24.07.14
Patients ‘should expect longer A&E waits’
Hospital patients should expect ‘greater waiting times’ in A&E units in the future, two leading health organisations have warned.
A report by the Nuffield Trust and the Health Foundation charities tracking the factors leading to struggles in emergency departments reveals ‘crowding’ closely linked to waiting times.
Tracking 41 million A&E attendances from 2010 to 2013, the ‘Focus on: A&E Attendances’ study showed that crowding has risen as the population has grown and aged, while the number of A&E units has been frozen or reduced under successive governments.
In particular, there was an 8% increase in crowding during the period under review, despite only a 3% rise in attendees, a trend which the charities feel will continue.
The comments come after recent figures from NHS England revealed that major A&E departments missed the target to treat, admit or discharge emergency patients within four hours for 52 weeks in a row.
Ian Blunt, report author and Nuffield Trust senior research analyst, said: “Prolonged poor performance on the four-hour target will not be popular with the public or politicians and will mean exposing patients to the worse outcomes that are associated with longer waits.
“But without either new money to invest in A&E, or new ways to divert people to other parts of the NHS, rising waits may be inevitable. A lot now rides on NHS England’s Urgent and Emergency Care Review.”
The report also revealed an age gap where older people wait in A&E longer than children and younger adults. This was due, in part, to the complexity of conditions that older people suffer, which often require longer periods of care. However, it was revealed that people over 75 spent around three and a half hours in A&E on average, compared with two and a half hours for under-75s.
Winter pressures are also associated with higher rates of people waiting for more than four hours, the report reveals. Analysis also showed that people whose local GP practice had better patient feedback were less likely to attend emergency units.
It has been recommended that the NHS has three broad options to address greater waiting times in A&E units: significant investment to increase the capacity of A&E; renewing efforts to reduce demand for urgent care and/or divert it away from A&E; or refocusing on alternative performance measures for A&E units. However, the report authors stated all three options have drawbacks.
It was stated: “Whatever route is ultimately taken to address the long-term issues, it is essential that we continue to monitor the many dimensions of quality of care delivered inside A&E and outcomes across the whole system for patients who use urgent care.”
A Department of Health spokesman said: “We know A&Es are experiencing increased demand but the NHS continues to meet its targets and see the vast majority of people quickly.
“We're giving the NHS extra support to keep services sustainable year-round and in the long-term, we want to reduce demand by looking after people better in the community.”
Dr Clifford Mann, president of the College of Emergency Medicine, said that that the report, founded on robust analysis of good data, vindicates the position of the College of Emergency Medicine in bringing the issues of ‘crowding’ and ‘exit block’ to the attention of clinicians, managers, commissioners and politicians.
“Failure to act will see a rapid decline in emergency department performance with attendant consequences for patient care and outcomes,” he said.
(Image: c. Rui Vieira/PA Wire/Press Association Images)
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