Fourteen NHS Accident and Emergency departments have now declared major incidents, cancelling all but the most essential operations and calling in extra staff to cope with the surge in demand that winter brings. Yet NHS bosses are still insisting that the service is better than that received in any other country.
Over the last three months, more than 90,000 A&E patients have had to wait on trolleys for between four and 12 hours to be attended to – the highest number in over a decade, and 40 percent higher than the last recorded peak, the Telegraph has reported.
Dr Cliff Mann, President of the College of Emergency Medicine, has conveyed concern over the performance, saying that “all bets are off” regarding how the NHS will cope between January and March, traditionally the service’s busiest time of year.
He added that hospitals were “full to bursting”, and unable to send people home as there is no community care for them.
Yet the Prime Minister David Cameron, although admitting that the NHS was under pressure, has told the BBC: “We’ve got a short-term pressure issue which we need to meet with resources and management.” He added: “We’ve got a longer-term issue, which is making sure that there are named GPs in your local area which are responsible for every single frail, elderly person.”
The health secretary Jeremy Hunt has also conceded that there is “huge pressure on NHS England” and that hospitals were “running just to keep still” to cope with rising demand, but insisted that the fact that 89 percent of patients are being seen within four hours is “better than any other country in the world”.
It was a claim echoed by Dr Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, who said: “Today’s figures show that, in the three months to the end of December, more than nine out of 10 A&E patients in England continued to be seen and treated in under four hours – the best measured performance of any major Western country.”
By the end of Tuesday, 14 hospitals across England had declared a “major incident”, usually a term reserved for major transport accidents or terror disasters. The status causes all non-essential operations, including cancer operations to be cancelled and outpatients appointments also to be cancelled, whilst people are warned to stay away from A&E unless strictly necessary.
The 14 hospitals include: the Royal Stoke University Hospital, Stafford Hospital, Gloucestershire Royal Hospital, Cheltenham General Hospital, Scarborough Hospital, Walsall Manor Hospital, Peterborough City Hospital in Cambridgeshire, Royal Bolton Hospital, Croydon University Hospital in South London and Ashford and St Peter’s Hospitals in Surrey; the Princess Royal Brighton and the Royal Sussex and Norwich and Norfolk Hospital.
Patients described Croydon Hospital’s A&E on Monday night as being like a “packed nightclub”, with some fearing to go inside lest they contracted an infection. They described scenes of people vomiting in the waiting room and supplies running low, before the major incident was declared at 7am.
And staff at Great Western Hospital in Swindon were forced to erect a giant “field tent” in its car park on Monday night, such was the demand for its services. Staff said that the tent was taken down on Tuesday, and that a major incident was not declared.
Meanwhile the 111 telephone service, designed to handle non-urgent out of hours calls, has been blamed for the influx of patients to A&E. Its call handlers are not trained medical staff but instead read from a script to assess patients, and are told by the system where to direct them for assistance.
But experts have blamed the inbuilt safety-first feature, which directs patients to A&E by default, for overloading A&E with people who don’t need to be there. They point to official NHS figures which show that 111 directs 50 percent more people to A&E on the weekends when GPs surgeries are shut, the Times has reported.
At present 7 per cent of callers are told to attend A&E, and an ambulance is sent to 10 per cent of callers. Suzanne Mason, professor of emergency medicine at the University of Sheffield, said that the 111 system sending callers to A&E was a huge problem, and that it ambulance services in some areas had been “brought to their knees” by call handlers following the risk-averse protocol.
“There are certain times of day and days of the week when call handlers get to the bottom of the algorithm and look at what services are available locally and there isn’t anything there,” she said.
Commenting on the fact that calls to 111 doubled over the Christmas period, Professor Mason added “The GPs have a choice: they don’t have to open. The emergency department doesn’t [have that choice]. One of the things we need to look at changing is the national availability of things like GP services over the holiday period. It just doesn’t make any sense for them to close down.”
Mark Porter, chairman of the British Medical Association’s governing council, said: “The system is struggling to cope with the sheer number of patients coming through the door. Growing pressure on services throughout the year means hospitals have no spare capacity to deal with the winter spike in demand.” He said that the 111 system required a “marked improvement” to stop patients turning up at hospitals needlessly.
Data collected by the Department of Health and NHS England between 1987 and 2013 shows that A&E admissions remained stable for the period between 1987 and 2003 at around 14 million a year. But from 2003 onwards, admissions grew year on year to nearly 22 million in 2012/13; a 50 percent increase in the last decade.
The rise coincides with a change in the way data was collected. Previously only attendances at major A&E departments were recorded, whereas in 2003 attendances at minor injury units and walk in centres were added. The rise shown has been almost wholly in those minor departments, whilst attendances at major units have remained relatively stable.
Commenting on the figures, John Appleby from the Kings Fund said “The change in trend attendances is somewhat abrupt, and could well reflect a degree of what economists call ‘supply induced demand’”.
The rise also coincides neatly with the uptick in immigration that was recorded from 2003 onward, following Labour’s policy to open the country’s doors.