A&E must change or face collapse NHS warned

Urgent changes must be made to the way Accident and Emergencies (A&E) units are run – or the system could collapse, doctors and managers say.A&E must change or face collapse NHS warnedBoth the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system.

Funding and staffing have been highlighted as key issues.

Health Secretary Jeremy Hunt said it was “very tough out there” and ministers would deal with it by “better joining up” health and social care.

The warnings come as fears grow over whether the NHS can continue to cope with rising demand.

Last week both ministers and the NHS regulator admitted the problems were a cause for concern.

A&E attendances have risen by 50% in a decade and this winter the NHS in England started missing its four hour waiting time target.

The review by the College of Emergency Medicine – based on feedback from more than half the A&E units in the UK – said the scale of the challenge was the biggest for a decade.

It said there were shortages in both middle-grade and senior doctors. As well as highlighting the workforce problem, the college also said more needed to be done to reduce unnecessary attendances.

It believes between 15% and 30% of patients do not need A&E care and instead could be treated in non-emergency settings.

Meanwhile, the Foundation Trust Network (FTN) highlighted the funding system in England which penalises A&E units seeing a rise in patients.

Under rules designed to encourage the system to reduce A&E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9.

But with the NHS failing to curb the rise in patients, that is costing some hospitals millions of Pounds a year.

Across the NHS more patients are being seen, but the upward trend is perhaps the greatest in A&E.

The lack of out-of-hours GP care is the cause of rising demands on A&E.

Since 2004 GPs have been able to opt out of providing night and weekend cover, leaving it to agencies to provide care.

A lack of confidence in the service has meant patients have to turn to A&E when they have not always needed emergency care.

This has been further compounded in recent months with the roll-out of the new 111 non-emergency phone line. Hospitals have reported rises in patients either because they cannot get through to 111 or have got poor advice and been told to go to their local A&E for trivial reasons.

But this does not tell the full story. The ageing population means there has been a rise in long-term conditions – about £7 in every £10 spent goes on patients with problems such as dementia and heart disease for which there is no cure.

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