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A bleak start to 2015 for Accident and Emergency departments

I recently wrote about delays in A & E departments but was shocked to read that as the New Year started major incidents were being declared at a number of hospitals in England as staff struggled to cope with patient numbers.

It has been widely reported in the media that hospitals have been forced to block doors to the Accident and Emergency departments, scheduled surgeries have been cancelled and patients have had to be treated in the corridors.

With major incidences being declared and hospital waiting times rapidly increasing, what has gone wrong? I discuss below some of the potential issues.

Staff Levels

It has been reported by the College of Emergency Medicine that an Accident and Emergency unit should have 10 consultants but that larger NHS Trusts should employ as many as 16.  Despite this, it was recently reported by the BBC that an average Accident and Emergency department employs just over 7 consultants along with shortages of A & E nurses.

With lower staff levels, it is perhaps unsurprising that efficiency suffers.

111 Helpline

In 2013 NHS direct was replaced by the 111 helpline which was designed to be better integrated with local health services to enable medical appointments to be booked as well as advice given.

Unfortunately, since its implementation an increasing number of patients have been referred to Accident and Emergency departments or advised to call ambulances with 1 in 10 calls resulting in an ambulance being sent.

Whilst it is always better to be safe than sorry, this increase in referrals to Accident and Emergency departments and calls for ambulances may be as a result of there being fewer clinically trained staff than were employed by NHS direct and this in turn is increasing pressure on A & E departments.

Cuts to Social Care

Although we live in a society with an increasingly ageing population, unfortunately cuts have been made to services for the elderly and disabled with the BBC reporting a 3% reduction over the past 5 years.

With a decreasing provision of social care, hospitals are struggling to discharge patients meaning that increasing pressure is placed on the Accident and Emergency departments for bed space.

Access to GPs

Recently both the Royal College of GPs and the British Medical Association have been voicing concerns about the workload of their members.

It has been reported that 24% of patients are unable to get through to their GP by telephone and when they did about 11% of those who contacted their GP were unable to get an appointment.

Very often if individuals cannot obtain an appointment with their GP they will refer themselves to the Accident and Emergency department which further increases this pressure on such departments.

Financial Pressure

As demand rises on the NHS, money becomes short.  Half way through the 2014-15 financial year the NHS in England was reported to have a deficit of £630 million.

Although an extra £700 million has been released to help Accident and Emergency departments during the winter £300 million of this came in the autumn which, arguably was too late to make much of a difference.

This is a major concern.  Often patients presenting to A&E may have critical and life threatening illnesses and if the departments are too stretched then this must lead to compromised patient care and causing patients to suffer worse outcomes due to delays in treatment.

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