Exclusive: ‘It was no accident’ - Government blamed for A&E crisis

Most senior emergency doctor says warnings about staff shortages were ignored by ministers

Health Reporter

England's A&E crisis could have been averted two years ago if the Government had heeded warnings of a looming collapse in casualty ward staffing, the country's top emergency doctor has said.

Dr Clifford Mann, President of the College of Emergency Medicine, said that ministers and health chiefs were "tied in knots" by the challenges of implementing the Coalition's health reforms from 2011 onwards, leading to them ignoring the first warnings of an imminent crisis from the College that the NHS was failing to recruit enough new A&E doctors.

Although a new recruitment drive for A&E doctors is now under way, Dr Mann told The Independent that the Government's reforms - which finally came into effect in April - had caused "decision-making paralysis" throughout the NHS for 18 months, leaving the College in a position akin to "John the Baptist crying in the wilderness".

"The first warning signs were three years ago when we failed to recruit to 50 per cent of our posts - that was 2010," Dr Mann said. "Those concerns were raised at the time."

"We failed to recruit enough staff again the next year," he continued. "The problem at that time was many people were still wrestling with moving the Health and Social Care Act through Parliament and working out how it was going to be implemented.

"It took a lot of time and resources from the medical royal colleges and other organisations wondering how they should approach such an enormous piece of legislation and potential change. It tied us all up in knots for quite a long time. There was a lot of decision-making paralysis and stasis in the system at that time."

Casualty wards up and down the country are under intense pressure this winter, with seasonal illnesses driving up demand for hospital beds, with a knock-on effect for emergency admissions.

A&E wards missed waiting times targets two weeks in a row before Christmas. Winter pressures last year contributed to the worst A&E performance in nine years.

Over the past year ministers have variously blamed the increased pressures on Britain's ageing population, changes to GP out-of-hours care, or more recently, denied that the crisis even exists.

However, Dr Mann said that the problems were a consequence of a staffing crisis that has left the country short of around 375 emergency doctors - which over the course of a year means "750,000 patients per year who aren't going to be seen".

He added: "They're never going to exist, we've lost that opportunity. It takes four years to train and you can't just be parachuted into the fourth year."

Dr Mann said the NHS has also had difficulty retaining its A&E medical workforce, with hundreds emigrating to seek better working conditions and pay overseas. In Australia, for example, there are 480 British or Irish-trained A&E doctors - now a quarter of the Australia's emergency specialists.

Growing anxiety in the Coalition about A&E performance this year has sped up efforts to address staffing levels. Health Education England recently announced that 75 new training places for A&E doctors will be created.

Dr Mann said that much time had been lost, in which NHS trusts had been forced to spend an average of £500,000 per year on locum doctors, while hundreds of millions of pounds had been spent by the Government on "short-term crisis management".

Before recent concerns about A&E waiting times surfaced, the representatives from the College met with the serving Health Secretary only twice in four years, but have now held two meetings with the current Health Secretary, Jeremy Hunt, in the past two months alone. "We've moved from crisis into resolving these challenges... We've finally got people to listen to our message," said Dr Mann.

A Department of Health spokesperson said that the NHS reforms had created the national training body - Health Education England - which would ensure A&E wards had enough doctors.

However, Labour said that the Health and Social Care Act had "pulled the rug from under the NHS" at a critical moment. Andy Burnham, shadow Health Secretary, said: "David Cameron's decision to break his pledge of 'no top-down re-organisation' was a monumental misjudgement. Doctors and nurses knew the dangers and pleaded with him to call it off.

"The result has been two lost years in the NHS. At a stroke, focus shifted from the front line to the back office - away from issues like the growing recruitment crisis in England's A&Es."

The Department of Health spokesperson said: "Since 2010, over a million more people are visiting A&E departments. We recognise that emergency medicine is under pressure and we are determined to tackle it. [NHS Medical Director] Sir Bruce Keogh's recent review gives us a blueprint for how the NHS should respond to demands for emergency services. It was based on extensive consultation, taking on board views from the College of Emergency Medicine."

Profile: The top doctor with the dire warning

Dr Clifford Mann is one of the UK’s leading emergency medicine consultants. Having trained in the UK, New Zealand and Australia he became a consultant at the Taunton and Somerset NHS Foundation Trust in 1999.

He was appointed president of the College of Emergency Medicine in 2013, and has been an outspoken critic of the Government’s response to ever-increasing pressure on A&E wards, warning in May that casualty units were becoming like “war zones”.

In November the College published 10 priorities for resolving the crisis, including improving conditions for A&E doctors to encourage more trainees into the profession, and to stop the drain of top doctors leaving the UK for better pay and shorter hours overseas. While serving as president, Dr Mann still works regular shifts on his hospital’s emergency ward.

