Editorial: Time is running out for A&E

The doctors’ plea is as stark, the despair is palpable and the situation is only worsening

The NHS has come to a pretty pass when hospital doctors are forced to warn that they “can no longer guarantee the provision of safe and high quality medical and nursing care”. Such is the crisis in Britain’s accident and emergency rooms, however, that 18 heads of casualty departments in the West Midlands have written to alert their hospitals’ management to just that.

The letter – published in this newspaper today – comes hot on the heels of the admission from the NHS watchdog, earlier this month, that pressure on A&E departments is “out of control” and “unsustainable”. And it does much to illustrate what so damning an assessment means on the ground.

The doctors’ plea is as stark as it is frightening. They write of “toxic overcrowding” that too often leaves medics patching up patients in corridors; of clinical incidents and complaints on the rise; and of their concern that “for every incident reported, there are multiple examples of substandard care that go under the radar”.

The despair is palpable. And the situation is only worsening. A&E attendance continues to rise, and a growing proportion of patients are elderly, often with multiple chronic conditions. Meanwhile, the pressure on clinicians is putting off potential recruits, exacerbating already acute staffing shortages. “It is not the case of standards slipping, but the inevitable consequence of being forced to work in sub-standard conditions,” the doctors opine. Quality care is already being substituted by merely safe care – and even that may not be possible for long.

There are several problems, here. The trickiest is the demographic change requiring a radical rethink of our approach to healthcare. But there are more immediate issues, too. One is that, since GPs relinquished responsibility for out-of-hours services, many patients no longer trust them and visit A&E instead. Another is the perverse incentives created by NHS funding mechanisms. Both must be addressed – and fast. How many more warnings of crisis does the Health Secretary need?