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A&E resource shortages cause delays

A&E resource shortages cause delays

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A&E departments are struggling to meet target times despite the fact that fewer people used the services this year than over Christmas 2012/2013.  

Recent data released by NHS England shows that there were 266,281 people using type-1 A&E facilities during the week ending 04/01/2015 and 262,879 the previous week - there were more patients using the facilities two years earlier.

During the week ending 6/01/2013 there were 270,905 patients using type-1 A&E departments and in the previous week 263,037 used th facilities.

Furthermore, in the first week of 2013, only 28,426 were left waiting more than four hours to be admitted to A&E in comparison to the 53,681 waiting this year.

The number of patients waiting to be seen this year has had a significant impact upon A&E departments across the UK this year. At one point only 90% of patients were seen within four hours in comparison the target of 95%. and 14 hospitals have had to declare a “major incident”.

One such hospital was  Norfolk  and Norwich University hospital. Mr Mark Taylor, the chief officer  at North Norfolk CCG believes that - aside from the amount of people using the services - there are a number of factors contributing to this.

Ambulance Services

He said: “It is not so much the overall increase in numbers which has put a strain on our system but the apparent acuity of older patients, especially those arriving by ambulance who require more intervention, and often a bed.”

The NHS data does suggest that this had an impact on the hospital’s decisions to declare a “major incident”on the January 5. Between the Jan 2 - 4, at The Norfolk and Norwich Foundation Trust more than 63 ambulances had to queue for more than half an hour to be seen; a figure double the national average.

Meanwhile Brighton and Sussex Hospital NHS Trust issued a “significant”incident alert on the same day for both the Princess Royal Brighton and Royal Sussex hospitals. Between January 2 - 4 they had 93 ambulances waiting more than 30 minutes to be seen.

Hospitals ran by Worcestershire Acute Hospitals NHS Trust had 164 ambulances queuing during the same time period.

Bed Shortages

However for hospitals covered by the trust, bed shortages were also a contributing factor towards the crisis that occurred. In the same time frame all 879 of the A&E beds were occupied. On the previous day 865 of the 866 available beds were used.

Since December 14, Worcestershire Acute Hospitals NHS Trusthave also been working with The Red Cross to ensure vulnerable patients –particularly the elderly –have the support available to function at home so they can be discharged as soon as emergency medical treatment is no longer required.

In total Wyre East CCG, Redditch and Bromsgrove CCG and South Worcestershire CCG, the groups responsible for the commissioning of services in the local area received a total of £4.96m worth of funding from the £700m Winter Fund. This was invested in urgent care centres and discharge systems helping to free up bed space.

Staff Shortages

Staff shortages were also cited as a significant factor leading to the A&E struggles over the festive season by numerous healthcare professionals who believed that a lower supply of staff meant that they were not able to cope with demand.

One junior doctor said: “There was a lot of emphasis on reducing patient numbers through using out-of hours services which is great.

“But even within the community, places such as GP surgeries and walk-in centres need more staff. I’m not just talking about doctors, but nurses as well.”

Complaints about staffing levels within the NHS have been rife all year. In early December it was announced that the UK had lost more that 1,000 matrons and 3,400 senior nurses within the year.

According to Peter Carter, chief executive of the Royal College of Nursing these cuts “mean that the NHS has lost vital experience and knowledge at a time when it needs it more than ever”.

In addition, there have also been a number of nursing strikes following the government’s decision to offer nurses a 1% pay rise going against the advices of the Independent Pay Review. Carter believes this means “many no longer see the health service as offering an attractive career”.

Winter funds

The increase in patient numbers during winter in comparison to other times of the year was anticipated by the Government which gave £700m to hospitals and CCGs across the country to help A&E departments cope with potential pressures.

Of the 14 hospitals who were forced to declare major incidents, five (Gloucester Royal Hospital, Cheltenham Hospital, The Norwich and Norfolk University Hospital, Addenbrooke Hospital and Walsall Manor) of those worked with CCGs which spent money on services such as NHS111 and a further three(including Croydon Hospital, Peterborough University Hospital and Princess Alexandra) had invested in further out-of hours services including urgent care units and longer GP opening hours.

Since its launch in 2011 NHS111 has faced a variety of criticism from healthcare professionals and Mr. Taylor did highlight that the service faced difficulties as December drew to a close.

North Norfolk CCG, South Norfolk CCG and Norwich CCG this year received a total of £5.9 m from the winter funds to invest in local healthcare services - part of this was invested into working with NHS111 providers.

He said: “It is always interesting to hear people talk about NHS111 and I’m still on the fence. What I do know is that there was a huge spike in NHS111 calls the first Saturday after Christmas and the system did struggle.”

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