Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. In recent years, patients have been waiting longer in A&E; this article from the Kings Fund explores the reasons behind this.
The article reports that not only are more people are attending A&E departments each year, but A&E waiting times have also increased substantially over recent years. The NHS has not met the standard at national level in any year since 2013/14, and the standard has been missed in every month since July 2015.
At the same time, longstanding staffing issues and continued reductions in the number of hospital beds have made it more difficult for A&E departments to admit patients.
The patients in the urgent care pathway who are at highest risk of preventable harm are those for whom a high priority 999 emergency call has been received, but no ambulance resource is available for dispatch.
Acute Trusts must always accept handover of patients within 15 minutes of an ambulance arriving at the ED or other urgent admission facility (e.g. medical/surgical assessment units, ambulatory care etc.)
Leaving patients waiting in ambulances or in a corridor supervised by ambulance personnel is inappropriate.
The patient is the responsibility of the ED from the moment that the ambulance arrives outside the ED department, regardless of the exact location of the patient.
Winter is coming. How much would it cost to keep the pressure down? | The Health Foundation | Story via OnMedica
New analysis from the Health Foundation suggests that this winter could see the worst performance against the NHS four-hour A&E target since records began in 2004-5.
The analysis uses projected trends in A&E attendances, the number of people waiting over four hours at A&E, and the number of those needing admission but waiting over four hours for a bed. The projections suggest that around 735,000 people will wait longer than four hours in the last quarter of 2017-18 (January – March), equal to a 311% increase on winter 2010-11.
The NHS aims to admit, discharge, or transfer 95% of people within four hours of arriving at A&E. But in a worsening financial climate, hospitals are now struggling to meet this target all year round, not just in winter.
The government’s response to the House of Commons Health Select Committee report on winter pressure in accident and emergency departments.
This report responds to each of the 27 conclusions and recommendations in the Health Select Committee’s report, Winter Pressure in A&E Departments . It highlights how the NHS prepares for winter, as part of its year-round operational resilience planning, to ensure the health and social care system in England is fully prepared for the increased pressures at that time of year.
The report focuses on the processes and behaviours of the emergency teams that are managing to deliver outstanding results despite the ever increasing challenges.
This report highlights the importance of using data to identify and shape solutions to the pressures in emergency departments. It identifies key lessons for managers working in or with emergency departments.
Sicker patients with more complex conditions are the main reason for worsening performance in A&E departments, according to The King’s Fund’s latest quarterly monitoring report.
Eighty per cent of NHS finance directors who responded to the latest Kings Fund survey identified higher numbers of patients with severe illnesses and complex health needs as a key reason for the pressures on A&E units, while 70 per cent cited delays in discharging patients from hospital. In contrast, only 27 per cent pointed to poor access to GPs and 20 per cent identified shortages of clinical staff as key factors.
The survey also highlights the effort made by the NHS to prepare for increased pressure on services during the winter. More than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of clinical commissioning groups (CCGs) paid for extra resources in primary care. Other common measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff.
An analysis of how NHS 111 has fared, especially over the winter period | Nuffield Trust
The proportion of callers being dispatched from NHS 111 to emergency services over the last three years has risen. There has been a particular rise in the share of people who are passed to ambulances.
There is great variability between different areas in how likely NHS 111 is to send people to A&E or the ambulance service. This might suggest that some areas are too likely, or not likely enough, to send people to emergency services. NHS 111 is also more likely to dispatch an ambulance than to simply send people to A&E – which is the reverse of the usual pattern of NHS use. This lends credence to claims that the service is too risk-averse in some cases.
However, contrary to criticism that it adds to the pressure on A&E, the service overall seems to steer people away from emergency services. Patient surveys suggest as many as 8 million more people would have gone to A&E and the ambulance service over the last three years without 111. The call line also soaks up extra demand during winter, when it becomes less likely to refer people to urgent services.
NHS 111 still answers the vast majority of calls within a minute, and few people hang up after having to hold for more than 30 seconds. However, it has not met its target of answering 95 per cent of calls within 60 seconds for two-and-a-half years, and it seems prone to serious under-performance when calls spike after Christmas and the New Year.