Accident waiting to happen: A&E departments ‘on the brink of crisis’

Surveys from the Royal College of Nurses, NHS Confederation and others reveal full scale of the daunting task A&Es face just to 'get through the winter'

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The Independent Online

Accident and Emergency departments are understaffed, overworked, and could be brought to breaking point this winter by little more than a prolonged period of cold, a series of surveys have revealed.

Health Secretary Jeremy Hunt said it will be “very, very tough” just to “get through this winter”, following comments from his opposition counterpart Andy Burnham saying: “Warnings do not come more serious than this.”

A survey of leaders from the major health service providers, conducted by their membership body the NHS Confederation, found that a lack of public faith in other services is leading more and more people to go straight to A&E, in a “vicious spiral” of pressure on doctors and nurses.

As a result, fewer than half of the respondents (45.7 per cent) said their organisation is likely to meet targets for waiting times in the period from October to December.

The report said: “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.”

The results, called Emergency care: an accident waiting to happen?, were published today by the Confederation.

In a Royal College of Nursing members’ survey, a staggering nine out of 10 nurses working in A&E said that current pressures were putting patients in danger.

With increased workload the primary reason blamed for the added strain, three quarters of nurses said the problems were being aggravated by people going to emergency departments when they could have been seen by their GP instead.

In a BBC 5 live investigation which surveyed hospital trusts across England, it has also been revealed that A&E departments are understaffed by an average of nearly 10 per cent.

For the 101 trusts which responded to a Freedom of Information request, there were 1,260 vacant, budgeted positions – the majority for nurses.

The situation was at its worst in London, where the greatest proportionate number of vacancies could be found in four of the capital’s trusts.

These problems being faced by A&E departments have not escaped the notice of voters, and yet another survey found that two thirds of the public believe there is a crisis and that it is putting patients at risk.

The poll, conducted by Survation, found that while 65 per cent blamed Government cuts and three quarters said NHS staff were doing their best while overworked, two thirds of those questioned felt consultants should be forced to work weekends and nights if it would solve the problem, and 43 per cent agreed those who refused should receive a pay cut.

Dr Clifford Mann, president of the College of Emergency Medicine, described A&E staffing as a “crisis” about which it had received many reports “for some time”.

“The impact for patient care is that there are fewer doctors to see them, which means that most patients may have to wait longer than we would ideally wish them to wait, in order to be seen,” he said.

“There's a delay in making key decisions and that in turn can have an implication for their recovery and wellbeing.”

Yesterday Professor Keith Willett, the doctor leading emergency services reform, said 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 told Sky News that this accounted for 15 to 30 per cent of A&E patients.

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.

Shadow health secretary Andy 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.”

Mr Burnham quoted figures that showed almost a million patients had waited longer than the four-hour target in the last 12 months, with England's major A&E departments missing the target in 41 of the last 52 weeks.

He said: “Jeremy Hunt has been in post for one year… These are the damning statistics on his watch.

“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.”

The Government has committed a £500 million bailout fund to the NHS in a bid to save A&E departments this winter, but Mr Hunt has still admitted it will be difficult to avoid long waits.

The Health Secretary said he was determined to ensure hospitals met targets and was taking action to support front line services facing unprecedented patient numbers.

“It is going to be very, very tough,” he told Sky News.

“But we can get through this winter. It is entirely possible to meet A&E targets, and I am determined we should.

“A lot of things are happening to give support to the front line. But that's not to say we are not worried about it, because it is going to be very tough, and we understand that.”