More than 15,000 patients waiting four or more hours for A&E at Morecambe Bay trust

Royal Lancaster Infirmary.
Royal Lancaster Infirmary.

More than 15,000 people waited four hours or more in A&E at the University Hospitals of Morecambe Bay Trust last year, according to NHS England.

The trust’s major A&E department is performing very badly against the NHS national standard for waiting times in A&E.

The NHS target is for 95 per cent of people visiting A&E to be discharged, transferred or admitted to a ward within four hours of arriving.

At the University Hospitals of Morecambe Bay Trust that figure was just 82 per cent.

The 2017-18 report shows that the trust’s major A&E department saw the equivalent of 243 people a day last year.

Around 88,500 people went to A&E, up from 88,100 the previous year.

Of these, 15,690 waited for more than four hours, from arriving in A&E to being discharged, transferred or admitted to a ward.

Dr Chris Moulton, vice president of the Royal College of Emergency Medicine, said that the pressure on A&E has “spiralled out of control”.

“If you keep stretching an elastic band, eventually it will snap,” he said. “You don’t ask ‘why did the elastic band snap’ - it snapped because you stretched it.”

He said that A&E departments were struggling to cope with the demands of a growing and ageing population, particularly since a lack of social care beds keeps elderly patients waiting in A&E.

He said that the more “badly stretched and understaffed” departments were, the more difficult it is to recruit junior doctors, creating a “vicious circle” of staff shortages.

Dr Moulton still supports the 95 per cent target, saying that it’s a “good pressure” on emergency departments to keep as few patients waiting as possible.

“Nobody wants to keep patients waiting,” he said. “That’s anathema to any emergency doctor.”

According to Dr Moulton, the solution is simple - more acute hospital beds, increased capacity in social care, and the staff and facilities to keep those beds open.

He said: “It’s not a magic formula. It’s a blindingly obvious solution.”

Independent health charity the King’s Fund said that A&E performance is a “barometer for the overall performance of the health and care system”.

Senior analyst Deborah Ward said: “A&E performance is influenced by activity and pressure in other services, affecting both the number of people going to A&E, and how quickly A&E can treat them.”

She said that the availability of social care services to support people at home, and how quickly wards are able to accept people who need to be admitted, were two key examples.

“Some of the pressure comes from within A&E departments,” she said. “Staff shortages are particularly concerning, and many have a lack of physical space. Some departments see twice as many patients as they were built for.”

“However, it isn’t relentlessly bad news,” she added. “A&E waiting times, whilst longer than we would like, are about average when compared to similar countries, and patient satisfaction is holding up.

“In July 2018, 87% of people said they would recommend the care they received in A&E to their friends and family.”

In England there were 23.8m visits to emergency departments last year, including urgent care centres, minor injury units and walk-in centres as well as major A&Es.

Of these, 88 per cent spent four hours or less in A&E. This figure has been steadily decreasing – the last time the 95 per cent standard was met was in 2013-14.

Commenting on the national figures, an NHS spokesperson said: “Minor injuries have fuelled a significant rise in A&E visits over the last decade.

“Yet against this backdrop, and with pressures increased by the hottest summer on record, hard-working NHS staff saw, treated and discharged or admitted 50,000 more patients within four hours last month than August last year.”

Foluke Ajayi, Chief Operating Officer, University Hospitals of Morecambe Bay NHS Foundation Trust, said: “As with the majority of hospitals across the country, our Emergency Departments at both Furness General Hospital and the Royal Lancaster Infirmary can experience increased pressure during busy periods.

“When there is an increase in the number of people who attend an Emergency Department or need admitting to one of our wards, this can impact on the time for patients to be seen, treated and either discharged or admitted. When this happens, patients are likely to experience longer waiting times whilst our doctors and nurses treat those who need urgent treatment first. Whilst we understand that this may be an inconvenience, we are sure they understand that we have to see those patients who are very poorly first.

“We have taken a number of measures to help manage our busy periods, including continuing to work closely with our local health and care partners to avoid admissions where we can, and help support discharging patients earlier with the appropriate care support in place.

“There is also a lot of work going on to improve the flow through our hospitals. This includes Discharge to Assess (D2A), the process whereby patients are transferred from an acute hospital at the point where they no longer require acute hospital care through one of three pathways: either at home and may require further care and/or therapy (pathway 1 - Home First); in a community intermediate care bed with rehabilitation (pathway 2); or in a care home to enable a period of recovery and completion of longer term care assessments (pathway 3). With these pathways, health and/or social care assessments are completed outside of the acute hospital environment.

“The public can help us at times like these by making sure they use the right service for their needs. There are many different options available to people when they feel unwell, including self-care, local pharmacies, and GPs. If you are unsure about which service is best, you can always call NHS 111 where trained staff will point you in the right direction.

“Of course, if someone is seriously ill or injured then 999 should be called or they should be taken to their nearest Emergency Department. An emergency is a serious or life-threatening situation, such as a suspected heart attack, loss of consciousness, breathing difficulties, chest pain, head injuries or severe bleeding that cannot be stopped.

“Details of local GPs and pharmacies, as well as advice on caring for yourself and your family at home, are available at http://www.nhs.uk/ or www.nhs.uk/111.”