Rise in A&E demand leaves SHAs mystified

Demand for accident and emergency services has soared across some parts of England, an HSJ investigation has found.

Provisional figures for the first quarter of this financial year show that A&E attendances are up by 10-20 per cent across some strategic health authority areas, with North East London, Cheshire and Merseyside, Thames Valley and Leicestershire the hardest hit.

HSJ asked all 28 SHAs to produce comparative A&E attendance figures for April-June 2003 and 2004.

Figures from the 17 respondents reveal that attendances have typically risen by around 6 per cent - discounting minor injuries units and specialist eye and dental units.

The increase on emergency activity appears to be a continuing trend. HSJ reported a big rise in ambulance calls at the end of last year (news, pages 6-7, 11 December). Many SHAs were unable to provide figures for the most recent quarter because they had not been approved by the Department of Health, but of the provisional figures, North East London saw the sharpest rise - up 19 per cent - with Cheshire and Merseyside and Leicestershire, Northamptonshire and Rutland SHAs in joint second place, with a 17 per cent increase in A&E attendances.

In fourth and fifth place were Thames Valley, up 10 per cent, and Birmingham and the Black Country, up 9 per cent.

SHAs are at a loss to explain why demand is rising so quickly.

Several, including South East London, Birmingham and the Black Country, and Northumberland, Tyne and Wear, are conducting reviews to find causes.

There is no suggestion that the rises are affecting trusts' performance, with most achieving 90 per cent four-hour wait targets.

North East London SHA director of performance David Welbourn said the increase in attendances in his SHA amounted to around 30 per cent compared with this time last year, if visits to walk-in centres were included.

He added it was difficult to find any hard evidence for the reasons behind the huge increase in demand across his patch, although he suggested that a massively improved service and significant improvements in A&E waiting times by his trusts could have contributed by 'flushing out unmet demand'.

Mr Welbourn dismissed suggestions that changes to the GP outof-hours contract had boosted demand for A&E services and said that the difference in contract arrangements made little real difference to patients.

Although South East London SHA could not produce figures for the first quarter of this year, in May it identified that A&E attendances across the patch had begun to increase significantly. The SHA is carrying out a review.

Leciestershire, Northamptonshire and Rutland SHA put the rises down to better data collection and more patients being referred by NHS Direct, their GP and other health professionals. Early results from the investigation at Northumberland, Tyne and Wear SHA suggest that increased attendances by children and the elderly are swelling attendance figures.

However, not every part of the country is experiencing such a surge in demand. Four SHA areas revealed year-on-year increases of less than 3 per cent.