Hospital Dr News

Downgrading of A&E symptomatic of services under massive pressure

A staffing crisis has resulted in an Emergency Department in Chorley being downgraded over the next week highlighting the mounting pressures hospitals are under.

Chorley A&E, in Lancashire, will close overnight because there are not enough doctors to staff it.

There is a national shortage of A&E doctors and Chorley said this had been exacerbated by the national cap on agency staff which the government has introduced.

The cap – introduced in November – limits the amount hospitals can pay for locum staff to no more than 55% above normal shift rates.

The Chorley unit – part of the Lancashire Teaching Hospitals NHS Foundation Trust – has not been able to fill its rotas at a compliant rate, and has a shortage of permanent doctors.

It comes as A&E performance in England sank to a new low in February for the second month in a row.

Hospitals are meant to see 95% of patients in four hours, but just 87.8% did according to NHS England figures.

That is a slight drop on the January figures, which were the worst since the target was introduced in 2004.

In major Emergency Departments the performance is worse with almost one in five patients (18%) waiting longer than four hours, the worst performance for over a decade.

The number of ‘trolley waits’ also remains high, with 15% of patients waiting in emergency departments to be admitted to hospital, another unwelcome record high for February.

Richard Murray, Director of Policy at The King’s Fund said: “Issues in A&E are symptomatic of the mounting crisis NHS trusts are facing as they try to maintain services while under increasing pressure to reduce their unprecedented overspends.

“Emergency admissions to hospital continue to rise, up by 5% over February last year. With rising admissions, compounded by increasing delays in discharging patients, hospitals have too few beds to meet demand. Better services outside hospital and investment in social care could help to reduce the numbers of people that need hospital care as well as speeding their discharge home.”

NHS trusts have been able to meet the 18-week waiting time target for planned procedures, an achievement given rising levels of demand and financial pressures, he added.

There is concern that other Emergency Departments could suffer the same fate as Chorley.

Trust medical director Prof Mark Pugh said: “We simply cannot staff the rotas and it is an unacceptable risk to patient safety to attempt to provide an emergency service with no doctors available to see people.”

The Royal College of Emergency Medicine said the downgrading of Chorley A&E is a reflection of the national picture of services under enormous pressure – fragile systems put under great stress will fracture.

A spokesman said: “If a department is already running on minimal staffing levels and further rota gaps appear it becomes impossible to maintain the service. The inability to recruit middle grade doctors is due to a general shortage of emergency medicine doctors nationally.

“The situation has been exacerbated by the capping of agency recruitment and in the short term has proved to worsen the problems it seeks to solve. As a result of this forced closure, surrounding hospitals will come under even greater pressure creating a domino effect.”

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