An investigation has indicated that nearly 125,000 patients were forced to wait in accident and emergency departments in England for at least 12 hours last year.
This is a dramatic figure in and of itself, but also represents a doubling of the situation in just twelve months.
With doctors having warned previously that crowding in these emergency departments can be no less than fatal, it is essential for the issue to be addressed in the foreseeable future.
Data from the Health and Social Care Information Centre indicates that the figure has surged from the 68,000 incidents of patients waiting at least 12 hours in 2013.
Commenting on the issue, Dr Adrian Boyle, chairman of the Quality Emergency Care Committee at the Royal College of Emergency Medicine, indicated that long waits in accident and emergency are associated with higher mortality rates.
“It’s not just about tedious waits for patients. Studies have repeatedly shown that there is an increased mortality in people who spend a long time in emergency departments, so crowding kills patients. These are almost always people who need admission to hospital, so these are the most vulnerable and the most seriously ill patients.”
The research has also led to calls from industry analysts for NHS England to investigate the matter more thoroughly, and release official data.
Other NHS departments in the UK do indeed publish information on this subject, but NHS England has declined to do so in recent years.
In fact, NHS England starts the clock running only once a doctor decides a patient should be admitted, completely failing to take into account any time spent waiting in the emergency rooms.
This had a massive influence over the way that trusts in England reported cases in 2015.
Only 1,282 instances of patients waiting more than 12 hours were reported, but in practical terms it could be argued that these figures are utterly meaningless.
The current NHS target is for 95% of patients to be discharged, transferred or admitted into hospital for treatment within four hours, and many doctors are now calling for NHS England to change the way that it assesses this data.
NHS England released an official statement on the subject, defending its position and procedures.
“The focus in England is the four hour standard to admit, transfer or discharge, and this applies to all attendances at A&E. For those who require admission we monitor the length of wait from decision to admit to admission. These figures collected by NHS England are published monthly.”
As winter occupancy problems grow for the NHS, official statistics indicate that 12 hospitals in the health service face serious difficulties.
According to reports, these dozen institutions are so full that there was not a single bed available at any of the hospitals.
Commenting on the reports, the Labour Opposition has suggested that the figures are indicative of a health service under unprecedented and intolerable pressure.
Other hospitals have been badly hit by bouts of norovirus. The worst affected trust was the Royal United hospital Bath NHS foundation trust, which had 169 beds closed on Monday last week as a result.
Figures acquired by NHS in England indicate that hospitals in Cheshire, Norfolk, Essex, London, Devon and Wiltshire all completely ran out of beds last weekend.
In addition, there were less than 10 beds free in a further 27 NHS trusts over the same period.
Commenting on this is grave ituation, Andrew Gwynne MP, Labour’s Shadow Public Health Minister, was critical of government policy.
“These figures show an NHS under deep pressure with hospitals facing unprecedented levels of demand. Twelve hospital trusts in England did not have a single spare bed available last weekend, and many more were dangerously full.”
The statistics follow figures showing that levels of “bedblocking” in the NHS reached a record high long before winter was underway.
And the NHS is also facing problems related to meeting targets for seeing patients in a satisfactory timeframe.
Just 92.3 per cent of patients were seen within four hours in October – the lowest on record for this month, compared with 93.7 per cent this time last year.
All available evidence seems to point to the fact that the NHS is struggling logistically to deal with the demands of winter.
This meshed with the opinion of Nuffield Trust chief executive Nigel Edwards, who predicted that this winter hospitals were going to find it “even more difficult to cope” unless the health service invested in intermediate care beds to get patients out of hospital.
There were 1,923,326 attendances at A&E in October – the highest number for the month since current records began in 2010.
This figure is 1.6 per cent more than October last year.
An NHS England spokesperson commented on the situation.
“Nobody could argue there isn’t ongoing pressure on the NHS. Despite this our staff continue to provide quality services in the face of increasingly high levels of demand throughout the healthcare system. Front line services are treating record numbers of patients. We continue to admit or treat and discharge more than nine out of ten patients within four hours – a higher standard than any major western nation.”
New data indicates that the number of patients waiting for lengthy periods in Accident and Emergency has increased massively.
A report from the Royal College of Emergency Medicine indicates that there has been a 1,000 per cent increase in the number of patients waiting for more than 12 hours in A&E.
This rather startling figure is indicative of the extent to which the NHS is struggling with organisational difficulties.
It also successfully illustrates the importance of the debates currently taking place regarding the future of the health service, and indeed why these have been so contentious.
Above all else, the problem of extended waiting times indicates the extent to which the NHS is seriously underfunded.
But it also calls into question the plans of the government to expand the NHS into what it describes as a seven-day service.
When combined with the massive issue of junior doctors pay, and a serious lack of social care provision, it is clear that frontline services are currently struggling and suffering in the health service ahead of the busiest period of the year.
