veterans campaign

    Cameron, Miliband and Clegg join forces for Homeless Veterans campaign

    It's in all our interests to look after servicemen and women who fall on hard times, say party leaders
    Millionaire Sol Campbell wades into wealthy backlash against Labour's mansion tax

    Sol Campbell cries foul at Labour's mansion tax

    The former England defender joins Myleene Klass, Griff Rhys Jones and Melvyn Bragg in criticising proposals
    Nicolas Sarkozy returns: The ex-President is preparing to fight for the leadership of France's main opposition party – but will he win big enough?

    Sarkozy returns

    The ex-President is preparing to fight for the leadership of France's main opposition party – but will he win big enough?
    Is the criticism of Ed Miliband a coded form of anti-Semitism?

    Is the criticism of Miliband anti-Semitic?

    Attacks on the Labour leader have coalesced around a sense that he is different, weird, a man apart. But is the criticism more sinister?
    Ouija boards are the must-have gift this Christmas, fuelled by a schlock horror film

    Ouija boards are the must-have festive gift

    Simon Usborne explores the appeal - and mysteries - of a century-old parlour game