UK emergency departments increasingly failing

[Frazers]

http://www.bbc.co.uk/news/health-30433575

A&E units across the UK are struggling to hit their waiting time target as winter hits, latest figures show.

Demands on the NHS tend to increase during the colder months because of illnesses like flu and norovirus.

But with winter just getting under way, pressures are already reaching record levels.

Extra money is being invested in each nation, but the four-hour A&E waiting time target is still being missed everywhere.

The mounting problems come as the BBC launches its NHS Winter project, which tracks how the health service is performing down to individual hospital trust level.

As health is devolved, data is published differently in the four UK nations.

Hospitals in England, Wales and Northern Ireland are meant to see 95% of patients in four hours.

In England weekly figures are released. The latest, for the first week of December, show 91.8% of patients were seen in four hours - the worst performance since April 2013.

In Wales the data is published monthly with the figures from October showing just 84.7% of patients were seen in time - with one in 20 waiting more than eight hours.

Northern Ireland is performing even worse - just under 80% of patients were seen within four hours in October.

Scotland has a slightly tougher waiting time target - 98% of patients should be seen in four hours. In September under 94% were.

The simple answer is that more people are visiting A&E units. This is true for each corner of the UK, but as the data is most up-to-date for England it can be seen clearest there.

Visits to A&E topped 436,000 last week - that is nearly 30,000 more than the same week the year before.

But it is also the nature of the conditions patients are presenting with that makes a difference.

The best indication of this is the numbers that need to be admitted into hospital as an emergency. They are the most complex cases that often take A&E staff the longest to deal with and lead to beds being occupied.

The numbers topped 110,000 last week - that is one of the highest figures ever recorded.

British Medical Association leader Dr Mark Porter said: "Pressure on NHS services is at a critical point and cracks are beginning to appear.

"While the NHS is used to seeing a spike in demand during winter months, this year emergency departments have experienced a spring, summer and autumn crisis as well, leaving no spare capacity in hospitals as we approach winter.

"At the same time, GP surgeries are struggling to cope with unprecedented levels of demand."

Rob Webster, chief executive of the NHS Confederation, which represents health bosses, said he agreed, adding the pressures were "huge" across the whole system.

"While the winter brings its own challenges, our members regularly tell us that it is 'winter all year round' with pressures being experienced regardless of the time of year."

But Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said: "The NHS is pulling out all the stops, with local hospitals, ambulances, GPs, home health services and local councils all working hard to open extra beds and seven-day services using the extra winter funding."

In England an extra £700m has been set aside to help the NHS. This is paying for the equivalent of 1,000 extra doctors, 2,000 nurses and 2,000 community staff, including social workers and physics.

Ministers in Scotland have announced an extra £8.2m for the NHS to increase capacity and an another £10m to improve the way patients are discharged during winter.

In Wales the NHS has been given an extra £200m for this year. The money is for the whole health service, but ministers say it will help relieve the pressures in the coming months.

Ministers in Northern Ireland have released an additional £5m for both hospitals and the community, including ambulance liaison officers to speed up handovers between paramedics and A&E teams

I'm ashamed to see Northern Ireland falling so far below the national targets and ultimately I think the five million being allocated to improve things is pitifully low. It would also be interesting to try and pin down exactly what Scotland is doing that means they can hit such a better marker (although not quite high enough). In the end though statistical markers such as these don't reflect the suffering and ongoing harm being caused by these shoddy services and we need to be more forceful in addressing them.

Any thoughts?

[Risottia]

Who is to blame? Is the health service a devolved competence, or is it entirely a responsibility of the British government?

[Frazers]

Who is to blame? Is the health service a devolved competence, or is it entirely a responsibility of the British government?

It's devolved to each of the respective governments.

[Marcurix]

Healthcare is a complex beast, and with the notable exception of N.Ireland the wait times aren't that far out all things considered. I can't really say with any confidence if the NHS is struggling due to lack of funding, or if there are other factors at play.

[Benian Republic]

Funding issues most likely

[Fionnuala_Saoirse]

Healthcare is a complex beast, and with the notable exception of N.Ireland the wait times aren't that far out all things considered. I can't really say with any confidence if the NHS is struggling due to lack of funding, or if there are other factors at play.

The main contributing factors are an ageing population, increased patient expectations, and insufficient funding.

[Benian Republic]

Healthcare is a complex beast, and with the notable exception of N.Ireland the wait times aren't that far out all things considered. I can't really say with any confidence if the NHS is struggling due to lack of funding, or if there are other factors at play.

The main contributing factors are an ageing population, increased patient expectations, and insufficient funding.

Oh it's this rude betch

[Fionnuala_Saoirse]

The main contributing factors are an ageing population, increased patient expectations, and insufficient funding.

Oh it's this rude betch

What's that now?

[Benian Republic]

Oh it's this rude betch

What's that now?

Why you gotta be so rude

[Fionnuala_Saoirse]

What's that now?

Why you gotta be so rude

Detailing contributory factors to the NHS' woes is rude these days eh. Well fuck me times have changed.

