Government paints too rosy a picture of A&amp;E, report says
Authors: L. Eaton
Journal: BMJ (2002)

The UK government's claim that waits of more than 24 hours in accident and emergency (A&E) departments have been eliminated is not true, a report from the British Medical Association says this week.

And the latest initiatives to tackle long waits will do little to resolve the main cause of the problem: insufficient numbers of staff and too few inpatient beds.

That is the message from a survey conducted by the BMA and the British Association for Accident and Emergency Medicine in July. It asked 549 consultants working in A&E departments in the United Kingdom to comment on their experience of how long and why patients waited in the previous week. It also asked them whether they agreed with the government's statements on progress towards the targets for waiting in A&E departments.

A total of 163 consultants replied, representing 135 departments—about 40% of all A&E departments in the United Kingdom. Of the 135 departments, 38% reported that the situation had deteriorated in the past year in terms of the overall service to patients.

One in three departments reported that at least one patient waited more than 12 hours in the previous week from the time when they arrived in the department to the time they were admitted, transferred, or discharged.

One in five departments reported at least one patient waiting more than 24 hours in the previous week. This, says the report, contradicts the government's policy document Reforming Emergency Care, published in 2001, which stated that “over 24-hour waits have been eliminated” and that “87% of patients admitted via A&E who need a bed are found one within four hours of a decision to admit.”

Don MacKechnie, chairman of the BMA's A&E subcommittee, said that it was heartening to see that many doctors had introduced new ways of working to help to reduce waiting times. But he added: “Sadly, many more are prevented from making change because of inadequate funding, not enough staff, or lack of management support.”

John Heyworth, president of the British Association for Accident and Emergency Medicine, added: “Too many patients are still waiting far too long in emergency departments throughout the UK. Some progress has been made, but overall this remains patchy and inconsistent.”

Respondents were asked to comment on the extent to which the Department of Health's statements in Reforming Emergency Care applied to their department. Only 30% of departments agreed that the statement “patients who need a bed are found one within four hours of a decision to admit” reflected the situation in their department.

The report highlights growing concern over the number of patients who are admitted to hospital but kept in a bed on the A&E ward, arguing this move has merely masked the delays in getting an inpatient bed.

A spokesman for the department of health said: “Three quarters of those who go to an A&E department who need to be admitted to hospital get a bed within four hours. Those aren't our figures—they're Audit Commission figures from 2000. By December 2004 all patients will be in and out of A&E within four hours.”