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NHS suffering a ‘year-round crisis’ in emergency care

Services struggling in summer as well as winter

Jo Carlowe

Wednesday, 07 November 2018

Emergency care services are suffering a ‘year-round crisis,’ according to data published today.

The new analysis from the British Medical Association finds the summer of 2018 delivered worse levels of care to patients than five out of eight recent winters.

The finding is based on an examination of data released each month by NHS England that shows the level of pressure on emergency care services. According to these figures, 200,000 more patients were left stranded for more than four hours on a trolley waiting for care after being admitted to hospital in the most recent winter period compared to the same timeframe in 2011.

In light of these findings, doctors’ leaders have warned the government must ensure extra funding reaches frontline services this winter.

Key figures from the BMA study include:

  • In a snapshot of three summer months of 2018 (July to September), 125,215 patients were left waiting on a trolley for more than four hours after the decision to admit, a figure that was greater than every winter (defined as January to March) between 2011 and 2015.
  • The figures were not far behind the last three winters, which registered increasing numbers of patients stranded on trolleys at 155,277 in 2016, 177,012 in 2017 and a record 226,176 in 2018.
  • Compliance with the waiting targets for patients to be seen in A&E, also set at four hours, were lower in the summer of 2018 than the winters of 2011 to 2015, with new lows recorded in the last three winters.

Commenting, Dr Chaand Nagpaul, BMA Council Chair, said: “These figures lay bare the long-term underfunding of emergency care services in England that have experienced years of declining budgets and staff shortages at a time when patient demand has rocketed. 

“It is shocking that the number of patients waiting more than four hours for treatment on trollies has increased seven-fold during the winter months since 2011, with almost 200,000 more patients left in this appalling situation. Compliance with the four-hour waiting time target has dropped 11% since 2011 and even during the supposedly quieter summer period there have been similar declines.

“Most worryingly, the pressure on the NHS has developed into an all year crisis. The BMA correctly predicted that the summer of 2018 would be as bad as many recent winters.

Dr Simon Walsh, an emergency care doctor and member of the BMA’s consultants committee added: “Behind these figures lie real stories of misery. Tens of thousands of patients are being left in crowded, cramped corridors, waiting for treatment while others are having to endure longer waits to even see a doctor or nurse. We cannot and should not allow this appalling state of affairs to continue.

“The recent budget showed signs that the government is beginning to understand that extra investment is needed. But this analysis shows the NHS needs this funding urgently. The BMA remains unconvinced that what has been pledged will meet the sheer scale of the problems underlined by our analysis. It is vital that the government ensures that frontline healthcare staff are given the resources they need to deliver the standard of care that patients deserve.”

President of the Royal College of Emergency Medicine, Dr Taj Hassan, welcomed today’s analysis which he says 'echoes and reinforces' what the College has been saying over several years

"While the figures in this report paint a bleak picture, it only tells part of the story; the number of beds across the system has declined by nearly 10% in the last seven years, with occupancy rates now routinely above safe levels. This is part of the reason why Emergency Departments are now experiencing winter conditions all year round with little sign of respite, and patients suffering as a result. We are undoubtedly heading into this winter in very precarious position,” he said.

“The annual ‘winter rescue package’ is always very welcome, but again has come a little late. We hope to see better planning in the forthcoming 10-year plan that will render ‘winter bailouts’ unnecessary; prioritising the recently agreed emergency care workforce plan and halting the annual decline of bed numbers is essential."

Responding to the BMA analysis, a spokesperson for the Department of Health and Social Care told OnMedica: “Demand for NHS services continues to grow and hardworking and dedicated staff ensured that nearly 2,000 more patients a day were seen within four hours this September than last year.

“We have given the NHS £1.6 billion this year to improve performance and cut waiting times, as well as £420 million in additional winter support to redevelop A&Es, improve emergency care and help patients get home quicker. 

“Our historic long-term plan for the NHS, backed by an extra £20.5 billion a year by 2023/24, will improve front-line services and put our health service on a long-term sustainable footing.”

Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said the findings came as no surprise to ‘hardworking GPs across the country’. She called for a well-funded and well-equipped primary care system to alleviate pressures across the NHS.

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