[Marcurix]

Why you gotta be so rude

Detailing contributory factors to the NHS' woes is rude these days eh. Well fuck me times have changed.

Apparently.

[The Grim Reaper]

Healthcare is a complex beast, and with the notable exception of N.Ireland the wait times aren't that far out all things considered. I can't really say with any confidence if the NHS is struggling due to lack of funding, or if there are other factors at play.

The main contributing factors are an ageing population, increased patient expectations, and insufficient funding.

What do you mean by increased patient expectations? The main worry that the article outlined was based on response times, which I would assume doesn't relate to patient expectations - although that could of course be a problem on its own compared to a health service without matching growth, it seems irrelevant.

[Marcurix]

The main contributing factors are an ageing population, increased patient expectations, and insufficient funding.

What do you mean by increased patient expectations? The main worry that the article outlined was based on response times, which I would assume doesn't relate to patient expectations - although that could of course be a problem on its own compared to a health service without matching growth, it seems irrelevant.

Depends. There have been mutterings of people going to A&E for trivial things over the years, and some have given the impression its a growing problem. Such occurrences would extend wait times simply by the virtue of making the queue longer.

[Fionnuala_Saoirse]

The main contributing factors are an ageing population, increased patient expectations, and insufficient funding.

What do you mean by increased patient expectations? The main worry that the article outlined was based on response times, which I would assume doesn't relate to patient expectations - although that could of course be a problem on its own compared to a health service without matching growth, it seems irrelevant.

Patients have unrealistic expectations of the role of the Emergency Department. It is as, the more traditional name implies, for accidents and emergencies. It is not to be used as an alternative to a failing GP service or as a quick way to obtain a second opinion. It's also not a way to try and obtain a faster referral to specialist services which seems to be an increasing view. We are simply not set up to deal with chronic illnesses and non-emergency cases.

[Olivaero]

A better funded NHS would probably go some way to relieving this problem.

[Avenio]

What do you mean by increased patient expectations? The main worry that the article outlined was based on response times, which I would assume doesn't relate to patient expectations - although that could of course be a problem on its own compared to a health service without matching growth, it seems irrelevant.

Depends. There have been mutterings of people going to A&E for trivial things over the years, and some have given the impression its a growing problem. Such occurrences would extend wait times simply by the virtue of making the queue longer.

I can't specifically speak to how it is in the UK, but here in Canada there's also the problem of elderly people taking up ICU beds for lack of a real chronic care infrastructure in the hospital system. The elderly people involved can't really help it - when they get pneumonia or what have you, it is a more serious problem than it would be for a 20-year-old - but it does mean they have to spend weeks recovering in an ICU bed when said bed could be being used to cycle through a number of shorter-term patients. In elderly patients especially you get the tendency for these sorts of visits to be repeated, as well - once or twice-yearly stints in the ICU for these sorts of issues do add up in terms of resources used.

Part of the solution here has been to offload some of the work to home-care nurses - elderly patients that don't necessarily need round-the-clock care but need some help to administer medications or change bandages/dressings and whatnot can go home rather than sit in a hospital for a few weeks and still get the care they need. Of course, the problem arises that peoples' insurance doesn't always cover home-care, so such things can get expensive quite quickly.

[Southern Hampshire]

Good.

It's time to wrap up NHS.

[Ostroeuropa]

I don't particularly give a shit about waiting times.
I care a lot more about survival rates. If you want the express treatment, go private.

Yes, the two are connected to a degree, but not always.
I don't care if someone has to wait 8 hours for a nail in their hand. I'm sure it does suck for them.
But you know, there are other patients with more serious shit. The focus on waiting times misses this.

[Olivaero]

Good.

It's time to wrap up NHS.

Y'know what? run for office, make that a main point of your manifesto, see how far you get. Even "Man of the people" Nigel Farage had to back away from that when pressed if he supported it. If he doesn't think he can get away with openly coming out and saying it how do you think anyone will?

[Quintium]

VOTE UKIP!

[Fionnuala_Saoirse]

I don't particularly give a shit about waiting times.
I care a lot more about survival rates. If you want the express treatment, go private.

Yes, the two are connected to a degree, but not always.
I don't care if someone has to wait 8 hours for a nail in their hand. I'm sure it does suck for them.
But you know, there are other patients with more serious shit. The focus on waiting times misses this.

Don't worry, a 4 hour breach target doesn't remove triage from the ED.

[Ostroeuropa]

VOTE UKIP!

You've finally convinced me. I've never heard it put like that before.

[Frazers]

VOTE UKIP!

How do they plan on remedying the waits?

[Alfegos]

It is a problem. The issue as normal is that long waits and backlogs in A&E come from a multitude of factors, though sadly the government can only focus on one issue at a time:

1 - People come to A&E rather than a GP as the wait times at GPs are very long (2 weeks in most cases), and many practices tend to not have the time to consider the patients as much more than numbers coming in/out the door. When you're feeling very unwell, you tend to want a solution quickly, rather than in 2 weeks time - and most workplaces sure as hell won't wait for you should you go down with an illness of some sort.

