Waits for emergency care are worst for 10 years, figures show
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* Gareth Iacobucci

Performance on waiting time targets by hospital emergency departments in England has fallen to its worst level for a decade, official figures have shown.

Figures published by NHS England show that only 92.6% of patients in emergency departments were seen within four hours in the quarter from October to December 2014, below the target of 95%.1 The performance is the worst quarterly result against the target since it was introduced in 2004. This is the second time that the target has been missed since the coalition government came to power: the previous lowest performance was 94.1%, recorded in the first three months of 2013.

The other three UK countries are also missing the target at present.

The news came as six hospitals in England were forced to declare “major incidents” owing to patient demand reaching a level that could disrupt services. Major incidents typically involve restricting emergency departments to seeing genuine emergency cases and drafting in extra staff to create additional capacity.

This week Scarborough Hospital in North Yorkshire, Ashford and St Peter’s Hospital and the Royal Surrey County Hospital in Surrey, and the Royal Stoke University Hospital in Staffordshire all declared major incidents, while Cheltenham General and Gloucestershire Royal declared their second major incidents in three weeks.

Mike Proctor, deputy chief executive of York Teaching Hospital NHS Foundation Trust, which runs Scarborough Hospital, told the BBC, “I’m seeing pressures in the system that I have never experienced before.

“When I came to the hospital this morning every ward was full, every escalation area we put beds into was full of patients. In addition to that there were 18 patients in our emergency department who had to be cared for on beds, because there were no beds in the hospital wards for them to go to.

“Whilst those patients were cared for properly, you get to a stage where if you carried along that line the emergency department would cease to function, which is why we had to do something different.”

Proctor said the pressure was partly caused by an inability to recruit staff: “In the emergency department we have a 30% vacancy rate for consultants. We’ve advertised time after time and can’t get people to come in. It’s an unpopular specialty at the moment.”

England’s health secretary, Jeremy Hunt, told the BBC, “There’s a huge amount of pressure—that’s absolutely clear.”

“I think they [the hospitals that have declared major incidents] are genuinely finding it very difficult . . . and we want to give them every support to get through a very difficult period.” But he added, “What we don’t want to do is for trusts to make compromises on patient safety [and] compassionate care just to hit the target. Targets matter but not at any cost.”

Cliff Mann, president of the College of Emergency Medicine, said that part of the reason for the pressure was that the NHS 111 non-emergency telephone helpline was advising an increasing proportion of people to seek emergency care at hospitals. He added, “My concern is that the daily intolerable pressure is starting to have an effect on staff—they are more likely to become sick, become unable to work, burn out and choose to go into other professions. That means it is not a sustainable situation.”

Mark Porter, the BMA’s chairman of council, said in a press release, “Patients should be treated on the basis of need, rather than arbitrary targets, but these figures show the NHS is under unprecedented levels of pressure.

“In the longer term, for the NHS to meet rising demand we need to address the underlying problems in the system. Preventing unnecessary emergency admissions by having an effective, out of hours telephone service is an important part of this, so there needs to be a marked improvement in NHS 111 to ensure it is clinician led. 

“We also need a long term solution to the crisis in social care, to reduce the number of patients being inappropriately held in hospitals. Outside of hospitals, we need to support general practice, which is struggling to cope with unprecedented levels of demand and a shortage of GPs.”

## Notes

**Cite this as:** *BMJ* 2015;350:h66

## References

1.  NHS England. A&E waiting times 2014-15 (October-December). [www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2014-15](http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2014-15).