A&E crisis: Urgent action demanded

Staff say some beds have been freed up over the past 24 hours, following unprecedented demand over the past two weeks.

Today, York health economist Andrew Street calls on national politicians to take the lead in ensuring such pressures do not become an annual crisis.

Prof Street said the current crisis was a result of years of misguided policies and said it could have been far worse had there been a major flu outbreak or a bitter winter.

He blamed a lack of vision in the system and said the buck had to stop with politicians.

York parish councillor Roger Bedford has told how he and a friend waited for eight hours for a bed to become free on Christmas Day, but staff believe they are now over the worst of the crisis for now.

Crisis could have been foreseen, expert says

Professor Andrew Street
 Professor Andrew Street

THE CRISIS affecting accident and emergency departments is caused by a combination of factors, according to a leading York health economist.

Many of these could and should have been foreseen, says Professor Andrew Street of the University of York. "There has been poor vision about the pressures building up in the system," he says.

Planners at all levels, from local hospitals to GP commissioning groups and the NHS nationally, must share responsibility. "But ultimately the buck stops at the top," Prof Street said. "These issues should have been anticipated by politicians."

Among the factors contributing to the crisis are:

• Funding shortages. It is not enough for politicians simply to ring-fence NHS funding, Prof Street said. Demand on the NHS is constantly increasing. Simply increasing the annual NHS budget in line with inflation will not, therefore, keep up with demand. "There is a shortfall that needs to be plugged, and projections going forward show the gap in funding going up."

• NHS reorganisation. With resources limited, NHS funding must be spent wisely, Prof Street says. But the coalition government's 2012 reorganisation, which aimed to scrap a whole tier of bureaucracy and put spending decisions in the hands of GPs, was not intelligent. A great deal of money was wasted.

"There were big redundancy payments, and people were then re-employed in similar sorts of organisations." The loss of experienced managers also caused problems. "Managers are there to predict crises like this. If you get rid of the managers..."

• Social care funding. Social care budget cuts have increased pressure on the NHS in two ways, Prof Street says. Because the eligibility criteria for social care have been tightened, more people are unable to get the care they need. They become ill - and turn to the health service. There is also bed-blocking, where patients who don't really need to be in hospital cannot leave because home care is not available. As a result A&E departments get overwhelmed.

• Bed occupancy. English hospitals 'bed occupancy' rates much higher than many other countries, Prof Street says. Even on normal days English hospitals have very few empty beds. Some operate day to day on bed occupancy rates of more than 100 per cent, with all beds full and some patients on trolleys. In a crisis, consequently, there is nowhere for patients to go.

• Staff recruitment. A&E is an 'unpopular' specialism for doctors because of the difficult hours and intense pressures. "So we seem to have a shortfall of consultants in A&E. They are the people who can get things moving. Ordinarily, hospitals can muddle through. But when they are under pressure, everything comes together in a crisis."

• Changes to GP contracts. These were brought in by the last government, but have meant some patients have found it harder to see their GP. Alternatives were put in place, such as minor injuries units, NHS walk-in centres and NHS Direct. But with more people now going to A&E, questions must be asked about whether these are working.

The current crisis could have been much worse, Prof Street says. The weather has been fairly mild, and we haven't had a major flu outbreak. We could be faced with worse problems in future.

To prevent that, there needs to be a proper understanding of the whole health system - and a plan in place for eventualities. It shouldn't be too difficult, he says - after all, winter comes around every year.

And the people who should be responsible for putting such a plan in place? Politicians and their advisers at the top of the NHS. "It needs to come from the top."

Slight relief for ‘tired’ staff


Mike Williams: “Situation has improved and we have been able to discharge some patients”

YORK Teaching Hospital NHS Foundation Trust said the situation had appeared to improve slightly yesterday. 

There had been a slight decrease in attendance overnight and throughout Wednesday morning but A&E in York had become busy in the afternoon. 

Mike Williams, clinical director of A&E at York Hospital, said: “The situation has improved, we managed to discharge a number of patients on Tuesday and that looks likely to continue, which means we will have had beds available. 

"It is still very busy and the situation changes frequently throughout the day, however the pressure has eased a little. We would like to thank our staff, many of whom are working under significant pressure, and also our patients for their understanding during this particularly busy time.” 

On Tuesday the 'major incident' at the heavily-inundated Scarborough Hospital was stood down, although it remains under pressure. 

At the same time staff at York Hospital revealed the impact unprecedented demand has had on patient care and employee morale.

As the hospital has been so full, some patients were left waiting for hours for a bed to become available, causing an "exit block" in the department.

The stress on services had caused considerable strain on staff, said Jill Wilford, the lead nurse in the emergency department said.

She said: "There has been no respite.. the nursing staff are tired."