A & E Crisis

There is growing concern over the increased demand in Accident and Emergency departments. Statistics show that there are now more than 21 million visits annually which is an increase of 50%. The four-hour target which advocates that  95% of patients have to be seen to in this time has been reported to be breached in many places.

It  is reported  that the lack of out-of-hours GP care is the cause of  the rising demands on A & E departments. Since 2004, GPs have been able to opt out of providing night and weekend cover, leaving it to agencies to provide care. This has been further compounded in recent months with the roll-out of the new 111 non-emergency phone line. Hospitals have reported rises in patients either because they cannot get through to 111 or have received poor advice and been told to go to their local A & E for trivial reasons.

The College of Emergency Medicine, which represents casualty department doctors, believes that between 15% and 30% of patients admitted could be treated elsewhere.

Health Secretary Jeremy Hunt reports that 4 million more people are using A & E than when the GP contract was changed. The Health Secretary has this week also been critical of the GP out-of-hours arrangements, saying the public has lost confidence with the system - now provided largely by agencies.

The situation has  prompted the Care Quality Commission to issue a stark warning about the future of A & E. The position is such that the provision of safe and high quality medical and nursing care can no longer  be guaranteed in A & E.  There have even been reports of temporary waiting areas being set up in hospital car parks and store rooms.

However, British Medical Association GP chairman Dr Laurence Buckman responds by saying that  there is no evidence that the system  set up in 2004 has been a major factor in the rising pressure being placed on A & E units. Dr Buckman advocates that the situation has been escalated by the failure to implement NHS 111 properly.

It has been described as the most challenging period for A & E for a decade. Leaders of eighteen of the twenty one A & E departments in the region have sent a letter to clinical commissioning groups and acute trusts raising serious concerns.

Extra money is being made available where problems are identified and regional health bosses are now being asked to work together, to ensure plans are in place for each A & E in their patch by the end of the month.