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.
This CQC report offers practical examples of how leading emergency departments are meeting the challenges of managing capacity and demand, and managing risks to patient safety .
This report from the Care Quality Commission details the good practice identified following the Commission’s work with consultants, clinical leads, senior nursing staff and managers from leading emergency departments in 17 NHS acute trusts.
This resource identifies:
strategies staff use to meet the challenge of increased demand and manage risks to patient safety
positive actions to address potential safety risks and to manage increased demand better
how working with others can manage patient flow and ensure patients get the care they need
that rising demand pressures in emergency departments are an issue for the whole hospital and local health economy.
The quarterly performance of the NHS provider sector for the second quarter (July to September) of the 2017-18 financial year reveals that NHS trusts and foundation trusts are collectively predicting a full-year deficit of around £623 million – £127 million worse than planned.
The data from NHS Improvement also showed that despite the NHS treating more patients than even before, more people were seen within four hours in A&E and within 18 weeks for planned care.
Between July to September of this year, 90.2% of emergency patients were seen within four hours – meeting the national ambition of 90% by September while 3.43 million patients were seen within 18 weeks, compared with 3.36 million during the same period last year.
Cost improvement programmes had delivered £1.25 million of improvements in the first six months of the year and hospitals had delivered a £119 million reduction in temporary staffing for the first six months of the financial year, compared to the same period last year.
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.
Half of NHS trust finance directors think patient care in their area has got worse over the last year, while just six per cent said it has improved | The King’s Fund
Analysis for the Kings Fund latest Quarterly Monitoring Report suggests that the NHS is heading into winter on a knife edge with performance worse than at this time last year against a number of key indicators:
89.7 per cent of A&E patients were seen within four hours in September compared to 90.6 per cent of patients in September last year.
89.4 per cent of patients waiting for treatment in August had been waiting up to 18 weeks for treatment in August, compared to 90.9 per cent in August last year. This is missing the target of 92 per cent. There are now 4.1 million people waiting for treatment, the highest number since 2007.
Emergency admissions are three per cent higher in September compared to the same time last year.
The report also shows that NHS finances remain precarious. Less than half of NHS trusts (45 per cent) expect to meet their financial targets this year, while commissioners are being forced to make tough decisions to reduce spending such as making people wait longer for planned treatment.
Trust finance directors also report widespread problems attracting nursing staff. The main reasons for this are the shortage in staff being trained; morale and work-life balance; and pay restraint.
Nearly 23 million people in England – more than 40% of the population – could be affected by proposed cuts to A&E departments, doctors are warning | BBC News
The analysis of NHS plans by the British Medical Association also warned the changes were being rushed through without the evidence they will work. The proposals have been put forward by local managers seeking to make savings under the direction of NHS England. Bosses have argued services in the community will be boosted in return.
Under the so-called “sustainability and transformation programme” (STP), England has been divided into 44 areas and each asked to come up with its own proposals.
After analysing local plans, the BMA found:
18 of them, covering a population of 22.9 million, involved the closing or downgrading of an A&E department
14 of them, responsible for 17.6 million patients, propose closing or merging a hospital
13 of them, covering a population of 14.7 million, have put forward closing hospital beds
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.