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Demand for A&E at record high in November

But discharge targets fell to record low

Jo Carlowe

Friday, 14 December 2018

Demand for A&E reached a record high in November, leading doctors’ leaders to warn there has been "no progress" in meeting winter pressures.

The total number of attendances in November 2018 was 2,037,000, an increase of 3% on the same month last year. Of these, attendances at type 1 A&E departments were 1.8% higher when compared with November 2017.

There were 545,000 emergency admissions in the month, 6.3% higher than the same month last year.

Meanwhile, the number of patients seen within four hours dropped, with the 95% standard last met in July 2015. In November of this year, 87.6% of patients were seen within four hours in all A&E departments, compared to 89.0% in October 2018 and 88.8% in November 2017.

Responding to NHS England A&E performance figures for November and the first weekly figures for winter, Dr Helen Fidler, British Medical Association consultants’ committee deputy chair, said: “We are at the very beginning of winter and yet hospitals in England are already feeling the pressure, with demand reaching a record high for November as more patients attend and are admitted to A&E. Despite the milder weather, the number of patients waiting in hospital corridors on trolleys this year has already exceeded the total in 2017 – with the situation only set to get worse in the coming month.”

She added: “On top of this, November saw the number of patients discharged, admitted or transferred within four hours fall to 87.6% – a record low for the month.

“Last week we warned that 10,000 extra beds will be needed to guarantee safe care this winter, and with bed occupancy rates already topping safe levels, these latest stats should set alarm bells ringing for the government and health chiefs.

“Every year doctors are clear in their warnings about what to expect from winter, yet we see no progress. The system is under-resourced and under-staffed, and both patients and health workers are bearing the brunt.

“As politicians remain pre-occupied with internal politics and the mess that is Brexit, those working and being cared for on the frontline of our NHS are suffering because of a lack of action. And while we continue to wait to hear from the government on how the promised £20bn a year will be spent in the NHS, there is an urgent need to address these issues now so that patients get the care they need this winter.”

The Royal College of Nursing has also expressed concern. Professor Dame Donna Kinnair, RCN acting chief executive and general secretary, said: “The cold weather is only just beginning to bite, yet it seems NHS performance dipped to a worrying level for mild temperatures last week. One in 10 hospital trusts in England hit capacity on at least one day in just the first week of December, and had not a single bed to spare. Two were at 100% capacity every day. And because the reporting system doesn’t allow trusts to record more than 100% bed occupancy, these figures often mask large numbers of patients on trolleys and chairs waiting for a bed to become available.

"The NHS desperately needs more beds, but can’t open them without more nurses to staff them – and with 42,000 nursing vacancies in England, this problem is only going to get worse, not better. As the weather turns colder and winter begins in earnest, these figures leave questions to be answered about how hospital services will cope. The forthcoming long-term plan for the NHS in England must address the year-round pressures in the health and social care system.”

A spokesperson for NHS England told OnMedica: “NHS staff continue to work hard to deal with increased demand across the board, seeing 1,000 more people within four hours in A&E every day in November compared to last year. A growing proportion of people are getting same day emergency care which prevents the need for an overnight stay and hospitals have freed up an additional 742 beds, by working closely with councils to help more people return home with the right care in place.

“As the colder weather begins to set in it’s important that the NHS and local authorities continue to work together to help people stay well and out of hospital wherever possible, and the public can also help NHS staff by making sure they have their free NHS flu jab if eligible, and by using NHS 111 as their first port of call for non-emergencies.”

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