Hospitals say there is ‘unprecedented’ demand on their emergency services as admissions hit their highest level in 10 years.
Accident and emergency departments also recorded their worst performance against the four hour target in 10 years with only 88.9 per cent of patients at major A&Es treated, admitted or discharged within four hours between October and December.
The latest data from NHS England shows that the already struggling performance of A&Es fell to its lowest level since 2004-05 as emergency admissions through major A&Es topped the 1 million mark for the first time.
Emergency admissions were at 1,013,307 in quarter three, a 43.5 per cent increase on the same period of time in 2004-05 and a 5.6 per cent increase on last year.
Attendances to major A&Es have increased by 12.5 per cent since 2004-05 and 5.4 per cent since last year.
There were 174 patients waiting over 12 hours to be admitted in quarter three compared with 42 last year.
Adrian Boyle, chair of the quality in emergency care committee at the College of Emergency Medicine, said the pressure on A&Es was not due to inappropriate attendances but to delays in moving patients to hospital beds.
He said: “This is not about inappropriate attenders. The college thinks at worse that among adult patients 15 per cent could be treated by a GP. This is almost entirely about exit block, about getting usually frail elderly patients into hospital beds that aren’t available and this is because the hospital is full. A crowded emergency department usually means a crowded hospital and this is partly because of problems with social care, delayed transfers of care.”
The number of patients who are experiencing a delayed transfer of care could be higher than official figures show, Dr Boyle said.
He said: “In most hospitals what I’m hearing from my colleagues is that there’s somewhere between 15-20 per cent of people which are delayed transfers of care. For every person who has been accepted as a delayed transfer of care you will have another two people who are a delayed transfer of care but their referral hasn’t been accepted by social care.”
Dr Boyle said the situation in A&Es was “tough”. He said: “The waiting times in A&E are as long as they have been since 2003 and the implementation of the four hour target so it’s pretty tough. A lot of hospitals are putting out major incidents and a lot more hospitals are near that point.”
However, he said that some hospitals have been “put under pressure” not to announce a major incident “because it will look bad”.
Scarborough Hospital declared a “major incident” yesterday after patients were left waiting in the emergency department because there were no beds available. Planned operations have also had to be cancelled.
The circumstances that trigger a major incident vary between hospitals but it is generally used when a hospital is unable to cope with demand.
Mike Proctor, deputy chief executive of York Teaching Hospital Foundation Trust, said Scarborough Hospital had experienced an “unprecedented surge in demand”.
He added: “Today in particular we have had people waiting in the emergency department before being admitted to a bed, and we need to make sure that our hospital beds and resources are saved for those who need them most.”
“We have also had to postpone some planned surgery and other procedures, and we apologise to those patients affected by this.”
Gloucestershire Hospitals Trust has also announced a major incident across its two hospitals – Gloucestershire Royal and Cheltenham General.
Elsewhere, Wye Valley Trust declared an “internal incident” yesterday because of the demand on Hereford County Hospital’s A&E over the past two weeks.
The trust has also taken the decision to postpone planned operations because of the demand.
Ambulance services have also been under increased pressure, with London Ambulance Service responding to 13 per cent more category A calls – the most serious – in the last two weeks of December compared to the same point last year.
East of England Ambulance Service saw a 12.6 per cent increase in demand, with 45,061 calls responded to by ambulance crews compared with 39,993 last year.
Commenting on the latest A&E figures Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said: “Today’s figures show that in the three months to the end of December more than nine out of 10 A&E patients in England continued to be seen and treated in under four hours – the best measured performance of any major Western country.
“In the immediate run up to Christmas the NHS treated 446,500 A&E attendees, up 38,000 on the same week last year. And there were 112,600 emergency admissions – the highest number in a single week since we started publishing performance figures in 2010.
“We faced similar demand over Christmas itself. In the week ending 28 December, A&E attendances were up more than 31,000 on the same period last year, meaning we successfully treated more patients in under four hours than ever before.”
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