NHS warned over emergency care: hospital A&E units facing 'collapse'

A survey of 131 hospital emergency departments says that A&E units are struggling to cope “unsustainable workloads” and lack of staff as new figures show the number of patients has increased by more than a million in just one year.

Experts warned that the emergency care system could collapse in six months as a result of rising demand. Latest data from the Health and Social Care Information Centre show that 18,300,190 people attended A&E units in England between February 2012 and January 2013 - a rise of 1,034,802 from the previous year.

The College of Emergency Medicine (CEM) called for "fundamental change" in the way emergency care is run, warning that A&E units are facing their biggest challenge in more than a decade as departments grapple with "unsustainable workloads" and lack of staff.

And the Foundation Trust Network, which represents more than 200 health trusts in England, warned that A&E services were in danger of collapse in six months time as a result of "huge pressure".

The Health Secretary, Jeremy Hunt, said changes to the way GPs provide out-of-hours care have had a "huge impact" on accident and emergency services.

He admitted there were "huge pressures" on accident and emergency services including a rising number of frail elderly patients with dementia".

"What we need to do is to have a very fundamental look at the way A&E departments work and in particular look at the alternatives to A&E because the government changed the GP contract in 2004 and they removed responsibility for out-of-hours care from GPs," he told ITV Daybreak. "That has caused a dramatic fall in confidence in the public in what their alternatives to A&E are - that is what we have to sort out."

He added: "I think one of the problems we have at the moment is that it is too difficult to access out-of-hours care. People don't feel confidence in the care they will get, if they speak to a GP, the GP probably won't be able to see their medical notes and know about their background."

Groups representing GPs complained about the Health Secretary's attack on out-of-hours coverage.

Royal College of General Practitioners chairwoman Dr Clare Gerada said she was "aghast at the constant denigration of my profession".

Pressed on BBC Breakfast whether he was going to change the GP contract, Mr Hunt said: "That is one of the things we need to look at, but I want to stress that it is not the only thing.

His comments come after the College of Emergency Medicine called for "fundamental change" in the way emergency care is run, warning that A&E units are facing their biggest challenge in more than a decade as departments grapple with "unsustainable workloads" and lack of staff.

The Foundation Trust Network, which represents more than 200 health trusts in England, warned that A&E services were in danger of collapse in six months time as a result of "huge pressure".

The trust's chief executive, Chris Hopson, said: "Athough performance is now stabilising, there is a danger the system will fall over in six months' time unless we plan effectively for next winter," he said.

He said A&E units were facing rising numbers of patients including more frail elderly patients with complex conditions leading to more hospital admissions.

"The wider NHS system isn't working effectively. Patients can't get the GP appointments they need, many doctors' out of hours services aren't working in the way they should and patients simply don't know where they should be going to get the right emergency care. So up to 30 per cent of people in A&E shouldn't even be there in the first place," he said.

"Under current rules, if a hospital admits more A&E patients than it did five years ago, they only get paid 30 per cent of the cost of treating those patients," he said.

"Two-thirds of hospitals are admitting more patients than they did five years ago, some as many as 40 per cent more. This means reopening wards and employing more staff to cope with this extra demand.

"Yet hospitals only get paid 30 per cent of these costs. Some are losing more than £5 million a year as a result, on top of the 5 per cent savings they're already being required to make."

He added: "NHS England has already done good work on developing a new model. We need Jeremy Hunt to commit to completing and then implementing the results of that work as quickly as possible, even though it's likely to involve difficult decisions in the run-up to the General Election.

"These include relooking at the GP contract, reconfiguring some hospital A&E departments and investing more in community facilities."

The College of Emergency Medicine report states that despite many initiatives to reduce the demand on services in the last decade, attendance rates continue to rise.

It makes a series of recommendations for the Government and health officials, including setting minimum consultant numbers in emergency wards.

At present, the average ward has seven full-time consultants but the College recommends that there must be at least 10 on normal wards and 16 on large wards to provide "sustainable cover".

The authors also call for better methods to assess the quality of emergency departments.

They said that the four hour attendance-to-treatment target is most commonly used, but only two fifths of departments surveyed said that they used patient experience as an indicator of care quality.

In Robert Francis QC's report into the "disaster" at Stafford Hospital, he highlighted that many patients or families at the hospital were not listened to by the Mid Staffordshire NHS Foundation Trust Board when they raised concerns about poor patient care.

The College also recommended that there should be a GP service at the hospital which would be more suitable for catering for as much as 30 per cent of the current traffic which is presently seen in emergency departments.

The report also reveals that blunders that should never occur in the NHS happened in one in every 17 accident and emergency wards in just one year.

In 2011/12, 6% of emergency departments in the UK reported a "never event", which are basic, preventable mistakes that should "never" happen in the NHS, the College said.

Never events include surgical instruments being left inside patients or operations being carried out on the wrong body part.

NHS England medical director professor Sir Bruce Keogh is investigating how urgent and emergency care should be delivered in the health service.

Taj Hassan, vice president of the College of Emergency Medicine, said: "It is clear that working environments for them (consultants and middle grad doctors) at times are intolerable, associated with risk for them and their patients and that action is required to stabilise our systems.

"The report has come at a timely juncture where our regulatory bodies and policy makers have also recognised this to be a crisis and suggested urgent action is merited.

"Our recommendations are based upon the need for close collaboration, system redesign, appropriate funding and sustainable working practices for care delivery and training."

The College's president Mike Clancy added: "We must get this right. The public rightly expects that the emergency department is their ultimate safety net when they are acutely ill or injured.

"Effective clinical care means safe high-quality care seven days a week that is consistent across the UK.

"We ask for timely action by NHS England and also policy makers in Scotland, Wales and Northern Ireland to review our recommendations and collaborate with local emergency medicine experts to help solve this very serious situation."

Norman Williams, president of the Royal College of Surgeons, said there are "relentless pressures" on A&E departments.

"We hear from our members that the current crisis in emergency departments in parts of the country is hampering access to emergency theatres and intensive care facilities and preventing consistent access to consultant-led care," he said.

"We also believe this is forcing some hospitals to drop the ball on elective surgery. If this is the case, action must be taken to tackle the detrimental effect of burgeoning emergency care and sometimes inappropriate admissions on the whole hospital system."

Dr Patrick Cadigan, registrar of the Royal College of Physicians, added: "The RCP very much welcomes this report. Emergency care systems must be redesigned to better deliver high quality care for patients in a time of need, whilst ensuring clinicians' workloads and working practices are safe and sustainable."