What’s Going On With A&E Waiting Times?

What’s Going On With A&E Waiting Times?

It comes as no surprise that the NHS has come under increased pressure in the last few years. There are many different factors as to why this is happening and we will outline some of the main factors.

Different types of a&e departments

Type 1- this is what people commonly think of when they think of A&E. The major emergency departments that provide consultant-led 24-hour service.

Type 2- consultant- led facilities but for specific conditions, for example, eye condition and dental problems. You may be referred here from opticians or dentists in some cases.

Type 3- treat minor injuries and illnesses, such as stomach aches, cuts, some fractures and lacerations, infections and rashes.

Being treated quickly and effectively in A&E is essential for both clinical results and patient’s experience. Delays in receiving care have been associated with the increased mortality rates and illnesses. Previous illnesses could become worse/ life threatening and any lacerations/ cuts could become infected.

the 4 hour standard

The 4-hour standard was introduced by the Labour Government in the early 2000s. The standard is used to monitor all attendances at all types of A&e departments.

what does the 4 hour standard monitor?

The 4-hour standard monitors the total time patients spend in A&E from the time they arrive to when they leave the department to be admitted, transferred or discharged. This is contrary to what people think as they believe it is the time they should be ‘waiting’ to be seen by a specialist.

has the 4 hour standard been changed?

Yes, in 2010 the standard was relaxed from 98% of patients to be admitted, transferred or discharged to 95% of patients in England and remained at 98% in Scotland.

A&E wait times are often used for an overall performance review of the NHS and the social care system. This is because A&E wait times are affected by the activity and pressure in other services such as ambulance service primary care, community-based care and social care services.

What has happened in recent years

There have been many failures over the past decade that should have helped keep up with the rising demand for A&E and growing staff shortages. Despite this effort the NHS has not met the 4-hour standard at national level since 2013-14, and the standard has not been met in a singular month since July 2015.

The 4-hour standard is implemented in all A&E departments across the country, but performance is the poorest in major A&E departments (Type 1). This is also the department with the majority of breaches of the standard.

rising A&E ATTENDANCES 

High volumes of hospital attendances can lead to overcrowding, raised pressure on A&E services and poorer care experiences for patients

Attendances at A&E were lower during the pandemic due to the availability of some services and the public attitude to using health care services at this time. Alongside Covide-19, the trends show the number of people going to A&E still significantly increased with 25 million attendances in 2019/20 compared to 21.5 million in 2011/12.

fewer hospital beds

Even though there has been many medical advances throughout the years that have reduced the average time people spend in hospital and allow bedsd to be ‘turned around’ or made available again.

Especially in the winter months, hospitals are routinely operating with bed-occupancy rates above 92%- the level as which the Department of Health and Social Care suggests that hospitals will struggle to deal with emergency hospital admissions.

Staffing pressures

The Royal College of Emergency Medicine notes that emergency medicine has a high attrition rate from doctors in training, high early retirement rates for experienced clinicians and significant reliance on temporary locum clinical staff. 

Nearly 3 out of 4 emergency medicine trainees rated the intensity of their workload as very or very heavy, this is substantially more than any other speciality. 

To finish on a positive note in the years between 2012 and 2019 the number of emergency medicine consultants increased by 7% each year. 

Activity at A&E departments 

Age of patients 

NHS Digital published detailed annual reports of activity in A&e departments in England. These reports show that the age-profile for patients attending A&E  has remained relatively stable over the past decade, with people 65 and over accounting for a larger number of A&E attendances per head than adults and children. 

Deprivation 

People living in the most deprived areas in England are twice as likely to attend A&E compared to other groups. 

Winter pressure and COVID-19

Winter

Although the volume of A&E attendances is not majorly higher in the winter, the demand for hospital admissions and more intensive medical care increases. These demands can rise due to an increased amount of influenza-like illnesses, respiratory diseases associated with colder weather such as asthma and pneumonia, and infectious winter vomiting bugs like norovirus. 

COVID-19

During the Covid-19 pandemic NHS leaders encouraged the public to use NHS care when needed. 

Waiting times for A&E care continue to be challenged as hospitals respond to the immediate demands of Covid-19, tackle backlogs for planned hospital care, and cope with staffing shortages.