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Missed A&E targets reflect cuts in social care and NHS funding

Proportion of A&E patients waiting for over four hours has quadrupled in five years

Louise Prime

Friday, 15 April 2016

The proportion of people waiting longer than four hours in A&E for a bed has almost quadrupled over the past five years and is the highest it’s been since 2004, although long trolley waits were only half what they were last year, according to NHS England’s latest figures. Commentators said the monthly performance statistics for February, which marked the end of an unusually mild winter, illustrated the impact of social care-related delayed hospital discharges, an “unprecedented slowdown in funding for the NHS” and a “constantly increasing demand for elective and emergency care”.

NHS England’s interim national director of commissioning operations and information, Richard Barker, said the impact of the late flu spike was compounded by a 40% rise in social care-related delayed discharges compared with the same month last year. But he pointed out: “Despite these pressures, for the year as a whole more than nine out of ten patients have been admitted, treated or discharged in under four hours, while long trolley waits have halved compared with last year.”

NHS England said the figures emphasised both the importance of joined-up care within the NHS, and the dependence of hospitals on well-functioning social care services – particularly for older people living at home.

The NHS Confederation joined calls for urgent action to make health and social care run more smoothly, and change the way care is delivered, as social care cuts have led to difficulties for hospitals discharging patients into the community. Its director of policy Johnny Marshall said: “For some people, hospitals are the most appropriate place for treatment, but for those that don’t need to be there we must make sure we’re providing the best care possible, where it is most appropriate for the community.”

Candace Imison, director of policy at the Nuffield Trust, added: “The proportion of people dealt with in less than four hours in February was the lowest since 2004 … But these delays are hardly surprising when you look at the number of patients who had to be admitted to hospital as emergencies … despite a huge policy push to try and enable these people, mainly of them frail and elderly, to be treated at home or in the community.”

The Health Foundation said mounting pressure on the NHS had – despite a mild winter – contributed to deteriorating performance in a number of key areas. Dr Jennifer Dixon, the charity’s chief executive, commented: “Of particular concern is the nearly fourfold increase, compared to five years ago, in emergency patients waiting more than four hours for a hospital bed after a decision to admit them to A&E … performance against the A&E target has fallen to an all-time low since 2010.”

She pointed out that over the past three months, delays in social care provision were the fastest growing cause of people not being able to leave hospital, which contributed to a backlog of patients in A&E as well as longer waits for non-emergency care beds.

But, she argued: “The root cause of deteriorating performance is an unprecedented slowdown in funding for the NHS – now halfway through the most austere decade of funding growth since records began in 1948 – and severe cuts to social care, impacting specifically older people. Providers are struggling to accommodate this slowdown because of the sheer pace and scale of changes required. Today’s performance figures, while worrying, are entirely predictable.”

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