Suggested Topics
The Banksy image in Folkestone before it was vandalised
Life and Style

Sales of the tablet are set to fall again, say analysts

football West Brom vs Man Utd match report: Blind grabs point, but away form a problem for Van Gaal
Arts and Entertainment
Gotham is coming to UK shores this autumn
tvGotham, episode 2, review
Have you tried new the Independent Digital Edition apps?
ebooksAn unforgettable anthology of contemporary reportage
Arts and Entertainment
Bloom Time: Mira Sorvino
tvMira Sorvino on leaving movie roles for 'The Intruders'
First woman: Valentina Tereshkova
peopleNASA guinea pig Kate Greene thinks it might fly
Brian Harvey turned up at Downing Street today demanding to speak to the Prime Minister

Met Police confirm there was a 'minor disturbance' and that no-one was arrested

Arts and Entertainment
George Lucas poses with a group of Star Wars-inspired Disney characters at Disney's Hollywood Studios in 2010

George Lucas criticises the major Hollywood film studios

Chris Grayling, Justice Secretary: 'There are pressures which we are facing but there is not a crisis'

Does Chris Grayling realise what a vague concept he is dealing with?

Life and Style
A street vendor in Mexico City sells Dorilocos, which are topped with carrot, jimaca, cucumber, peanuts, pork rinds, spices and hot sauce
food + drink

Trend which requires crisps, a fork and a strong stomach is sweeping Mexico's streets

Life and Style
The charity Sands reports that 11 babies are stillborn everyday in the UK
lifeEleven babies are stillborn every day in the UK, yet no one speaks about this silent tragedy
Blackpool is expected to become one of the first places to introduce the Government’s controversial new Public Space Protection Orders (PSPOs)

Parties threaten resort's image as a family destination

Life and Style
Northern soul mecca the Wigan Casino
fashionGone are the punks, casuals, new romantics, ravers, skaters, crusties. Now all kids look the same
Life and Style

I Am Bread could actually be a challenging and nuanced title

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating

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

iJobs Job Widget
iJobs General

Year 5 Teacher

£80 - £140 per day: Randstad Education Leeds: Year 5 Teacher KS2 teaching job...

Software Developer

£35000 - £45000 Per Annum Pensions Scheme After 6 Months: Clearwater People So...

Systems Analyst / Business Analyst - Central London

£35000 - £37000 per annum + Benefits: Ashdown Group: Systems Analyst / Busines...

Senior Change Engineer (Network, Cisco, Juniper) £30k

£30000 - £35000 per annum + Benefits: Ampersand Consulting LLP: Senior Change ...

Day In a Page

Two super-sized ships have cruised into British waters, but how big can these behemoths get?

Super-sized ships: How big can they get?

Two of the largest vessels in the world cruised into UK waters last week
British doctors on brink of 'cure' for paralysis with spinal cord treatment

British doctors on brink of cure for paralysis

Sufferers can now be offered the possibility of cure thanks to a revolutionary implant of regenerative cells
Ranked seventh in world’s best tourist cities - not London, or Edinburgh, but Salisbury

Salisbury ranked seventh in world’s best tourist cities

The city is home to one of the four surviving copies of the Magna Carta, along with the world’s oldest mechanical clock
Let's talk about loss

We need to talk about loss

Secrecy and silence surround stillbirth
Will there be an all-female mission to Mars?

Will there be an all-female mission to Mars?

Women may be better suited to space travel than men are
Oscar Pistorius sentencing: The athlete's wealth and notoriety have provoked a long overdue debate on South African prisons

'They poured water on, then electrified me...'

If Oscar Pistorius is sent to jail, his experience will not be that of other inmates
James Wharton: The former Guard now fighting discrimination against gay soldiers

The former Guard now fighting discrimination against gay soldiers

Life after the Army has brought new battles for the LGBT activist James Wharton
Ebola in the US: Panic over the virus threatens to infect President Obama's midterms

Panic over Ebola threatens to infect the midterms

Just one person has died, yet November's elections may be affected by what Republicans call 'Obama's Katrina', says Rupert Cornwell
Premier League coaches join the RSC to swap the tricks of their trades

Darling, you were fabulous! But offside...

Premier League coaches are joining the RSC to learn acting skills, and in turn they will teach its actors to play football. Nick Clark finds out why
How to dress with authority: Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear

How to dress with authority

Kirsty Wark and Camila Batmanghelidjh discuss the changing role of fashion in women's workwear
New book on Joy Division's Ian Curtis sheds new light on the life of the late singer

New book on Ian Curtis sheds fresh light on the life of the late singer

'Joy Division were making art... Ian was for real' says author Jon Savage
Sean Harris: A rare interview with British acting's secret weapon

Sean Harris: A rare interview with British acting's secret weapon

The Bafta-winner talks Hollywood, being branded a psycho, and how Barbra Streisand is his true inspiration
Tim Minchin, interview: The musician, comedian and world's favourite ginger is on scorching form

Tim Minchin interview

For a no-holds-barred comedian who is scathing about woolly thinking and oppressive religiosity, he is surprisingly gentle in person
Boris Johnson's boozing won't win the puritan vote

Boris's boozing won't win the puritan vote

Many of us Brits still disapprove of conspicuous consumption – it's the way we were raised, says DJ Taylor
Ash frontman Tim Wheeler reveals how he came to terms with his father's dementia

Tim Wheeler: Alzheimer's, memories and my dad

Wheeler's dad suffered from Alzheimer's for three years. When he died, there was only one way the Ash frontman knew how to respond: with a heartfelt solo album