On 10 October the UK government revealed figures showing that only “74.2% of patients attending A&E were admitted, transferred or discharged within four hours, which is below the NHS … [standard] of 95%.”
The Kings Fund
The Kings Fund, founded is 1987, has as its mission to improve health and care for all. The Kings Fund is independent of any political party, professional or any other interests.
Responding to the NHS performance data, Siva Anandaciva, Chief Analyst at The King’s Fund, said:
“Today’s statistics show it has been three years since A&E performance was above the current temporary target of 78% of people waiting under four hours, and nearly a decade since the official target of 95% of people being seen in four hours was met.”
Autumn budget
The chancellor of the exchequer presented her Autumn budget to parliament on 30 October 2024.
As part of the new investment for health and social care the government said:
“The NHS needs both investment and reform. As part of the Autumn Budget 2024, the government has allocated our most valued public service an extra £25.7 billion over this year and next.
“It includes funding to reduce waiting times by supporting the NHS to deliver an extra 40,000 elective appointments a week.
“Since July, the government has invested an additional £1.8 billion to support this.
“These extra appointments will help reduce waiting times. This is part of our plan to make sure patients wait no longer than 18 weeks from their referral to getting treatment.”
How do overall waiting times impact on A&E wait times?
In June 2024 the Kings Fund explains how poor waiting times in one part of the health service impact on waiting times in other services.
“Long waiting times in one part of a patient pathway can have a knock-on effect on the rest of the pathway; for example, when social care capacity is full, patients wait longer to be discharged from a hospital bed. When hospital bed capacity is full, patients wait longer in A&E for a hospital bed. When A&E capacity is full, patients wait longer in an ambulance to be ‘handed over’. And when handover times are long, patients in the community wait longer for an ambulance to respond to their 999 calls. This can cause aggregate waiting times across an emergency pathway to rise rapidly.”
Personal experience in a North East A&E
I wasn’t intending to personally investigate patient flow in a local A&E in the lead up to the budget. An unusual medical symptom was responsible. Google had told me not to worry. My wife, who is a medical consultant, noticed abnormal movements in my left limbs and drove us to A&E.
We were directed to the triage team where questions and answers assess the severity of the complaint. We were behind a woman with a child and a very young baby; the woman was clearly suffering and in a lot of pain. After being interviewed by the triage nurse I was told to wait. A sign told us the wait time was two hours.
We found seats together in the busy A&E. A rare mix of age, culture, shapes, type and colour of clothes, abilities and ages. Smells range from coffee, sweet aromas to rank odours. Some people were crying, some hugging, some watching the TV screens discussing the missile attack from Iran to Israel and subsequent ground attacks in Lebanon.
I heard a series of:
“Mrs YYYY…Mr XXXX…Come this way”.
It was impossible not to overhear a man yelling into his phone “I’ve been here two hours now. Some people came in after me have been called. I complained at the desk. That took ages, they just tell me I will be called, just wait patiently. I’ve been doing that. It’s outrageous”.
A man brought tea to a woman and hugged her. A couple hugged and walked through a door. The woman with a baby and child in front of us at the triage were thankfully called.
The wait time notice had changed to four hours.
The man on the phone said to his phone and all in the vicinity of the waiting room: “I’ve had enough. I’m leaving! I’m not wasting my time waiting anymore. Just wait until….” The rest of his rant to his phone went unheard as he stomped through the exit.
I was called. I suggested to the A&E consultant that my complaint wasn’t too serious. My wife gave more information.
“We’ll do some tests.” “Uhm, let’s do that again. Point at my nose with your left finger. Ahha, now walk towards me. Hmm. We’ll do an ECG. I’m contacting the XX team.
Many hours, more tests, an MRI, a CT scan and several cups of tea later the consultant said, “These are the results of your MRI. I need to admit you”
Up to two-fifths of A&E attendances were avoidable
NHS England estimated up to two-fifths of A&E attendances were avoidable or could be better treated elsewhere.
“Prof Julian Redhead, NHS England’s clinical director for urgent and emergency care, urged people to use 999 or A&E services only for life-threatening emergencies and serious injuries, and otherwise to call 111 or use 111 online or via the NHS app.”
Redhead said: “I really want to encourage everyone to use our free, around-the-clock 111 service that can give millions of people this winter fast, safe and easy access to the advice or treatment they need.”
Kings Fund response to autumn budget
Commenting on the autumn budget, Siva Anandaciva, Chief Analyst at The King’s Fund, said:
“This Budget has been delivered among a backdrop of dire NHS performance and extremely tight public finances.
“The Chancellor has said that ‘change must be felt’, but the health spending announced today is unlikely to be enough for patients to see a real improvement in the care they receive…
“It is positive to see the government using its fiscal and regulatory tools to help improve the nation’s health, including increases to tobacco duties and the soft drinks levy. But the government has chosen to provide little clarity on overall budgets to support public health services.”
There is a way to go before A&E wait times reduce. My lesson would be to phone 111 rather than ask Google.
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