13/10/2004

A&E's have made progress but more work is needed, says NAO

A&E departments need to improve in their care of the elderly and mental health patients, and some trusts still have some way to go to achieve waiting list targets, according to a report out today by the Natoinal Audit Office (NAO).

The NAO report, 'Improving Emergency Care in England', also highlighted the problem of bottlenecks in NHS A&E departments resulting from mismatches between admissions and discharges, barriers to obtaining a specialist opinion, and difficulties in obtaining authority to admit patients to wards.

According to the NAO report, more than half of trusts who responded in April had shortfalls in the numbers of emergency care medical staff needed to provide a "robust and responsive service 24 hours a day, seven days a week". The design of A&E buildings was also cited as an obstacle.

Further reductions in time spent in A&E will depend on better working between A&E, the rest of the hospital and other parts of the health and social care system, the report said.

However, the report found that trusts had achieved a "large and sustained reduction" in the length of time patients spend in accident and emergency (A&E) departments, largely through improved working practices and extra central and local funding.

The audit praised improvements in working practices within hospitals and in particular the A&E departments which has driven down wait times. The environment and facilities in A&E have also improved, to the benefit of both patients and staff.

In 2000, the health department set a target that, by December 2004, no patients would spend more than four hours in A&E. By April-June 2004, against a background of hig demand, over 5% of patients spent longer than four hours. And in August nearly a quarter of patients needing admission to hospital spent more than four hours in A&E.

The NAO also hailed the set up of local emergency care networks as a "promising development".

The BMA's chairman of the A&E committee, Don MacKechnie, said the report clearly demonstrated that A&E departments had been working "exceptionally hard" to bring down waiting times.

"However, the report also recognises that there are still unacceptably long waits for some groups of patients, such as the elderly or people with mental health problems, especially when a decision is taken to admit the patient into hospital," he said.

"Trusts who have not already done so, need to establish Clinical Decisions Units (CDUs) adjacent to A&E and managed by A&E clinicians to allow appropriate care for the more complex clinical presentations. These CDUs will serve not only to reduce unnecessary hospital admissions but also to ease pressure on doctors to discharge patients prematurely."

But, he said, better bed management strategies and enough specialist doctors to quickly attend to patients in A&E were needed to improve standards, he said.

Mr MacKecknie added that were still "significant changes" that many trusts must make to other areas of the hospital and in their relationships with other providers if they are to meet targets.

(gmcg/mb)

Related UK National News Stories
Click here for the latest headlines.

30 August 2011
A&E Waiting Times 'Over Two Hours'
A report from the NHS has revealed the average waiting times for those attending A&E is over two hours, writes Damien Whinnery in a 4NI.co.uk exclusive.
08 August 2005
A&E departments warned on pain relief delays
Some accident and emergency departments are not providing patients with pain relief quickly enough, a report from the healthcare watchdog has warned.
22 September 2008
Scottish Government Pledges Cap On Surgery Waiting Times
Scottish patients may soon have a legal guarantee that they will wait no longer than 12 weeks for surgery. The Scottish Government's Patient Rights Bill proposes a strict limit on how long they have to wait from their surgical referral to receiving their operation.
13 February 2015
'Cautious Optimism' Over Improved A&E Waiting Times
NHS bosses in England have suggested "cautious optimism" following an improvement in weekly A&E waiting times. In seven days to Sunday 92.9% of patients were seen in four hours, up from 92.3% the week before. The figure is still below the target of 95%, which was last hit in September 2014.
09 January 2015
British Red Cross Drafted In To Help With A&E Crisis
The British Red Cross are being called in to help the NHS deal with the Accident & Emergency crisis. Figures released this week showed the NHS missed its A&E waiting time target, its worst performance in 10 years. Volunteers from the relief charity are helping to transport patients.