Elderly man waited 28 hours for a bed

THE PRESSURES on the NHS, despite the mild winter, were thrown into relief yesterday with publication of a survey showing accident and emergency departments clogged with patients who could not be admitted to wards.

An 84-year-old man with diarrhoea and vomiting waited 28 hours in a cubicle at City Hospital, Birmingham, clocking up the longest wait recorded in the survey by the Association of Community Health Councils.

In its annual snapshot of waiting times in 180 casualty departments taken on Monday, it found 10 patients who had waited more than 20 hours for admission. Most were elderly, with conditions including chest pain and digestive and breathing problems.

At Greenwich District Hospital, south London, a 79-year-old woman with diarrhoea waited 25 hours; a 64-year-old man with a blood disorder waited 23 hours. At Kent and Sussex Hospital, Tunbridge Wells, a 33-year-old woman with abdominal pain waited 23 hours.

Nursing unions said the findings were "totally unacceptable"; doctors' leaders blamed shortages of staff, beds and funding. But NHS managers said they failed to distinguish between patients held in casualty because there were no beds and those with infectious conditions who could not be admitted to wards because of the risk to other patients. Four of the six patients with the longest waits were held in cubicles in casualty, in beds, until they could be moved to single rooms.

But the spectacle of patients waiting in rows on trolleys has receded. Of the 17 patients with the longest waits identified in the survey, four were on trolleys, the rest in beds. The Association of Community Health Councils said the situation was better than last year.Donna Covey, director, said: "It is much better but patients are still waiting too long."

The Government gave an extra pounds 209m for England to help the NHS through winter (pounds 250m for the UK), which was helping, but there was still "an awfully long way to go".

Even the Tories conceded things were better, if only marginally. "The situation has gone from very grim to pretty grim," said Alan Duncan, health spokesman. He accused Frank Dobson, Secretary of State for Health, of "distorting clinical priorities" by his obsession with cutting waiting lists.

Mr Dobson is to appear today before the Commons Health Select Committee, which is investigating the medical workforce needs of the NHS. He is expected to be challenged on evidence published by the British Medical Association today, which says an extra 2,000 doctors a year are needed to treat the rising number of hospital in-patients, up by 4.2 per cent a year, and out- patients, up 4.8 per cent a year. The Government has pledged to increase the number of doctors by 1,000 by 2005.

In Birmingham, which had some of the longest waits, an outbreak of diarrhoea at Good Hope Hospital halted admissions, putting pressure on neighbouring hospitals. Bob Ewings, chief executive of Birmingham's City Hospital, said the two patients who topped the survey had highly infectious complaints and the delay was in finding suitable side-wards.

He conceded the situation was not ideal; both patients had received an apology. "One had vomiting and diarrhoea and the other was suffering from the highly infectious bug MRSA. We kept them in A&E in a proper bed. It was better than putting them in a bed on a ward, because it would have been dangerous for other patients."

The British Association of Accident and Emergency Medicine said staff in casualty departments were doing a "wonderful job" and could not be blamed for a situation beyond their control.

The NHS Confederation stressed that all patients were being treated, wherever they were held. Tim Jones, policy officer, said: "It is encouraging to see that of the 11 longest waits that have been recorded, all but four patients were waiting in beds. Even those waiting on trolleys are being cared for and monitored, although we recognise that it can cause anxiety and stress."

The Health minister John Denham said the improvement on last year showed the success of the Government's cash injection to ease the winter crisis. The Government has announced a pounds 30m package to modernise 50 casualty departments by next year.

Top Delays

These are the worst waiting times identified by the survey.

Birmingham City Hospital: 28 hours 43 minutes and 27 hours 30 minutes.

Greenwich District General Hospital, South London: 24 hours 56 minutes.

Good Hope Hospital, Birmingham: 24 hours.

Kent and Sussex Hospital, Tunbridge Wells, Kent: 23 hours 30 minutes.

Greenwich District General Hospital: 23 hours 19 minutes.

Kent and Sussex Hospital: 21 hours 29 minutes.