Casualty waits 'getting longer'

Many patients are not seen by a doctor within an hour

Patients are waiting longer in accident and emergency departments than they did five years ago, according to a report from an independent health watchdog.

The Audit Commission says fewer patients are being seen by a doctor within an hour, and it is taking longer for patients to be admitted to wards from A&E.

This is despite an increase in the number of doctors.

In 1996, 72% of patients were seen in an hour - now it is just over 50%.

The revelations came as the Department of Health published details of a three-year £100m investment programme for A&E, including £40m to fund 25,000 extra operations in the private sector.

It is clearly disappointing that there is extra investment and doctors yet waiting times are growing quite significantly

Sir Andrew Foster
Audit Commission

Health Secretary Alan Milburn told the BBC that the money, plus £10m for planned operations in the NHS and more NHS beds would free-up NHS capacity for emergencies, help eliminate trolley waits, and cut the number of operations cancelled at the last minute by 75%.

But he said that while money was "hugely important", he wanted to make sure the worst-performing A&E departments changed the way they approached the job.

"We have got to get the reforms in," he said, "and this is where the frustration happens.

"We know there are some hospitals are cracking these problems - and some aren't."

The government has warned that management will be replaced at trusts that continue to under-perform.

The Audit Commission found the number of patients seen within an hour by a doctor at trusts across England and Wales varied from 5% to 100%.

We know there are some hospitals are cracking these problems - and some aren't.

Health Secretary Alan Milburn

Performance is worse than when it was measured by the commission in 1996, and the decline has accelerated since 1998 even though patient numbers rose by just 1%, while the number of doctors increased by 10%

Fifteen million people pass through A&Es in England and Wales each year.

Around 20% are admitted.

The Audit Commission found rural areas tended to see patients faster.

Wales fared best, with 84% of patients in Wales seeing a doctor within an hour, compared to 69% in the South West and 68% in Northern Yorkshire.

Priority patients

London performed worst, with just 30% of patients seen within the hour.

In general, smaller departments, seeing under 40,000 patients a year, are quickest. More than half of patients are seen within the hour.

% of patients seen by a doctor inside an hour

London - 30%

West Midlands - 50%

Northern Yorkshire - 68%

South West - 69%

Wales - 84%

Large departments show significant variation in the speed they see patients.

But the report does not "name and shame" individual hospitals.

Sir Andrew Foster, controller of the Audit Commission, said the reasons for hospitals' poor performance must be looked at on a "trust by trust" basis.

He added: "It is clearly disappointing that there is extra investment and doctors yet waiting times are growing quite significantly."

Performances checked on 'trust by trust' basis

Sir Andrew welcomed the Department of Health's announcements, but said new initiatives would not be in place for six to 18 months.

"The issue is how these hospitals are being managed now," he added.

Shadow health secretary Dr Liam Fox said the loss of 50,000 beds in the care home sector has made it more difficult to discharge patients into the community.

"Patients and staff recognise that things are deteriorating. They recognise that it is not a simple solution, but would expect ministers to at least acknowledge where they made mistakes," he told BBC Radio 4's Today programme.

The £100m announced by the Department of Health also includes £40m to fund 600 new specialist nurses.

Streaming

It also announced A&E patients would in future be streamed, depending on the seriousness of their condition, and round-the-clock diagnostic services would be introduced.

Dr Peter Hawker said the fundamental problem was under-resourcing of the NHS

And as part of the NHS Plan, the government pledge to cut waiting times in A&E to no more than four hours.

Mr Milburn said: "Change takes time, but we can make real strides over the next few years to dramatically reduce the wait in A&E and eliminate long trolley waits altogether."

The Audit Commission report says doctors in A&E see between 2,500 and 6,000 patients per year, but remarkably, there appears to be no link between workload and speed of treatment.

The report calls for more nurses and better use of nurse practitioners, who may be able to treat some of the 80% who do not need admission.

Currently, just one in 20 A&E departments makes "significant use" of nurse practitioners.

Dr Evan Harris, the Liberal Democrat health spokesman, said: "The Alan Milburn strategy seems to be to blame managers and staff for not working hard enough or failing to embrace so called reforms.

"But it is the government's own failure to invest sooner and deeper that is causing the problem."

Dr Peter Hawker, chairman of the British Medical Association's consultants committee, said: "A&E departments over many years have been understaffed and inadequately resourced.

"What we are seeing is the inevitable result of an attempt to catch up. Yes, we have 10% more doctors, we need a lot more."