Monday, 10 November 2014

London’s A&Es Struggling With Patient Waiting Times

Photo by Arpad Lukacs from the Londonist Flickr pool

Two months after A&E departments at Hammersmith and Central Middlesex hospitals were downgraded into Urgent Care Centres, we’ve had a press release from the London Assembly Labour group telling us that A&E waiting times at North West London NHS Trust recently became the less-than-proud owner of the ‘worst performer in England’ badge.
In the week ending 19 October, only 67.8% of patients needing ‘proper’ A&E care were seen within four hours (the government’s target is 95%). The following week, the trust saw 73.3% of A&E patients within four hours. No other NHS trust performed so poorly in that period. However, we wanted to see what the trust’s figures were like before Hammersmith and Central Middlesex were downgraded. We looked at the data for week ending 7 September, the last full week before the closures, and saw that NW London was still only managing to see 75.5% of A&E patients within four hours (two other trusts performed worse). The trust has clearly been having problems for some time.
We actually found something more alarming in the figures Labour sent us. Of the 20 worst performing NHS trusts for A&E patient waiting times, five were in London w/e 19 October (NW London; Barking, Havering and Redbridge on 75.5%, Hillingdon on 81.1%, Imperial on 82.5% and Lewisham and Greenwich on 83.1%) and four were in London w/e 26 October (NW London; Barking, Havering and Redbridge on 77.9%, Hillingdon on 79.3% and Lewisham and Greenwich on 82.8%).
For the most recent week for which information is available (w/e 2 November), only three London NHS trusts hit the government’s 95% target: Homerton, Kingston and University College London. Five trusts reached the target for the w/e 7 September: Homerton, Kingston, North Middlesex, St George’s and Whittington (Guy’s and St Thomas’s nearly made it with 94.9%). And this is before the weather turns really cold and flu season stretches capacity further. London has 19 NHS trusts with emergency units: when it comes to A&E, this really is looking like a postcode lottery.
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  • This piece of writing could be a lot better. Yes you have numbers, congratulations; and yes two departments have been downgraded. Why not look into why London's departments are so busy, the amount of non-appropriate visits made to A&E by Londoners, the lack of availiability of GP's and the low budget that the NHS has to cope with in London. It's an incredibly busy city, unlike any other. It just seemed that you were solely blaming the hospitals and their respective boroughs.
    This is a huge issue, one that is only going to get worse (increasing population, reducing budgets etc) reporting, and bring it to peoples attention is great, just try to piece together the bigger picture before commenting.


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        Thanks Jen. If you're interested in the reasons, we've written articles in the past about A&E - have a look at http://londonist.com/2013/11/l... orhttp://londonist.com/2013/05/l... for examples. The King's Fund has also done an excellent myth busting articles on whether or not we're using A&E more (we're actually not using 'type 1' A&E that much morehttp://www.kingsfund.org.uk/pr... )


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            We are discussing here of 4 hours time target that even at 100% is miserable. A decent level should be 80% in 30 mins. 85% in 45 mins. and 95% in an hour just to be similar to other worlds capital. Every visit to a doctor is appropriate - I would like just to remind You the Hippocratic Oath. We can discuss over it for decades but two millennia of culture can't be wiped out by a poor managed system. And much more is not about money, is about the lack of the vision that we have this issue. A&E is the core of any public services, more then school and army, because involve the preservation of life in every form, not only the appropriate one, that is most supreme value of our civilization - and for this reason without any doubt must be performed in an excellent way. Just to look to the real bigger picture before commenting.


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              Shouldn't it be pointed out that photo is of uclh, the hospital which is meeting the A&E target, not north west London trust


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              • London A&Es Keep Patients Waiting

                 
              • There are concerns over how London’s A&Es will cope this winter, as departments are already failing to meet targets for seeing patients within four hours.
                A new London Assembly report shows that more than 50% of the capital’s A&Es are missing a target to see 95% of patients within four hours – and missing it at least 50% of the time. Barking, Havering and Redbridge University Hospitals Trust has missed the target every week for the past year, only managing to see 85% of patients within four hours. North West London – where A&E departments are due to be cut – missed the target 50 weeks out of 52, Croydon and Imperial missed it a total of 46 weeks and Barnet and Chase Farm missed it for 45 weeks. Chelsea and Westminster, however, always meet the target, with 98% of patients being seen within four hours. (98% is, incidentally, what the target used to be before the government reduced it to 95% in 2010.)
                More of us are going to A&E than before: annual attendance over the past decade is up from 2.5m to 3.6m. And in September A&Es were experiencing waiting times not normally seen until December, raising fears that if we have another bad winter, emergency healthcare won’t be able to cope. In the short term some (but not all) NHS trusts are getting extra money to help take the pressure off A&E, but expert submissions to the Assembly said that what’s needed long term is better community, social and primary (i.e. GP) care – in other words, keep patients out of A&E in the first place.
                But there’s the rub. Enfield Council is currently in court to try to stop Chase Farm A&Ebeing closed before community health centres are opened. Channel 4 News recently highlighted a report showing that Walk In Centres are closing (12 that we can see in London, PDF) which could add to the numbers piling into A&E. Basically, things look likely to get worse before they get better.
                Photo by Tom Ledger from the Londonist Flickr pool.
              •  | GENERAL NEWS | BY: 

              • London’s Hospitals Under Strain



              • Barely a day goes by at the moment without some kind of WTF-is-going-on hospital news. Charing Cross Hospital was so overcrowded last November that operating theatres were being turned into intensive care wards, five London A&E units had to close their doors in the last month because they were too busy and UCL is going to double the size of its A&E – despite others in the capital being earmarked for closure or downgrade.
                You’ve no doubt heard of the ongoing row between Health Secretary Jeremy Hunt and GPs, who the minister blames for the A&E crisis. A&Es are seeing more patients – 1m more nationally between February 2012 and January 2013 than the previous 12 months – and Hunt says it’s all the fault of GPs failing to provide adequate out of hours care, following a new contract agreed in 2004. But that’s 2004; there surely comes a point during any government when it can no longer blame its predecessor. GPs point fingers at our ageing population and the new 111 helpline. Idiots like the woman who took her child to Whittington A&E to remove dog poo from a shoe don’t help.
                Romford, Waltham Forest, Bromley, Lewisham and Newham A&Es were all too busy to take in new patients at some point over the last month – yes, that’s Lewisham where the A&E isdue to be downgraded to an Urgent Clinical Care bumps-and-grazes unit. Charing Cross is also due to lose its A&E, even though a report published today says its operating theatres being used as wards was “a symptom of a healthcare system working close to full capacity”. UCL says it has no choice but to expand its A&E, which was only completed in 2005, because of a surge in demand.
                So the answer is to keep all the hospital services open, right? Perhaps not necessarily; another report yesterday flagged up a slightly increased risk to patients of being in hospital over a weekend. It’s down to staff availability, basically. Larger hospitals have the flexibility to rota more, and more senior, staff at all times. What is certain is that our health system is experiencing serious pressure and needs investment, either in out-of-hospital social care and general education to keep people out of A&E, staff, facilities, or everything. Fast, please.

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