Published: 16/01/2003, Volume II3, No. 5838 Page 4 5

Accident and emergency departments are 'busy but coping' and have so far escaped a winter crisis, early indications show.

Though many A&E departments are struggling to achieve tough targets to cut waits to four hours, winter pressures have so far not added significantly to the challenge, according to operational managers who spoke to HSJ.

Cases of flu are down; figures from the Public Health Laboratory Service show the rate of flu per 100,000 of the population was 27.2 cases for the week ending 5 January. That compares to a normal seasonal level of between 50 and 200 cases and epidemic levels, defined as 400 cases and over.

But diarrhoea and vomiting have been more of a problem this year, with PHLS noting a 'substantial rise' in the gut infection which has peak incidence in winter. Whipps Cross University Hospital trust closed five wards in the run-up to Christmas, and East Sussex Hospitals trust has closed 45 beds because of 'D&V'.

Managers of emergency departments said the smooth running of services so far showed that strenuous efforts to tackle delayed discharges were showing results.

Annette Sergeant, chief executive at East Sussex, and former head of the winter and emergency services team at the Department of Health, said the trust had seen 5 per cent more admissions this December than last. She said the trust was 'busy but coping'.

She said the trust - which in July 'was the worst in the country' for its level of delayed discharges - had tackled the situation in a 'triumph' of joint planning between the trust and colleagues in primary care and social care.

The number of medically fit patients 'blocking' beds has now been reduced from 15 per cent in July to 5 per cent.The trust has also opened a medical admissions unit and a surgical admissions unit.

St Helens and Knowsley Hospitals trust general manager for operational services Dianne Johnson said the trust had experienced 'very high levels of emergency activity and has been very busy.'

'We have seen the same level of pressures as other years - the difference has been that we have worked very hard on robust winter planning and also with social services to get movement on delayed transfers, ' she added.

At Whipps Cross, director of emergency care David Cheesman is enjoying an unusually smooth winter for the hospital, whose A&E department was highlighted by the Daily Mail in 1998-99 to illustrate a 'third-world NHS'.

But Mr Cheesman said the distance to go to achieve A&E waiting targets meant the hospital was forced to engage in a 'high-risk strategy' by closing a ward and opening a temporary emergency centre between Christmas and new year.

He said: 'Whipps Cross has a poor record in terms of A&E, so we have got a long way to go. It wouldn't be possible for us to achieve the targets without this.'

Mr Cheesman was among several managers who suggested that increased uptake of flu vaccinations among staff had been crucial in reducing staff sickness.

A DoH spokesman agreed: 'Staff shortages because of illness do seem to be down, but you can't vaccinate against D&V and that continues to be a problem.' He said investment in critical care in the last two years - following wellpublicised shortages of intensive therapy unit beds over the millennium - had paid off.'

But he cautioned: 'Winter is not over yet. We are only just going into what is traditionally the most difficult phase of it.'