Committee warns poor A&E performance has ‘become the norm’ for NHS trusts

Poor performance in A&E has “become the norm” for some NHS trusts, MPs say.

A new report from the Commons Health Committee warns the NHS could face a “substantially more difficult” winter this year than last, with increasing demand for services, trusts suffering due to too-few staff and a widespread inability to move out patients who are medically fit to be discharged.

Evidence submitted to the MPs’ inquiry showed that A&E departments are now routinely missing the national target to deal with 95% of patients within four hours.

Major type 1 A&E departments – those that are located in hospitals – perform the worst, with only 87.9% of patients admitted, discharged or transferred within that timeframe in 2015/16.

MPs expressed concern over a continued fall in standards, saying: “The ongoing decline in performance of type 1 emergency departments against the four-hour target should be regarded as a matter of patient safety rather than a failure to meet a bureaucratic objective.”

While in the past NHS trusts would experience their most intense problems in the winter and would enjoy a respite in the summer, now “pressures are high year round and just reach a more intense peak during the winter”, MPs said.

They added: “The winter of 2015/16 was mild and the flu vaccine worked. We heard of a fear amongst leaders of acute NHS trusts that 2016/17 could be substantially more difficult.

“It is both significant and concerning that compared to previous years hospitals are working from a much lower base in terms of their performance as we enter the winter period.

“The decline in performance of emergency departments which is usually associated with winter pressures has become the norm for some NHS trusts.”

On staffing, MPs heard from the Royal College of Emergency Medicine (RCEM) which said among the 176 type 1 departments in England, there are currently “insufficient consultants in post to provide even one on duty in every department for even 16 hours per day”.

If the number of doctors had kept pace with the increasing number of patient admissions in recent years, there would now be 8,074 doctors working in A&E departments rather than 5,300.

Some trusts also told how neighbouring hospitals were refusing to obey a Government cap on how much they could spend on agency staff, which led to them being “outbid” for workers.

One NHS trust said “there is a seller’s market for A&E doctors and the lowest bidder can find themselves struggling to have enough doctors to meet the demand in A&E …Without increasing staffing levels both during winter months and over the long term, safe staffing levels will not be achieved.”

The report also detailed problems with the handover of patients at A&E, which means ambulances are unable to get back on the road to attend other patients.

Modelling by the Centre for Urgent and Emergency Care Research reported that in the year 2015/16, the 10 ambulance services in England lost a total of 407,000 hours through handover delays at A&E.

As an example, one English ambulance trust loses approximately 700 hours every week due to this issue.

MPs also pointed to the major problems in social care, saying they believe it is “underfunded”. This impacts on hospitals’ ability to discharge patients into the community to care homes or their own homes with a package of support.

They also warned that the Government should not rely on GPs to relieve the pressure on A&E departments in winter, including over the festive period.

Dr Sarah Wollaston, Tory MP and chairwoman of the Health Committee, said: “Accident and Emergency departments in England are managing unprecedented levels of demand. The pressures are now continuing year round without the traditional respite over the summer months as departments try to cope with increasing numbers of patients with complex needs.”

Dr Mark Porter, chairman of the British Medical Association (BMA), said: “Doctors are particularly concerned that a lack of investment and resource in social care is increasingly impacting on the provision of healthcare, especially in winter.”

RCEM president Dr Tajek Hassan said: “Whereas traditionally winter would be a busy period, the system would always, to an extent, recover. We are now failing to see recovery with almost year round pressure resulting in delays and overcrowding.”

Health Minister Philip Dunne said: “The NHS is better prepared for winter than ever before, with plans in place to help hospitals cope with additional demand – and the NHS is performing well despite the pressure of an ageing population, with nine out of 10 people seen in A&E within four hours.

“Crucially, we are ensuring the money available to local authorities for social care will rise in the coming years – by up to £3.5 billion extra in 2020.

“We are investing £10 billion to fund the NHS’s own plan for the future to reduce pressure on hospitals, and will have spent billions on capital projects by 2020.”

Hospital staff were too busy to help patients use toilet, report finds

Patients at a hospital were told to wear incontinence pads because staff were too busy to help them use the toilet, while others waited up to two months for their hair to be washed, a damning report has found.

NHS inspectors at Queen Elizabeth Hospital in Woolwich, south London, also had to raise serious concerns about the A&E department after they observed a patient with sepsis deteriorate before them.

The Care Quality Commission (CQC) has told the hospital it “requires improvement” after the inspection in June, which also found some patients were spoken to “sharply” by staff.

Inspectors found people in A&E being treated in corridors and on chairs due to overcrowding, and a failure to carry out a full range of checks on children attending A&E.

The report said: “We spoke with a patient on ward 18 who told us they had repeatedly asked staff for a bath or shower and had been told it wasn’t their job to provide this. Two other patients on this ward told us they would like to have their hair washed but staff told them they were too busy.

“We spoke with the nurse in charge who said staff were often too busy to provide personal care and this meant some patients could go up to two months without having their hair washed.

“In the AMU (acute medical unit), one patient told us they had to use pads for incontinence because staff were too busy to help them use a commode.

“They said they felt very embarrassed because it meant they went to sleep with dirty pads. We asked the nurse in charge about this who said patients were encouraged to wear pads because there were not enough staff for the volume of patients who would use commodes.”

In A&E, CQC inspectors raised the alarm after a patient with sepsis did not receive basic observational checks often enough to pick up the fact they were deteriorating.

The patient was scored according to the National Early Warning Score System (News), which checks for six simple things – respiratory rate, oxygen saturation, temperature, systolic blood pressure, pulse rate and level of consciousness.

The report said: “We raised our concerns with senior staff and they recognised the delay to carry out observations as a risk to patient safety. The department investigated this as a serious incident.”

The patient recovered and was discharged the following week.

The CQC inspection report also showed that “patients were often cared for in escalation areas including corridors” within A&E, which was often overcrowded with long waiting times.

Patients at risk of developing pressure ulcers were not always transferred to a bed from a trolley within four hours and there were long delays outside, with ambulances queuing.

Inspectors found problems similar to a previous inspection in 2014, with “patients being cared for in chairs (and in public corridors during this inspection), and long waiting times in the ED due to an increase in demand and a lack of available beds in the hospital.”

A discharge lounge was also being used as an escalation area.

Queen Elizabeth Hospital is part of Lewisham and Greenwich NHS Trust and serves people in Greenwich, Bexley and neighbouring boroughs.

Professor Sir Mike Richards, chief inspector of hospitals, said further checks would be carried out, adding: “Queen Elizabeth Hospital had made some progress since the last inspection in 2014 but other changes had not been embedded.

“During our inspection we witnessed long waiting times in the emergency department. The emergency department was full and patients were being cared for in public corridors and transferred to areas that did not meet their needs.

“We observed some instances of poor care on the medical wards. The leadership in medical services was variable. Some of the problems we found were not being adequately managed.”

A spokesman for Lewisham and Greenwich NHS Trust, which runs the hospital, said: “We welcome the CQC’s report. The report does note that we have made progress since the last CQC inspection in February 2013, and we are pleased that our staff received a rating of ‘good’ for providing a caring, kind, and compassionate service.

“We recognise there is more to do and we have a detailed programme of improvements to our emergency pathway, and care in our wards.”

Justin Madders, Labour’s shadow health minister, said: “This deeply shocking case is yet another example of a health service stretched to breaking point due to underfunding by the Conservatives.

“Theresa May needs to act urgently and use the Autumn statement to deliver a rescue package for the NHS. Anything less will leave more vulnerable patients across the country at risk.”

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