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Better funding and capacity vital for A&E to survive

A&E attendances rose 611,000 per year for past five years

Adrian O'Dowd

Monday, 18 April 2016

England’s A&E system will not survive without significantly more investment in the form of funding, capacity and staffing in the coming years, according to experts.

The Royal College of Emergency Medicine has published a report called Why does winter in A&E get worse every year? which highlights the current pressures being faced by emergency departments throughout the year and shows how winter unmasks the pressures and constraints within the emergency care system.

The report explores the three main determinants of system performance:

  • demand
  • hospital capacity
  • the rate at which patients’ progress through A&E.

The report authors have gathered and analysed existing data from many sources including the Department of Health, NHS England, statutory bodies and health foundations and tried to examine what can be done to better align current services.

The data shows that in the past five years, patient attendances have risen by around 611,000 per annum – almost an additional 3.1 million patient attendances collectively.

Crucially, there has been a disproportionate increase in admissions – 75% of the attendance increase at the same time as demographic and co-morbidity changes.

Data also shows there is evidence that a third of attendances could be managed without input from an emergency medicine doctor.

The report warns that data shows admissions are likely to continue to rise by more than 50,000 patients per year and says: “It is beyond dispute that our hospitals will need greater acute bed capacity and more senior decision makers within the emergency department and A&E hub.

“Planning must address the need to cope with rising numbers of attendances by the frail elderly – with complex interactions between health and social care and long term co-morbidities rather than focussing on reducing attendances by other groups – which are already amongst the lowest per capita in Western Europe.

“Correct funding of emergency care, fairness of contracts to promote a sustainable career in emergency medicine and the creation of A&E hubs to decongest emergency departments will underpin a successful strategy that is patient centred, affordable, efficient and effective.”

Dr Clifford Mann, college president, said: “The report shows just how great the pressure on A&Es is over winter. We have been campaigning to improve emergency care for five years but these data unambiguously show the need to decongest emergency departments and resource them to meet current and future challenges.

“Over two decades the cumulative effect of under investment, failure to acknowledge annual trends, inadequate tariffs and wishful thinking have left the system inadequate to the task.

“Our STEP [staffing, terms and funding, exit block and primary services] campaign aims to build a consensus to address the fundamental challenges faced i.e. sustainable staffing, tariff reform and contract terms that support a work-life balance, the eradication of exit block and co-location of primary/urgent care services.”

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