‘Worst winter’ looms as AE crisis grows at hospitals

Guardian News and Media/London

The NHS figures also reveal an 89% leap in the number of “trolley waits” of four to 12 hours when data for September is compared with September 2011.

Describing the NHS England figures as “a cause for grave concern”, the leader of Britain’s AE doctors, Cliff Mann, said this winter was shaping up to be the toughest the NHS had ever faced.

“All the worrying indicators are up already. And they seem to indicate that this winter will probably be worse than last winter, which was the worst we have ever had, a tipping point for the NHS’s delivery of acute care.”

Mann, who is president of the College of Emergency Medicine (CEM), which represents AE doctors, added: “It’s not chaos in emergency departments, but it is a crisis. Colleagues at hospitals report that there are almost daily instances in most AE departments of patients facing extended trolley waits.”

‘Exit blocks’ - the inability to move patients elsewhere, even when they have been declared fit to leave hospital - were a major problem.

“That could be the lack of transport to get a patient from an acute hospital to a bed in a community hospital, or the fact that there’s nowhere for the patient to go,” said Mann.

“People call it ‘bed blocking’, but it’s not the patients who are blocking the system; it’s the system blocking the patients”.

The most recent data available from NHS England shows that the number waiting over four hours reached levels this summer that are more normal for the winter months: The number waiting longer than four hours in AE departments in England rose in September this year to 69,268, compared with 48,283 in September 2011, an increase of 43%.

The total waiting more than four hours before admission, transfer or discharge between April and October this year was 513,626, compared with 356,056 in the same period in 2011.

The number waiting more than four hours during a single week in mid-August was higher, at 17,037, than the total during a week in mid-January 2011 (16,479).

“Trolley waits” reached 87,186 between April and October, compared with 47,644 over the same period in 2011.

Days lost because of delayed discharges or “bed blocking” rose to 75,297 in September this year, against 60,316 in September 2010.

A department of health spokesman said: “We know the NHS is under increasing pressure, but AE departments have still been seeing 95% of their patients within four hours since the end of April. This is testament to the hard work of staff. More work needs to be done, so we are investing £500mn over the next two years to help AE departments through winter. Longer term, our £3.8bn integration fund will focus on joining up health and care services, keeping people healthier and treating them closer to home.”

Shadow health secretary Andy Burnham accused ministers of having “left the NHS on the brink of its most dangerous winter in years” and of refusing to heed warnings about the looming crisis.

“These worrying new figures expose the intense pressure that England’s AEs and hospitals are under. Too many are already sailing dangerously close to the wind, and that is before the winter has even started. AEs suffered their first summer crisis in living memory, with thousands more patients stuck in queueing ambulances and on trolleys in corridors.”

After last winter, when the number of people not seen within four hours in AE did not fall as usual at the end of February, NHS England chief executive Sir David Nicholson ordered the service to prepare for this coming winter earlier than usual.