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Problems at A&E must be addressed as a whole

Health Committee holds emergency session

Jo Carlowe

Thursday, 15 January 2015

The problems in A&E cannot be addressed without a review of the whole system.

Commenting, following yesterday’s Health Select Committee’s emergency session on pressures on A&E, Dr Mark Porter, the British Medical Association’s council chair, said: “Emergency services are under unprecedented pressure. Staff are working flat-out but with demand at historic highs, the system is struggling to cope with the sheer number of patients coming through the door.

“You can’t address problems in A&E without looking at the system as a whole. Problems at the hospital front door are often linked to delays at the back door, as a shortage of social care beds creates ‘exit block’ in hospitals, meaning patients can’t be discharged because there is simply nowhere for them to go. Outside of hospitals, investment in general practice is declining while demand is on the rise and more care is moved into the community - this simply isn’t sustainable.

“We can only get to grips with pressure on A&Es if every part of the system - from our GP surgeries, to hospitals, to community care – is fully supported and working well, and this includes urgently addressing the shortage of A&E staff and GPs. We also need to ensure NHS 111 is improved to make it a doctor-and nurse-led service. This will help prevent patients being unnecessarily directed to A&E.”

The Health Select Committee was told the reasons for the surge in demand were "many, varied and complex", but staff were doing a "heroic" job.

Visits to A&E in England have soared by more than 400,000 so far this financial year, leading to a number of hospitals declaring ‘major incidents’ and waiting times recorded as the worst in a decade. 

The NHS in England has missed its four-hour A&E waiting time target. Some 92.6% of patients were seen within four hours during the October-to-December quarter. The target is 95%.

Last week, data for the start of the new year showed the proportion had dropped to a new weekly low of 86.7%.

Giving evidence at the committee, were: Dr Cliff Mann, President of College of Emergency Medicine, Prof Chris Ham, Chief Exec of the King's Fund health think tank, and Sir Bruce Keogh KBE, Medical Director, NHS England.

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