COMMENTARY

Worst-Ever A&E Waiting Times on Election Agenda

Dr Dan O'Carroll

Disclosures

November 15, 2019

I'd imagine that Armando Iannucci is most likely relieved that his fabulous political satire The Thick of It finished in 2012, as it seems that many of the current politicians and situations are beyond satire. Fictional spin doctor Malcolm Tucker would have been rubbing his hands with glee with the seeming own goal of the Prime Minister's election campaign slogan 'Britain deserves better', which surely would have been more appropriate for the opposition rather than the party that has been in Government for the last 9 years!

And although it is sorely tempting to cut and paste the following dire warnings and comment from last winter's articles, it seems that this year could be even worse. The system has been running in the red for so long now, it seems that much of the reserves and resilience have been exhausted.

CQC Survey

The Care Quality Commission (CQC) recently published the findings from a survey of more than 50,000 people who had received urgent and emergency care across England at either a major consultant-led A&E department (type 1) or an urgent care centre or minor injury unit (type 3), run directly by an acute hospital trust during September 2018.  It is a testament to the staff that the majority of those surveyed were positive about most aspects of their care and treatment. Around 75% of those attending type 1 departments had enough time to discuss their conditions with the doctor or nurse and 76% said they 'definitely' had confidence and trust in the staff examining or treating them. Only 79% felt they were treated with respect and dignity 'all of the time'. Across both type 1 and type 3 departments there was  a small rise in patients rating their overall experience as 10/10, at 29% and 37% respectively.

Areas for improvement identified by the survey included waiting times, with 41% of respondents visiting type 1 departments saying that their visit lasted more than 4 hours, which is noticeably worse than the reported figures (see below). Discharge information was also frequently inadequate, with 26% not told who to contact if they had concerns and 32% not told when they could return to normal activities such as work or driving a car.

Just over half of respondents felt that staff 'definitely' did everything to help to control their pain.

Professor Ted Baker, CQC chief inspector of hospitals, recognised that the pressure and the demands being placed on the staff may be a contributing factor to those areas where the survey reported negative results, eg, waiting times, information provision, and pain control.

This would seem obvious to all of those working in emergency medicine, and certainly all of the areas of the survey are absolutely correctly identified as being important for our patients. I'm sure that many of us can reflect on our own individual departments and their results and aspire to be better. It would seem that in the constant pressure and chaos that many departments face, some of the softer focus sides of medicine can be forgotten or neglected. This survey is a timely reminder of their importance to patients as we go into a winter period with the NHS in its worst position for many years.

'Cusp of Collapse'

It's being widely reported that key targets for the NHS in England for cancer care, hospital care and A&E are at their worst levels since the targets were introduced. The latest NHS statistics for October show that only 76.9% of cancer patients started treatment within 62 days, below the target of 85%. In A&E performance, across all departments a worrying 83.6% of patients were admitted, discharged or transferred within 4 hours, as against the target of 95%. For type 1 departments this fell to just 74.5%. Only 3 of 118 reporting type 1 departments achieved the 95% target. There were more than 80,000 4-hour delays from decision to admit to admission in the month of October, a huge increase from 49,000 in the same month last year.

And whilst politicians of all persuasions now seem to have found the previously mythical 'magic money tree', there is a feeling amongst many medical professionals that what is being promised is too little, too late.

The BMA states that the NHS is on the cusp of collapse, and gives terrifying first hand accounts of the pressures, conditions, and despair being endured by the patients and the staff. The BMA also, rightly, highlights that the on-going pension tax relief scandal that the Government has failed to address is a huge contributing factor. Many colleagues are no longer willing to take on the extra work that the NHS has become reliant on, and some have even taken early retirement.

Election Manifesto for Emergency Medicine

The Royal College of Emergency Medicine (RCEM) has published its own election manifesto in response to the awful published data from October. Among its recommendations it calls for:

  • At least an extra 4000 beds to help maintain flow in emergency departments and get bed occupancy back to safe levels

  • Publication of a social care white paper that addresses the £2.3bn shortfall in council social care budgets

  • Improvement of primary care provision via the expansion of the GP workforce and their hours of availability

  • Sufficient capital funding to improve outdated buildings and equipment and transform the emergency care system

  • A clear strategy to address emergency medicine staff shortages, in particular supporting adequate numbers of nurses

  • Rebuilding of many departments that are not adequately designed for the delivery of 21st century emergency medicine

It's impossible for me to argue against any of these points. For many years now, my response when dealing with patients or relatives who are angry about waiting times, or delays in transfers to wards, is to agree that it is unacceptable, but they can see that all of the staff on the shop floor are doing their best in increasingly challenging conditions. On many occasions, I have suggested that they should write to their MP to voice their concerns as all of the staff would agree with them, but it is not within our power to bring about the necessary change.

I absolutely believe that Boris Johnson is right, Britain deserves better!  It deserves proper funding for both NHS and social care, so that patients can get the care they deserve, and staff can be recruited, retained, and enjoy long careers giving the high-quality care that we all aspire to.

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