By Darren O’Coghaidhin, 29 January 2015
Hospital A&E units are suffering their worst crisis since the founding of the NHS in 1948. Nurses warn that patient safety is being is increasingly being compromised by growing pressures across the system.
Quarterly performance figures from NHS England for the last quarter of 2014 showed that, for the first time in a decade, A&E departments missed the four-hour waiting target for 95% of patients from arrival to admission, transfer or discharge, with 92.6% of patients seen within the target timeframe. Sixteen of London’s 19 NHS hospital trusts missed the target.
Statistics covering the week ending 4 January suggest the situation has worsened, with 86.7% of patients waiting four hours or less from arrival to admission, transfer or discharge. In addition, hospitals in Staffordshire, Gloucestershire, Cambridgeshire, London and Surrey have all declared “major incidents” due to high A&E demand.
If a hospital declares a major incident it’s a sign that things have got unbearably busy and special measures are needed to cope. One of the first measures is to restrict the flow of patients into the hospital, postponing routine operations or outpatient appointments. Some hospitals have resorted to setting up makeshift wards, while one site set up a large green “field tent”. The FBU has reported fire engines being used as ambulances in a desperate attempt to cope.
Causes
This crisis follows four years of Con-Dem cuts, privatisation and a £3 billion top-down NHS reorganisation. Trusts have been forced to make financial savings resulting in decreased bed capacity, while cuts to social care have led to more older people “blocking” hospital beds. Research from Age UK showed that some elderly patients have spent up to 30 days in hospital, despite being well enough to leave, and despite this undermining their chances of recovery.
Councils face increasing pressure to slash social care budgets by £1.2 billion. To deal with this most councils have also tightened the eligibility criteria for social care assistance. Fewer elderly people are now supported by social care services, despite the growth in the ageing population.
Health Secretary Jeremy Hunt has sought to downplay suggestions that A&E departments are in crisis by continuously blaming a traditional winter spike in admissions. But a Quality Watch investigation estimated that we would have needed an additional 25 A&E units to meet increased demand just due to population growth since 2003. Instead the number of major A&Es has been cut by 8% since 2003 – and more A&Es are still scheduled to close.
Unions say that many hospital staff worked extra, unpaid hours and volunteered to do supplementary shifts to cope with the deluge of patients l despite the government withholding a 1% pay rise.
NHS workers are overworked and underpaid. A recent Income Data Services survey of 30,000 union members conducted for NHS trade unions found that increased workload, low pay, constant restructures and the stresses of working in the NHS are driving two-thirds of its workers to consider leaving their role.
Such a loss of talent and waste of training would deepen the crisis. The joint NHS pay strikes by 12 unions on 29 January and again on 25 February therefore would not divert funds from patient care, but are vital in keeping dedicated staff from being forced out of their chosen career.
