Is There Now an All-year Crisis in A&E?

Peter Russell

November 07, 2018

Labour Prime Minister Jim Callaghan was famously misquoted in the late 1970s for saying 'crisis? what crisis?' when challenged about the UK's economic woes in the so-called winter of discontent.

These days, a 'winter crisis' has become a familiar label for the state of the health service whenever cold weather coupled with high demand for NHS and social care services clashes with NHS funding limitations.

During the last few years in particular, the NHS pips have squeaked particularly loudly as years of austerity bit more deeply.

A new analysis, published by the British Medical Association (BMA), suggests that the emergency care arm of the NHS in England frequently struggles to cope in the summer, as badly as during recent winters, to become an 'all-year crisis'.

Doctors' leaders said the findings came as no surprise.
 

NHS England Data

The BMA said its policy team analysed three emergency care indicators from NHS England data to assess the pressure on emergency care over 7 years between 2011 and 2018.

The indicators used were:

  • Emergency admissions

  • Trolley waits of more than 4 hours

  • The percentage of accident and emergency attendances which were completed within 4 hours

Researchers then compared these indicators during summer and winter months.

The analysts acknowledged inconsistencies in defining 'summer' and 'winter'. In order to include the average hottest and coolest months of a typical year within each period, they defined winter as January to March and summer as July to September for the purpose of the study.

They found that average 4 hour waiting target compliance rates were lower during the 3 summer months of 2018 (89.3%) than during the 3 winter months of 2011 to 2015 which saw average waiting compliance rates of 96.6%, 95.8%, 94.1%, 95.0%, and 94.2% respectively.

However, the figures showed the pattern reversed in 2016 and 2017 when waiting times during the winter were on average 87.9% and 87.5%.

Increased Admissions and Trolley Waits

Among the main findings from the study were:

  • During the summer of 2018, 125,215 patients waited on a trolley for more than 4 hours after the decision to admit – a figure that was greater than every winter between 2011 and 2015

  • The figures came close to rivalling the winter of 2016, in which 155,277 patients were left on trolleys, and winter 2017 when the figure was 177,012

The figures also showed that, comparing summer 2011 and summer 2018:

  • Average accident and emergency 4 hour wait compliance reduced from 97.3% to 89.3%

  • Total trolley waits of longer than 4 hours increased from 18,095 to 125,215 – a six-fold increase

  • Total emergency admissions increased from 1,247,113 to 1,558,691 – a rise of 25%

Commenting on the analysis, Dr Chaand Nagpaul, BMA council chair, said: "These figures lay bare the long-term underfunding of emergency care services in England that have experienced years of declining budgets and staff shortages at a time when patient demand has rocketed."

He continued: "Most worryingly, the pressure on the NHS has developed into an all-year crisis. The BMA correctly predicted that the summer of 2018 would be as bad as many recent winters."

'Urgent' Funding Needed

Dr Simon Walsh, an emergency care doctor and member of the BMA's consultants committee said: "The recent budget showed signs that the government is beginning to understand that extra investment is needed. But this analysis shows the NHS needs this funding urgently.  

"The BMA remains unconvinced that what has been pledged will meet the sheer scale of the problems underlined by our analysis."

Commenting on the analysis, Prof Helen Stokes-Lampard, chair of the Royal College of GPs (RCGP), said: "Our emergency care colleagues are, as this analysis highlights, operating under enormous strains, but it is important to remember that GPs are also on the frontline of patient care and our profession – and our patients – are facing the impact of these pressures on a daily basis.
 
"Health Secretary Matt Hancock has said that preventing people from getting ill in the first place should be central to how the NHS works, but first of all we need a well-funded and well-equipped primary care system. This will alleviate pressures across the NHS and allow us to deliver care in the community where it is more cost-effective, and where our patients want it most."

An NHS spokesperson said: "The NHS’s extensive planning for winter is already well under way, with access to clinical advice through NHS 111 and evening and weekend GP appointments improving people's access to care, plus action by hospitals and local councils to free up beds by reducing long stays. 

"Staff getting vaccinated against flu will also help reduce the pressure on services over winter."
 

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