Issues Facing Accident and Emergency Departments

Written by Sophia Azam, medical negligence solicitor at Fletchers

Accident and emergency room waiting times are one of the major benchmarks that the NHS sets for itself in order to measure its performance.

The maximum four-hour waiting time for patients to be assessed following attendance at A&E is a contractual requirement for all NHS Hospitals. It is also an issue which attracts much attention from the press. Looking at the NHS published data regarding waiting time increases over the past 5 years it is clear that the reduction in funding is impacting front-line services.  Recent data collected by the Royal College of Emergency Medicine showed that the four-hour standard was not met by the NHS, and was failed every month for the last 17 months.

The reasons behind the increase in waiting times are far from simple. Data collected by an independent review agency cited an increase of the number of visitors, staffing issues, bed occupancy rates and public uncertainty regarding other out of hours services amongst the reasons there has been a year on year increase on these figures.

The President of the Royal College of Emergency Medicine issued a stark warning to the government that the issue of bed occupancy must be addressed as a matter of urgency. He states that this impacts on the elderly and frail patients, who are experiencing long waits in colder conditions. He proposes funding for an extra 5000 beds to help lower the bed occupancy figure to 85% (the deemed safe level) and to reduce it from the current 92% rate.

A response from the NHS National Director for Urgent and Emergency Care said that the delays were regrettable but did not affect a considerable number of people.

Worryingly, a study by the General Medical Council found that junior doctors were being left in charge of A&E and other departments due to understaffing and pressures on senior doctors.  A survey of 55,000 junior doctors found that some were showing signs of post-traumatic stress disorder, describing symptoms of uncertain decision making and continually interrupted sleep.

The governments well publicised £59m funding promise for emergency departments, announced in April 2017, has done little to help on the ‘front line’. Union leaders have described the additional funding as a ‘sticking plaster’ on a widening crisis. They state that long-term investment, together with a long-term plan, is required in order to address the multi-factorial issues affecting the performance of these departments.

NHS England has suggested the role out of ‘Primary Care Streaming’ where patients are assessed by a suitably experienced Emergency Department Nurse and then referred to either the on-site GP or the emergency department, whichever is deemed most suitable for that individual. This has been trialled in some areas, with initial results showing that 40% of patients were seen by the GP service.

This is one of the long-term solutions proposed but it remains to be seen whether this will have the positive impact it aims to achieve.