A and E Waiting Times

Ann Clwyd Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

It is a huge privilege to chair the debate. Had I not been in the Chair, I would have asked to speak, because there is an issue with accident and emergency waiting times at Kettering general hospital, but as it is, we go straight to our main speaker, Ann Clwyd.

[Ann Clwyd (Cynon Valley) (Lab)]

Thank you, Mr Hollobone. It is a pleasure to be here under your chairmanship. I am sorry that you are unable to be on the Floor making your own points, but I am sure you will find other ways to do so.

I shall start by going through some press headlines from the past few weeks: The Mail on Sunday, “Shock 250% rise in patients waiting more than 4 hours in A and E: Six-month total soars by 146,000”; Mail Online, “Major hospitals have missed A and E targets every week for 6 months”; The Daily Telegraph, “Crisis hospital sets up tent for A and E patients…A hospital set up a makeshift tent to treat casualty patients amid a deepening crisis in emergency services across the country”; The Guardian, “NHS failed to hit A and E target for two months”; Mail Online, “Mother barely conscious with pneumonia was treated in a cupboard because hospital was ‘too full’ to give her a bed”; The Guardian, “The latest casualty of health reform: casualty itself …A and E departments are the pressure valve of the health system, yet the Government is moving rapidly to turn it off”; The Daily Telegraph, “Inquiry into failings in NHS emergency care...MPs are to launch an inquiry into NHS emergency care amid fears that patients are being put at risk by catastrophic failings in the operation of a new 111 helpline”; and Mail Online, “A and E patients ‘still waiting too long’”.

As you know Mr Hollobone, official figures this month show that many A and E departments are failing to meet their target of dealing with 95% of patients within four hours. The NHS in England has missed targets for major A and Es for 29 weeks and missed the target for all A and Es for the past 12 weeks. The failure to meet targets on so-called “trolley waits” happened despite the Government’s reducing the target figure from the previous target of 98%. In the past six months, more than 530,000 patients have waited more than four hours at A and E departments—a rise of almost 30% since last year. England’s A and Es are struggling. One in three patients now waits four hours or more for emergency treatment in the worst affected areas.

About 14 million patients a year are seen in major A and E units. A Department of Health spokesman has said that the NHS is experiencing an extra 1 million patients in A and E compared with two years ago. Research by the King’s Fund shows that A and E attendance was up by 353,457 patients in the first three quarters of 2012-13 compared with the same period in 2009-10. Unfortunately, the Government also propose to close or downgrade 34 more A and E departments across the country in the coming months. Most trusts are reducing the number of beds as part of their quality, innovation, productivity and prevention plans. Pressure on A and E is felt at both ends of the system. A lack of free beds on wards means that staff cannot admit patients and, with A and E full, paramedics cannot hand over patients.

The resulting strain in A and E departments was nowhere more obvious than outside Norfolk and Norwich university hospital. Over the Easter weekend, the east of England ambulance service was forced to erect a major incident tent outside the hospital to treat patients and relieve pressure on the A and E department. Reports say that there were queues of up to 15 ambulances waiting with patients. One patient was made to wait more than five hours under the West Midlands Ambulance Service NHS Trust. Given the pressure they are under, we must all applaud and commend the work of Britain’s ambulance men and women—they are doing an extraordinary job.

Hospitals continue to make severe cuts to front-line staff, with many operating below recommended staffing levels. The Care Quality Commission has warned that one in 10 hospitals is failing to meet the standard on adequate staffing levels. Worryingly, a recent CQC report found that patients report not only longer waiting times, but a reduction in the quality of care in A and E. Thirty-three per cent. of respondents said that they waited more than half an hour before they were first seen by a doctor or nurse—up from 24% in 2004 and 29% in 2008. One in 10 respondents said that they could not attract the attention of staff, nearly a fifth felt that staff were not doing “everything they could” to control their pain, and 59% were not told how long they would have to wait for an examination. Compared with previous years, fewer patients had conversations with staff about their condition and fewer felt appropriately informed. Senior doctors now say that lives are being put at risk, because people are unable to get through to the new 111 number, which replaced NHS Direct. Many argue that it is difficult to access and mistrusted by patients, which has led to an increase in emergency call-outs and trips to A and E. Desperately ill patients are left waiting for hours while ambulances are dispatched to less critical cases.

