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NHS is starting to buckle,' warns BMA

Politicians must face up to the reality of a buckling NHS highlighted by an analysis of rising pressures on emergency departments, the BMA has warned.

NHS ribbonThe Nuffield Trust and Health Foundation report tracks a number of factors which have contributed to emergency departments missing set targets to treat, admit or discharge patients within four hours.

BMA council chair Mark Porter (pictured below) said: ‘The continued failure to meet rising demand with necessary investment means the NHS is now starting to buckle.

‘Our emergency departments are full, patients are waiting longer to be seen and frontline services are stretched to breaking point.

‘GPs are being unfairly blamed for queues in emergency departments, but they too are under unprecedented pressure with many surgeries unable to cope with rising patient demand.’

Appropriate care

Dr Porter added that it was crucial patients were treated in appropriate settings to help alleviate pressure on emergency departments and said many older patients would be better treated in the community.

Mark PorterHe added: ‘An effective out-of-hours telephone service is also key, yet the government's implementation of NHS 111 was disastrous, adding to the pressure on emergency departments rather than reducing it.

‘Ultimately, politicians have to face up reality — we have an aging population with more complex medical needs.’

He said demand on the NHS was rising and would only continue to do so.

Dr Porter added: ‘The message is stark and clear — without urgent investment in frontline services and real action to put the health service on a sustainable financial footing for the future, the NHS simply will not be able to cope.’

Weather factors

The Nuffield analysis showed overcrowding in emergency departments was closely linked to waiting times, that winter pressures were associated with higher rates of people waiting but by less than most people thought.

It also outlined the pressure that hot weather puts on emergency departments — when average daily temperatures hit 20°C, compared with 5°C, trips to the emergency department rise by nearly 20 per cent.

Nuffield Trust senior research analyst Ian Blunt said many of the external factors used to explain performance decline in the four-hour target since 2012 only had a small effect.

He said: ‘We show that weather is only part of the problem — we may have reached the limit of what we can delivery with our current [emergency department] capacity.

‘But without either new money to invest in [emergency departments], or new ways to divert people to other parts of the NHS, rising waits may be inevitable.’

Time to act

He added that ‘a lot’ now rode on the NHS England Urgent and Emergency Care Review.

College of Emergency Medicine president Clifford Mann said: ‘This excellent report founded on robust analysis of good data vindicates the position of the College of Emergency Medicine in bringing the issues of “crowding” and “exit block” to the attention of clinicians, managers, commissioners and politicians.

‘Failure to act will see a rapid decline in emergency department performance with attendant consequences for patient care and outcomes.’

 Read the Nuffield Trust report

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