This site is intended for health professionals only

Emergency services are “stretched to capacity”


24 July 2014

Share this story:
Nuffield Trust and Health Foundation have released a report revealing a wide range of factors contributing to the failure of A&E to reach waiting-time targets.
Data published by NHS England showed that the emergency units had failed to meet the goal of treating, admitting or discharging patients within four hours for 52 weeks in a row.
Report author and Nuffield Trust senior research analyst, Ian Blunt believes the study provides “new evidence” to help produce a policy for targeting “limited resources”.

Nuffield Trust and Health Foundation have released a report revealing a wide range of factors contributing to the failure of A&E to reach waiting-time targets.
Data published by NHS England showed that the emergency units had failed to meet the goal of treating, admitting or discharging patients within four hours for 52 weeks in a row.
Report author and Nuffield Trust senior research analyst, Ian Blunt believes the study provides “new evidence” to help produce a policy for targeting “limited resources”.
Blunt said: “This report shows that many of the external factors suggested to explain the decline in performance on the four-hour target since 2012 only had a small effect. Although many people in the NHS fear a repeat of the difficult 2012/13 winter, we show that the weather was only one part of the problem. We may have reached the limit of what we can deliver with our current A&E capacity.
“Prolonged poor performance on the four-hour target will not be popular with the public or politicians and will mean exposing patients to the worse outcomes that are associated with longer waits. But without either new money to invest in A&E, or new ways to divert people to other parts of the NHS, rising waits may be inevitable. A lot now rides on NHS England’s Urgent and Emergency Care Review.”
The report underlined the link between crowding, which is defined as the number of people in the department at any one time, and waiting times.
An 8% increase in crowding between 2010/11 and 2012/13 was reported, despite just a 3% rise in attendances.
This is owing to fact that population has grown and aged, whilst the number of A&E units have been reduced or remained the same.
Winter pressures did result in higher rates of people waiting more than fours, although despite common conceptions, not by as much as hot weather.
When temperatures hit 20°C, a greater strain was put on the emergency services, with attendances rising by 20% in comparison to with an average winter’s day of 5°C.
Extremely cold weather resulted in longer waits and increased chance people needing to be admitted to hospital.
In a pool of 41 million A&E attendances from 2010 and 2013, the data exposed an aged gap, with older people waiting longer in than children and younger adults – over 75-year-olds waited three and a half hours on average, compared with two and a half hours for those under 75.
The likely reason for this is that the elderly require longer treatment times to deal with their complex conditions, according to the Nuffield Trust-report.
On average, those who suffer with long-term conditions such as arthritis wait longer to be admitted or discharged, while patients with more than one condition wait the longest.
Chief executive of the Health Foundation, Dr Jennifer Dixon believes the matter requires greater attention than simply more investment.
She said: “As this report shows, A&E departments are completely stretched, aggravated by increasing demand for emergency care. But the solutions are more complex than simply ‘more investment needed’, even if that were forthcoming. The access and quality of health and social care available to people outside hospital also needs to be very carefully examined – is it good enough to prevent the need for an A&E visit? We also know that hospitals have huge difficulty discharging patients because of a lack of social care. The flow of patients through hospital – to relieve A&E departments and also free up beds – is often disordered and blocked: two projects funded by The Health Foundation in Sheffield and Warwick have shown that improvements can be made within existing budgets. Only careful attention to all these areas is the solution.”
Chair of BMA Council, Dr Mark Porter responded to the findings and thinks that with an ageing population the services have been “stretched to capacity” and without investment they will be unable to handle the rising demand.
He said: “The continued failure to meet rising demand with necessary investment means the NHS is now starting to buckle. Our emergency departments are full, patients are waiting longer to be seen and front-line services are stretched to breaking point. GPs are being unfairly blamed for queues in emergency departments, but they too are under unprecedented pressure with many surgeries unable to cope with rising patient demand.
"To alleviate pressure on emergency departments it's crucial that patients are treated in the most appropriate setting. Many elderly patients, for example, could be better treated in the community. An effective out of hours telephone service is also key, yet the government's roll out of NHS111 was disastrous, adding to the pressure on emergency departments rather than reducing it.”

Want news like this straight to your inbox?

Related news


School vaccine programme queue
Target for 12-15-year-olds to receive Covid jab by October half-term
NHS England has set out a target for Covid vaccinations of healthy 12-15-year-olds to start...
Booster vaccination
Winter Covid booster plan to begin from next week
Eligible patients will begin receiving Covid booster vaccines ‘from next week’, the health secretary has...