And this is not the first issue related to Accident and Emergency departments that has emerged in recent weeks.
It was also revealed recently that the critical first line of defence in the NHS was also suffering from an issue related to patients waiting on trolleys.
The number of patients waiting for longer than 12 hours in this situation had grown substantially over the same three-year period.
When one considers that A&E departments all over the country were besieged with patients last year, and to some extent crumbled under the pressure, it is clear that there could be massive issues this year as well.
Yet government policy now dictates that Accident and Emergency departments in the NHS are placed under increasing pressure to deal with patients.
The current target for A&E departments is to see 95 per cent of patients within four hours of arriving in the emergency department.
Yet official data indicated that the number of patients waiting at least four hours had nearly trebled, with some 304,276 cases seen in 2014/15.
The issue at least partly originates from an increase in the number of social care patients.
Not only is there a lack of provision for home care, but there is also a significant number of hospital beds unavailable, leading to a significant amount of bed blocking.
Indeed, the report from the Royal College of Emergency Medicine documented a 61 per cent increase in the number of patients taking up beds despite being well enough to leave hospital.
Head of the Royal College of Emergency Medicine, Dr Clifford Mann, commented on the issue, offering his opinion that this is an extremely serious situation.
“This is the minimum time they have been waiting – some of these waits could go on for days. These are vulnerable people, mainly elderly. The A&E department is not where they should be – they have a far greater chance of deteriorating there, suffering delirium, and an increased chance of death. No civilized society should be leaving people on trolleys for 12 hours or more. These figures are moving rapidly in the wrong direction – this is not something we can tolerate.”
Considering the extent of the issues related to Accident and Emergency, it seems absolutely inevitable that the NHS will once again experience a crisis over the winter months.
A recent think tank study suggests that people suffering from mental health problems are far more likely to face emergency health issues.
The Nuffield Trust and Health Foundation think tanks discovered that people in England who have mental health difficulties are five times more likely to be admitted to hospital as an emergency patient.
It was notable that the think tanks found that the majority of admissions of mental health patients were related to physical ailments.
This perhaps goes against the orthodox view which would expect such individuals to generally be admitted to hospital for psychological or mental health-related conditions.
Researchers working on the study believe that its results indicate that the NHS is prone to treat mental health conditions in isolation.
This opinion was supported by the fact that only 20 percent of admissions in the study were explicitly linked to mental health conditions.
By contrast, mental health patients were considerably more likely to be admitted to emergency units as a result of what are considered routine problems such as hip replacements and other minor surgery.
In order to draw this conclusion, the think tanks assessed over 100 million hospital records dated between 2009 and 2014.
This was a comparative survey, with patients suffering from mental health problems and those without such issues both assessed.
The study found that in 2014, for every 1,000 people with mental health difficulties, there were 628 emergency admissions.
This concurred starkly with the same figure of 129 for individuals without any such issues, meaning that mental health admissions were approximately 5 times those of other individuals.
In addition, visits to accident and emergency units were also three times higher in the mental health problem grouping, with more than 1,300 attendances for every 1,000 patients with mental health problems.
Report author Holly Dorning concluded that many of the problems that befell individuals with mental health difficulties could be overcome with superior care. “It is striking that people with mental ill health use so much more emergency care than those without and that so much of this isn’t directly related to their mental health needs. This raises serious questions about how well their other health concerns are being managed. It is clear that if we continue to treat mental health in isolation, we will miss essential care needs for these patients,” Dorning concluded.
Roughly one-quarter of the UK population will experience some kind of mental health problem in the course of every year, with mixed anxiety and depression the most common mental disorder in Britain.
NHS organisations and the government need to take “rapid action” to avoid winter pressures in A&E, the NHS Confederation warns in a briefing paper released today.
The NHS Confederation’s parliamentary briefing – due to be discussed in the House of Commons on Wednesday 24 June – warns that many patients who attend A&E could have their needs better met outside of hospital if sufficient capacity existed.
The briefing also highlights pressures in A&E are symptomatic of issues across the whole system affecting a raft of services including ambulance services, general practice and community and mental health and cannot be dealt with in isolation.
These issues were referenced in a recent NHS Confederation member survey which found that 99 percent of respondents thought cuts to social care funding were increasing pressures on the NHS as a whole, particularly on hospital services.
Dr Johnny Marshall, director of policy at the NHS Confederation, which represents 85 per cent of NHS providers and commissioners, said: “NHS organisations need to take rapid action now if they are to change services to make sure all patients have access to good quality urgent and emergency care services. Many local organisations are already making significant progress on this but local leaders need further support from the Government and national bodies, particularly NHS England, if we are to be successful across all parts of the country.”
The NHS Confederation briefing also covers recent changes to waiting time standards, links between health and social care, as well as a commission on improving urgent and emergency care for older people (set up by the NHS Confederation).