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Why are A&E waiting targets being missed?

Wednesday 8th April 2015
A&E units in England are failing to meet their target of seeing 95 per cent of patients within four hours. Performance levels are at their lowest ebb since 2004. Image Credit: iStock/ImageegamI
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    Accident and emergency (A&E) departments across England are targeted to see all patients within four hours, but this key metric has been missed for the past three months, according to official figures.

    Covering the quarter from January to March, the statistics reveal that 91.8 per cent of patients were seen inside four hours over the period, missing the target by 3.2 percentage points. It represents the worst performance since the target was implemented back in 2004.

    It should be stressed that this result was anything but a surprise; the weekly performance has been beneath the all-important 95 per cent mark since last September.

    So why is NHS England struggling so badly to hit this key target? We take a look at some of the major issues affecting the health service.

    A&E staffing shortages

    Unfortunately, it's a simple fact that A&E departments are struggling to both recruit and retain staff across all disciplines.

    Recent guidance from the National Institute for Health and Care Excellence (Nice) declared that nurses on emergency units should have to look after no more than four patients at a time, while trauma and cardiac arrest cases should have two patients per nurse and resuscitation requires one-on-one care.

    Under the recommendations, hospitals would be forced to tell members of the public if A&E departments are understaffed - an issue that is affecting many emergency units and potentially putting patients at risk, according to Nice.

    And the health service isn't just short of nurses. The College of Emergency Medicine says each A&E unit should have ten consultants, with up to 16 serving the largest trusts. However, this target is also being missed, with the average standing at just seven per unit.

    Even when emergency units are able to find new staff, they are often failing to keep hold of them; many doctors and nurses take up positions in other departments, move to the private sector, or emigrate for higher wages or the perception of a better quality of life.

    Difficulties in accessing GPs

    The vast majority of people understand when to visit their GP and when to go to A&E. This is all well and good if they're actually able to secure a GP appointment, but research suggests that this isn't the case.

    Asked by the British Medical Association to describe their workload, two in five hospital doctors said it is "unmanageable", but this figure rose to three in four among GPs.

    Furthermore, fears of a significant staffing crisis were sparked when a study from the Royal College of General Practitioners revealed that a third of trainee GP posts across the country haven't been filled. 

    The organisation went on to warn that more than 500 practices are at risk of closure due to the sheer number of GPs approaching retirement age, coupled with the lack of younger doctors ready to take over from them.

    NHS budget cuts

    It's hardly a secret that the NHS has had to tighten the purse strings in recent years. 

    A BBC report claimed the health service in England is facing a funding gap of £2 billion - equivalent to about two per cent of its total budget - over the current financial year; inevitably, this would have a negative effect on certain services.

    Hospital boards have hit out at this year's funding system, arguing that patient safety could not be guaranteed under the new approach, which is based upon a series of rewards for the number of people treated. NHS Providers, the body representing NHS trusts, said this was the fifth successive year of payment system cuts, and that the health service could no longer cope.

    Written by Megan Smith

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