2 - Most people I see in A&E are in three categories: 1) The elderly suffering from old-people's illnesses (COPD exacerbations, Pneumonia, Heart attacks, Collapses), a lot of which could be prevented if there were better social care structures in the UK. The current system seems to be "throw money at a million competing enterprises and individuals and it'll somehow sort itself out", which is pretty shocking in my view.
2) The young with drink, drug and mental health issues, who've overdosed or tried to kill themselves. When I started my shift on wednesday morning, there were 6 overdose patients in A&E (out of the 15 beds available there). Most of them had been in hospital with suicide attempts before - and again, the mental health services seem to be massively neglected in terms of the resources they have, and the options available. There's waiting lists for mental health beds at the local mental hospital, of about a week long, and those services are being cut for the sake of "efficiency" as the "community services" that supposedly exist can deal with it.

3 - A&Es are underfunded from misplacement of funds. That's simple enough. We have the kit most of the times - there just isn't the staff. At my last count, there were more managers than doctors in A&E and the CDU (sadly named ISIS at my hospital - brings a chuckle to me at least). One of the managers who pisses me off no end spends his entire time just hanging around the computers in A&E, just to hurry people up if someone nears the 4 hour target. That's all he seemingly does, for his 50 000 pound salary. But besides that, the A&E consultant has noted that the number of medical staff in the department has decreased in the past 5 years, whilst there are more managers. Curious.

4 - Most of the A&E consultants and registrars are locum (i.e. Temp/Agency) staff. Why? Because you get paid more to locum rather than work at a fixed place, and because most people don't want to go into A&E because the work conditions are shite in comparison to, say, cardiology.

5 - Back to the GPs, again fewer and fewer people are training as GPs because the job is nothing like it was - instead of being based on clinical judgement and patient problems, most GP consultations I've experienced have been box ticking exercises for 10 minutes, by which time the original presenting complaint has been forgotten.

6 - There are simply no beds to transfer people to often, as the beds are taken up with ill patients who are recovering. The elderly tend to take far longer to recover - and if you send them home too early, guess what... they come back again within a couple days, only even worse the next time! Sadly, noone's really considered that in policy.

The system is a mess as progressive governments have seen fit to put more and more emphasis on meeting targets and hiring policy consultants and managers, whilst cutting corners in the name of efficiency at whatever point is possible. And, by essentially breaking hospitals up into competing departments often run by different companies (the hospital's rheumatology patients are actually treated by a private company contracted by the NHS - I have no idea in god's name why they did that, but that's the state of affairs), who will not budge from what their contract states. There are two engineering groups on site, as one company will ONLY repair some buildings that were built as a PFI, because that's all they are contracted to. The generators and heating for the buildings have to be seperate as well, as do the fire systems and the security systems - again, contract. What genius came up with that - someone who only wanted profit for themselves or their company.

And yes, get rid of the NHS or get UKIP in, by all means. Watch the system completely collapse, as it's torn apart by private firms who only want to go in and make a quick buck. Just look at what happened to the very successful health services in the eastern bloc and former USSR after the collapse of communism, in the name of private enterprise.

Final point to note is that the real target missing is far, far higher than you'd realise. People in A&E just play the numbers game. The number of patients who were in for 3:59 staggers me. But a patient can be waiting on a trolley to be put on the computer, and that time isn't counted. They could be waiting in the corridor to be transferred to another ward for 2 hours, but that doesn;'t count as the transfer request has already been made. They could be sent to the "Clinical Decisions Unit" (ISIS, hurhur), which is essentially a cupboard with some beds in, at which point the clock stops, and they still haven't gone to a ward or been fully sorted out. I suspect that if these things were taken into account, you'd find 50%+ of patients have to wait for 4 or more hours.

Any questions, please ask. My experience is as a medical student, currently working nights in A&E with the Acute Medical team, in a smallish London hospital. We see about 1600 people come through A&E in a normal week.

[Alfegos]

What do you mean by increased patient expectations? The main worry that the article outlined was based on response times, which I would assume doesn't relate to patient expectations - although that could of course be a problem on its own compared to a health service without matching growth, it seems irrelevant.

Depends. There have been mutterings of people going to A&E for trivial things over the years, and some have given the impression its a growing problem. Such occurrences would extend wait times simply by the virtue of making the queue longer.

The most trivial thing I've seen in A&E was a man who came in with mouse bites on his feet, which he got after putting his boots on in the morning with a live mouse inside, before walking around for 2 hours in them. Safe to see that as soon as he took his boot off in the waiting room, the mouse fucked off pretty quickly, causing a nice ruckus.

Seriously though, a lot of the presenting complaints will be UTIs, bad coughs, and minor injuries (e.g. grazes, hammered thumb, penis in zipper), for whom most didn't want to wait for 2 weeks before being prescribed antibiotics or having somewhat definite treatment. They would be (on a typical day I suppose) 30% of people, with the other 70% with more serious illness. In our A&E at least (not being a trauma centre), only about 10% of people are SERIOUSLY ill (National Triage category 2 or 1), with only 3-4 people in a week being category 1 (I.e. Not breathing on arrival).