I have had something like 2,000 e-mails and letters over the past few months since I first raised compassion in nursing, and they are still coming in. They are obviously not all about A and E, but some are. One man told me that he took his wife, who had injured her lower left leg, to A and E at 7.20 pm on a Thursday evening. On arrival at the hospital, he registered at reception at 8.10 pm and about one hour later his wife was seen by a male nurse, who said that the injury needed to be seen by a doctor because the damage was extensive—about 1.5 square inches of skin was only partially attached. The husband sent me a diary of his time in A and E. The male nurse cleaned and dressed the wound and said that it would be less than one hour before the doctor could see her:

“Apparently there had been a longer wait but he assured us that several more doctors were now attending the minor injuries section. With about 6 other patients we were told to wait in an ante room closer to the surgery rooms. At 11.15 pm after we had waited for over 3…hours an announcement over the loudspeaker system said ‘It would be a further 6 hours before a doctor would be available to treat anyone’. This was a general message, and indicated that no one would be seen for 6 hours. The voice then said ‘anyone feeling that they were fit enough to leave without seeing a hospital doctor should visit their own doctor in the morning’. It must be stressed here that these people were previously told by the nurse that they must see a hospital doctor. If the injury was so minor that they could go to see their doctor in the morning then why not tell them then?

One young lady had already spent 6 hours the previous day waiting to see a doctor because she was vomiting blood. She was there again with her friend and had already waited another six hours to be told that she was required to wait another six hours. Intolerable! She should have been admitted straight away the previous day. Another…young man was waiting almost as long as us because he had been in a three car pile up on the M4 and had damaged both knees and his back. He left after the announcement. He could have had internal injuries as well but was untreated.

How could my wife, and most of the people who were instructed to wait for a hospital doctor have the medical knowledge to leave hospital and wait another day? I went to reception to state that my wife needed to take her medication housed at home and could not wait another 6 hours on the off-chance that she may see a doctor. That was greeted by a shrug of the shoulders. I asked if any doctors were at all present and was told that one was on duty. There were 20 to 30 people waiting there at that time and most were casualties.”

On the way home, at about midnight, the man took his wife to a local hospital—no A and E there—to see if she could be treated the following day. His letter continues to tell how the next day he

“took her to this hospital and she was registered and treated within one hour not by a doctor but by a sister and a nurse. The skin flap had shrunk by that time and attempts were made to re-stretch it back over the wound. We were informed by these nurses that injuries such as this must be treated straight away to avoid shrinkage of the skin flap. This was an extremely painful process for my wife, but very necessary. Butterfly stitches were put in place that were intended to pull the skin flap back to its original size and cover the open wound.”

That is just one of many letters I have had. I have the consent of the people concerned to quote from their letters, and I will briefly read from two others. The first says,

“my wife miscarried at 10 weeks and I had to race her down…at 4am. She was left to sit in A&E for ages and I feared she was beginning to go into shock. I was pleading with the people behind the screen to help but kept being told with increasing irritation by them to sit with her and wait. Eventually they found a bed for her but there were no sheets, no drip. I had to cover her with my coat to keep her warm while nursing our sleeping 2-year-old in my arms. It took both of us a long time to get over that. To be honest we have never got over it. The sheer lack of sympathy and comfort, and being made to feel that you were an irritant. I should have made a formal complaint at the time but just didn’t have the energy.”

The second letter is from someone whose elderly mother needed an urgent blood transfusion:

“an ambulance collected mum and myself around 7pm and we arrived shortly after. Mum was placed on a trolley in A and E where we waited and waited. After an hour or so I could tell mum was deteriorating, she was in pain and distressed, I asked for help from various different nurses, I wanted a doctor to look at her. I can’t tell you how upset and frightened I was, I knew something was seriously wrong, I broke down and cried in front of everyone I was so desperate, at this point it was about 2 o’clock in the morning”—

that was after five hours—

“I begged a nurse for some pain relief for her and she gave mum a paracetamol that had zero effect. Mum was transferred to an observation ward at the side of the A and E, she was put in a bed with a tiny blanket over her, I tried to keep her warm and calm myself, no nurse came to see how she was, a lady in another bed was crying that she needed the toilet, I tried to find a nurse with no luck. We waited there until around 6am coping as best we could, it was a nightmare. Finally around 6am a consultant and 2 doctors came, they examined her and she called out in pain, the consultant advised me that mum would be put on a ward and a blood transfusion would be carried out, and she would be returned home later that day.”

The upshot was that the lady died at 11 o’clock that night.

I could go on and on with the letters. They illustrate that behind the stark figures and the problems in A and E, there are many human stories of people in distress, and left in distress, and sometimes the outcome of their very long waits is a tragedy for them and their families. The King’s Fund has recently published a report on the increasing demands on accident and emergency departments. The fund says that there are no easy answers—something we all know.

Few health policy issues have received greater attention than that of how best to meet the demands on A and E departments and manage the associated unscheduled admissions to hospital. I think that hon. Members of all parties know that there is a problem and want it to be resolved. The sooner it is resolved, the fewer the people who will suffer the long anxieties of waiting in A and E and the unfortunate outcomes that there are for too many people.

[Several hon. Members]

rose—