15 October 2004
A National Audit Office health expert has questioned whether the rapid fall in patient waiting times across NHS accident and emergency departments in England is sustainable.
Karen Taylor, NAO director of health audit, told Public Finance that the NHS faces three key threats to maintaining what the watchdog this week described as a 'large and sustained' reduction in the time patients spend in A&E.
Taylor said staff shortages at trusts, new restrictions on doctors' hours under the European Working Time Directive and plans to close some A&E departments could undermine progress.
A report by the NAO's health team, Improving emergency care in England, published on October 13, found that 23% of patients spent more than four hours in A&E during 2002/03. But, by June 2004, only just over 5% waited this long.
The watchdog concluded that many trusts would now meet the government's NHS Plan target to eradicate waiting times longer than four hours by December 2004.
But Taylor warned: 'Unless measures are taken to address issues such as staff shortages across A&E departments and the WTD, then there is a genuine threat to sustainability.'
Taylor's team found that 43% of trusts have a shortage of permanent consultants, while 84% have insufficient nursing staff.
The waiting time reduction follows several changes to hospital practices, including the introduction of schemes allowing the first practitioner to see a patient to treat them throughout their stay.
Taylor said the reduction was 'remarkable' because demand for A&E services has increased, partly because some people now treat them like GP surgeries.
But Sir George Alberti, national clinical director for emergency care, said: 'There is no existing evidence to suggest that a rise in [A&E] attendance is linked to the handover of responsibility for evening and weekend medical cover from GP practices to primary care trusts.'
The cost of improvement has been minimal: Whitehall distributed just £140m to support the initiative, although some trusts used additional funds.
NHS chief executive Sir Nigel Crisp said: 'It is particularly pleasing that the NAO found a general consensus in the NHS that the four-hour A&E target has substantially benefited both patients and staff.'
PFoct2004
