Did the annual embarrassment of casualty watch encourage ministers to abolish CHCs? We may never know, but Tash Shifrin assesses their last snapshot survey of A&E waiting times

Snapshots are happy things.

You can look back at them fondly: this is me and a pyramid, in gorgeous sunshine.

Here I am again, in a gondola, weather still fabulous.

Of course, sometimes they capture a bad day: this is me in the rain, during a power cut, being stung by jellyfish.

A snapshot survey of casualty departments admittedly tends slightly more towards the rain and jellyfish end of the spectrum.

But it can be seen as a valuable exercise, providing a sample of data for accident and emergency department managers to chew on.

The annual casualty watch survey, carried out by the Association of Community Health Councils for England and Wales, has traditionally been seen as a thorn in the government's side, producing screaming tabloid headlines.

Now, the abolition of CHCs and ACHCEW means that this year's survey - with synchronised visits to A&E by CHCs across the country on Monday of last week - will be the final one.

ACHCEW points out that this is a loss. Spokesman Murray Benham says: 'It is a very vital function. These figures are not available anywhere else.'

This is because the casualty watch figures record waiting time from the patient's time of arrival in A&E - often much longer than that shown by Department of Health figures, which count waiting times from when the decision to admit a patient is made.

ACHCEW director Donna Covey says: 'We measure waits from the patients' perspective.

The DoH measures waits from a clinician's perspective.'

The DoH is to change its methodology for calculating waiting time next April but Mr Benham says: 'There is still a case for saying these things should be conducted independently. Our figures may have been an embarrassment to them.'

And he adds: 'They may have played a role in the DoH changing to a new system.'

Were it not for abolition, Mr Benham suggests, the organisation might have looked at the new-style DoH figures, decided they were reasonable, and transferred the casualty watch survey to another service area.

HSJ's trip to A&E at the Royal London Hospital, Whitechapel, in the company of two members of Tower Hamlets CHC, pinpoints the key resource behind casualty watch: eager CHC visitors.

Chair Miriam Tarran says: 'We enjoy it.We find the staff make us very welcome and we feel we are achieving something. If we find very long trolley waits, we can draw it to their attention.' She is also keen to see if a new walk-in centre 'has had much of an effect'.

CHC member Belle Harris, a former local councillor, exemplifies the close connection many casualty watchers have with their local A&E. 'This is my hospital, it always has been. It was my mother's hospital.My brother was here in A&E when he had a stroke.'

After a walk past the walk-in centre - a prefab block with a smooth grey paint-job - we receive the promised staff welcome.

'We think It is quite important because we view the CHC as a local watchdog and quite supportive to us.We do not try to hide what's happening, ' says Jill Williams, associate clinical director for A&E and pre-hospital care.

'We do not find it threatening.

It is important for people to see it like it is.'This particular snapshot is going to be a rather crowded one. It is a 'bad day' in A&E, Ms Williams confirms.

She escorts casualty watchers from 'majors' to 'resus' to 'minors' to 'paeds', introducing them to senior staff nurses who take CHC members through the figures.

Ms Williams says the hospital is some way from the target of getting 75 per cent of patients through A&E within four hours.

'We are at 41 per cent now. It is a myth that the walk-in centre takes away a big load - it handles the patients who only take a small amount of time.These patients are the least of our problems.'

Obtaining data on A&E work is crucial, Ms Williams says.

Demonstrating 'case-mix' is an important factor: 'The known audit tools on the wards that measure dependency do not work that well in A&E.'

ACHCEW says this year's national results show 'very very long waits' in 'significant pockets' of the country, although as the survey is a snapshot picture, it should not be seen as statistically robust.

At Craigavon Area Hospital in Northern Ireland, A&E consultant Charles Fee admits some long waits: casualty watch has found two of more than 22 hours.

'There have been many days like these in recent months, which critically impair the capacity of the department, ' he says. 'There is no specific reason why this Monday was busy.We have lost a lot of acute beds. The situation is now critical.

'We have closed smaller hospitals to put patients into bigger and better hospitals, but now patients end up in corridors so, from the patient's point of view, they'd argue that it wasn't really better.'

In Kent - where the survey finds serious problems across the county - there is a touch more hostility towards casualty watch.

A spokesman at East Kent Hospitals trust - occupier of the top three slots on the results table, with one wait of 54.5 hours - claims ACHCEW has 'an agenda'.

He blames the long waits on 'a combination of winter pressures and bed-blocking'. Some patients are waiting for assessment, some for home care packages.

The spokesman says blocked beds have been in 'steady decline' since January and the trust has started a 'bed bureau' to aid allocation. He concedes: 'We were surprised it was that length of time.'

Maidstone and Tunbridge Wells trust chief executive Stephen Collinson brands a finding of long trolley waits at Maidstone Hospital 'misleading and unhelpful'. 'Most of the patients noted in the CHC report were being nursed on beds in our observation area, and none were on trolleys, ' he adds.

Mr Collinson says he is 'concerned at the ongoing confusing and conflicting criteria between national performance standards relating to 'trolley' waits in A&E departments, and the overall waiting time from arrival in A&E through to admission onto a ward or discharge'.

Elizabeth Manero, chair of CHC umbrella group London Health Link, believes casualty watch could be seen in a more positive light.What the DoH doesn't hear about, she says, are 'all the good relations, where CHCs say: 'It is going well, You have improved''.

But she is concerned at the lengthy waits. 'Until the DoH gets proper data on three key indicators that impact on bed availability - trolley waits, delayed discharge and cancelled operations - I do not think these problems are going to be solved.'

There is clearly some way to go before data on patients' experience in A&E shows the full picture.

But ACHCEW, having pioneered one approach, will not be there to push it further.

National casualty watch - 10 longest waits in hours and minutes

Hospital Age Provisional diagnosis/ Total wait so far reason for attending CHC DoH Kent and Canterbury 41 Abdominal pains 54:30 48:30 Kent and Canterbury 45 Kidney problem 52:30 50:30 Kent and Canterbury 62 Chest pains 49:30 46:30 Maidstone Hospital 45 Abdominal pains 30:20 25:30 Maidstone Hospital 93 Hypothermia/leg ulcer 30:10 28:30 St Helier 84 Abdominal pains 29:53 19:40 Maidstone Hospital 41 Pulmonary embolism/chest 29:30 25:30 University 77 Collapse-alcohol 28:42 19:30 Hospital, Aintree University 90 Chest 28:38 20:30 Hospital, Aintree Kent and Canterbury 65 Post-operation problem 28:30 27:30 Source: ACHCEW (Note: all patients shown here were listed by ACHCEW as in a bed)