Trust chiefs see sicker patients as key cause of A&E crisis

Trust bosses were asked to select all the issues they thought had contributed to the difficulties in admitting, treating and discharging accident and emergency patients over the past winter.

Many hospital trusts are predicting that they will fail the A&E waiting time target for the first quarter of 2013-14, as poor performance in March continued into the current financial year − although performance has since improved.

Of the 45 respondents, 93 per cent said the increased acuity of patients was a factor. This was followed by “increased attendances” and “poor access to out of hours care in the locality” which were both cited as factors by more than three-quarters of respondents.

Official data shows that while some trusts saw increased attendances and the national total has grown over the past decade, the difference in overall attendances this year and last year was negligible.

Most chief executives highlighted three or more causal factors, suggesting there was no single solution to the issue.

Seventy per cent of respondents said delays in transferring patients to community care facilities was one of the issues affecting their trust’s performance.

Despite a national shortage of senior emergency department doctors, only a third of chief executives said staff shortages had been a contributing factor.

Only a quarter of respondents said problems with the rollout of the NHS 111 urgent care phone service were a significant factor. Only one in eight said their trust’s performance had been affected by cultural change related to the Francis report on the care scandal at Mid Staffordshire Foundation Trust.

Nearly one in five hospital chief executives admitted they might not have dealt with A&E problems as firmly as they could.

“Lack of management ‘grip’ of the issue” was admitted by 18 per cent of respondents.