NHS in ‘chronic crisis mode’ worst ever four-hour A&E figures show

Author: Caroline White

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The NHS had the worst four-hour A&E waits since records began 15 years ago, with a sharp rise in the number of people waiting on trolleys and the highest ever number of emergency admissions last month, reveal the latest performance figures for January 2019 issued by NHS England.

Only two out of 134 major A&E departments met the four-hour target in January, while their attendances surpassed 1.34 million ─ 7% higher than in January last year and 3% higher than in December 2018, reveals a summary analysis of the data by think tank, The Nuffield Trust.

The NHS is now in “chronic crisis mode”, president of the Royal College of Emergency Medicine, Dr Taj Hassan has warned.

“Sadly the situation afflicting our emergency departments has become seemingly normalised with a 'chronic crisis mode' that does not allow staff to deliver the quality of care they would wish and patients should rightly expect. The evidence on resultant crowding in departments is clear - it adds to the risk of harm to patients leading to excess deaths and disability. 

“These figures make clear the true scale of this crisis facing our systems. Despite a relatively mild winter, with lower rates of norovirus, nearly one in four people are waiting over four hours and nearly a third of all attendances require admission; the need for more beds could not be clearer.”

Hospitals, he urged, should see the four-hour target as a systems wide issue, not just a departmental one.

“As part of this, they should be looking to implement full capacity boarding, where patients are sent to wards before being admitted to a bed, in order to share risk evenly rather than just in the emergency department. It is also important to have additional medical and nursing staff to support patients waiting for a bed in crowded departments. Instead, too many clinical directors are having to cope with clinical rota gaps and nursing levels remain woefully inadequate to cope.”

The fact that the Long Term Plan was focused on redirecting patients away from hospitals was likely to make matters worse.

“Even with the best intentions, this may not have the desired impact of improving flow within hospitals. The systemic issues need addressing urgently. In the meantime, the suggestion that perhaps the NHS in England should find ways to change the best measure of system flow we have – the four-hour standard – seems wholly inappropriate,” he said.  
“If we are to really improve flow, we will need a fully funded, long-term plan for social care and an increased acute bedbase to help reduce bed occupancy levels,” he insisted.

BMA council chair, Dr Chaand Nagpaul, fumed: “It is totally unacceptable that, last year, almost 640,000 patients waited on trolleys for over four hours. This is only 20,000 fewer than the total number recorded between 2011 and 2014 and it is inhumane, that in the 21st century, patients are facing these conditions.

“Rather than seeing the improved performance that was promised, we are instead seeing a health service that is on its knees, buckling under unprecedented pressure.” This was despite the relatively mild winter.

“With each set of winter figures becoming worse than the last, and patient care suffering as a result, we need to see a tangible release of new funds in the immediate term to address these deficits over and above the proposals in the Long Term Plan.”

Nick Ville, director of policy at the NHS Confederation said the NHS was “buckling under the strain,” despite the best efforts of its staff.

“We need to find a more sustainable way of providing care to an increasingly aging population with ever-more complex needs,” he insisted.

Tim Gardner, senior policy fellow at the Health Foundation, said: '[The] data highlight the fragility of a health service after nearly a decade of austerity, with insufficient staff or funds to keep pace with rising need. 

Despite lower rates of flu and winter vomiting viruses than last year, the NHS is under more pressure than ever, he added.

“Over 100,000 more people attended emergency departments in January 2019 than in the same month last year, and performance against the four-hour A&E target has fallen to its lowest level on record. Bed occupancy has reached the highest level so far this winter, and at 95.2% is well above levels deemed to be safe. Last week over 3,000 people waited for more than an hour in an ambulance outside a hospital.”

He continued: “We can’t blame current NHS performance on bad weather or a viral outbreak alone. Instead we’re seeing a continuation in the trajectory of significantly raised demand for emergency hospital care from rising numbers of sicker patients.

“The NHS has a new long-term plan, but it doesn’t exist in a vacuum. Significant cuts to public health services, and the ongoing lack of a solution for social care are taking a toll which the government needs to address,” he warned.

Chief economist at the Nuffield Trust, Professor John Appleby, commented: “[The] figures remind us that the NHS is fighting a losing battle in trying to meet its commitments to provide timely health care in the face of the pressure it is under.

“There is a risk that we lose sight of these problems as Brexit distracts us, or we become numbed as we forget the last time targets were met. But this situation has a serious impact on hundreds of thousands of patients, and will be demoralising for many staff.”


Editorial team, Wilmington Healthcare

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