NHS debt is taking its toll on accident and emergency (AandE) departments in England, the BMA said recently (17/1/07) at the launch of a new report on AandE waiting times.

Despite the best efforts of staff to tackle A&E waiting times, a survey conducted by the BMA and the British Association for Emergency Medicine (BAEM) suggests that departments are struggling to sustain the four-hour access target because a shortage of hospital beds is delaying the admission of patients from A&E. All emergency departments in England must ensure 98% of patients wait no more than four hours from arrival to admission, transfer or discharge - a target set by the Department of Health.

Mr Don MacKechnie, Chairman of the BMA's Emergency Medicine Committee said: "Many hospitals have cut bed numbers as part of their financial recovery plans and attempts to balance their books. This means that there are fewer available beds for patients coming through A&E who need to be transferred within four hours to a hospital ward from the emergency department to meet the Government's access target."

A survey of all grades of medical staff working in emergency departments was conducted by the BMA and BAEM at the end of 2006 to find out how departments are faring since the previous assessment almost two years ago.

Almost nine out of ten (87%) respondents reported a shortage of available hospital inpatient beds as the main reason for not meeting the access target. Delays in accessing other hospital services and shortages of staff were other reasons given.

Just over half (54%) of respondents believe the four-hour target is in fact met by their department despite official figures submitted by the trust*. A third (33%) of respondents claimed that data manipulation was used in order to meet access targets and a half (53%) said additional agency or locum staff on short term contracts were brought in to help. Almost all (95%) of respondents said they had experienced direct or indirect pressure to meet the four hour target.

Respondents were also asked if there were any clinical concerns arising from efforts to meet the access target. Two-thirds (66%) of respondents said that some patients may be moved to inappropriate areas or wards and over half (58%) reported that patients may be discharged from A&E before they had been adequately assessed or stabilised.

When asked how emergency medicine could be improved, respondents suggested that education of the public in how best to access emergency care and additional resources was needed.

Mr MacKechnie, added: "The report finds that doctors and other staff are working exceptionally hard and putting in extra hours to meet access targets. Working towards the four-hour target on A&E waiting times has been a fantastic achievement, it has proved good news for patients and the extremely long waits seen in the last decade are now very rare. However respondents tell us that despite this success, the level of performance in many departments is proving unsustainable and these departments are finding it difficult to cope on a daily basis.

"It is frustrating to find that two years on a lack of available inpatient beds is still delaying patients who attend emergency departments. There have been dramatic changes to the way A&E deals with patients to ensure care is delivered efficiently and their wait in the department is minimised. But there has to be a co-ordinated, hospital-wide approach that ensures beds are available, if trusts are to make any further progress on improving waiting times for emergency patients."

Mr Martin Shalley, President of BAEM said: "Attendances at urban A&E departments continue to rise and pressure on beds remains a significant factor for achieving the four-hour target. It is vitally important to separate acute and elective facilities so that each can perform efficiently and improve the patient journey."

Respondents were also asked if their emergency department was at risk of closure or being downgraded. 19 departments in England were identified by those who responded to the survey, as being at risk of closure. 42 respondents reported that their department could be downgraded.

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Notes:

* 65% of respondents in England reported that the figures submitted by their department showed the target had been met.

1. The specialty of accident and emergency medicine has changed its name to emergency medicine and many hospital departments have changed their title from "Accident and Emergency" to "Emergency Department" to reflect this.

2. The survey was direct mailed to 1538 UK members of the British Association for Emergency Medicine on 11 September 2006. 503 responses were received (33%) response rate between 11 September and 20 November 2006. 420 of the responses were from England.

3. In February 2004, the Government in England introduced an incentive scheme, as part of an emergency access target, aimed at reducing waiting times in emergency departments. NHS trusts must ensure 98% of patients wait no more than 4 hours from arrival to admission, transfer or discharge.

4. The figures contained within this press release relate to respondents from England only.

5. The report can be accessed on the BMA website at: bma/ap.nsf/Content/Emergencymedsurvey07

For further information please go to:
British Medical Association
Source:
BMA News, the membership magazine of the British Medical Association