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CQC head warns that A&E demand is ‘unsustainable’

Up to 30% of attendances did not require emergency department services

Louise Prime

Thursday, 09 May 2013

Accident and emergency departments will be unable to cope if people continue to attend at their current rate, the head of the Care Quality Commission has warned. He added that he couldn’t guarantee there wouldn’t be a repeat of the problems at Stafford Hospital.

The Today programme said this morning that pressure on A&E departments across the NHS had intensified over recent months – and that in England, the number of patients not being admitted, treated or discharged within the 4-hour target is growing. It reported CQC chair David Prior’s comments to a King’s Fund conference yesterday that attendance at A&E departments was rising at an unsustainable rate, and that he couldn’t offer a “cast-iron guarantee” that there wouldn’t be a repeat of the situation at Stafford Hospital.

BBC News said Mr Prior went on to suggest the large-scale closure of hospital beds and investment in community services. It also reported care minister Norman Lamb’s claim at the same conference that people end up in A&E as a “default option” because they have lost confidence in the services provided when their GP surgery was shut.

The College of Emergency Medicine welcomed David Prior’s comments, and said: “We have been saying for some time that action needs to be taken to address our concerns about the rising demands on Emergency Departments. The challenges faced are caused by a variety of factors and reflect a system-wide challenge for emergency and primary care.”

The College believes that 15-30% of the roughly 22 million people seen in emergency departments last year did not require Emergency Department services. But it warned that redirecting patients away from Emergency Departments only works if reliable alternatives are available. It cited the challenges as:

  • Rising numbers of patients presenting to A&E because of inadequate social care beds, a frail elderly population with multiple co-morbidities and challenges with out-of-hours services.
  • An ‘access block’ caused by hospital wards that have insufficient capacity to allow patients to be moved from A&E into wards in a timely way. But any further closure of hospital beds needs to be considered only when there is sufficient community-based care to cover the needs of patients.
  • A crisis in workforce recruitment and retention, with three successive years of only 50% fill rates for senior emergency medicine trainees.

The College called for sufficient capacity in primary care for NHS 111 to access as an alternative to the Emergency Department, as well as for clinical commissioning groups to urgently commission innovative and consistent tested patient-centred services.

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