Record numbers of patients are leaving A&E units without being treated, new figures reveal, sparking fears that the NHS is on the brink of a winter crisis and cannot cope with soaring demand.
The figures for September show 53,000 people left an emergency department in England before receiving treatment, up 24% compared with September 2015.
The data released by NHS Digital does not include patients’ reasons for leaving, but many are likely to have done so because they felt they had waited too long to be seen.
“Our NHS is facing a massive crisis and most politicians seem happy to look the other way,” said Tim Farron, the Liberal Democrat leader. “The strain of overcrowded A&E units and a creaking social care system means the government are failing millions of sick and vulnerable people.”
Questions are also being asked about the quality of care that A&Es provide because the number of patients who have to come back for further treatment within a week of their first visit is increasing quickly. Experts say the trend may indicate A&E staff are struggling to provide the highest standard of care because they are now too busy too much of the time.
In September, 137,164 patients (8.1% of all 1.68m attendances that month) came back to an A&E in an unplanned way within seven days of their first attendance, compared with 119,856 (7.6%) in the same month a year earlier.
Prof John Appleby, chief economist and director of research at the Nuffield Trust health thinktank, said: “There is no doubt that this winter will be exceptionally tough across the NHS. A&E targets have been missed for months, record numbers of patients are waiting on trolleys to be admitted to hospital and, as today’s figures show, there is a worrying rise in people going back to A&E units within seven days, raising questions about whether they’d had the right treatment or advice.
“These figures paint a picture of an NHS under severe pressure, which will put staff under great strain over the winter period and could put patients at risk. The NHS has managed in previous years by opening extra beds, deploying more staff and reducing the numbers of non-urgent operations. We expect to see the same this year, but the question for this winter is whether there will be enough slack in the system to deal with a sudden outbreak of flu or norovirus.”
The NHS Digital figures show that the time it takes for a patient to start treatment in A&E has risen in the past year, from 55 to 59 minutes – a 7% increase. In September last year, 95% of all A&E cases left the unit within 5hrs 53mins of arriving; this September 95% left within 6hrs 30mins.
NHS Improvement, the health service’s financial regulator, ordered hospitals last week not to carry out non-urgent surgery over Christmas so that beds were left free to help deal with a potential influx of patients. Jim Mackey, the agency’s chief executive, told hospital bosses that the NHS was facing a “critical” time.
A separate study suggests the NHS is on track to have its most difficult winter ever. A total of 785,883 patients could end up waiting more than the supposed maximum 4hrs for A&E care in the December to February months, far more than the 613,971 who did so in those three months in 2015-16.
The projection is based on a 28% year-on-year rise in such delays seen each year between 2010-11 and 2015-16, according to Incisive Health, a specialist health communications and policy firm.
Similarly, trends over the past six years suggest A&Es in England may have to treat as many as 5.76 million patients over the winter period, up from 5.65 million last winter.
“The NHS has got used to difficult winters but this looks likely to be the toughest yet,” said Sarah Winstone, one of Incisive Health’s founding partners.
Dr Taj Hassan, the president of the Royal College of Emergency Medicine, which represents A&E doctors, said that the figures underlined that the NHS was now facing winter-type levels of demand all year round, to the extent that some hospitals could “fall over”.
He criticised ministers for inaction. “The situation continues to worsen every year despite repeated pleas for emergency medicine, social care and the wider NHS to be appropriately funded and resourced,” he said. “All evidence points to a badly failing system, yet these warnings continue to fall on deaf ears. Unless appropriate action is taken, patients will continue to suffer and some systems will fall over completely.”
The Department of Health said that many patients did not need to go to A&E in the first place and insisted that hospitals had made good preparations to cope with extra demand over winter.
“Increasingly, hospitals have systems in place to direct patients to the best NHS service. We know that four out of 10 patients going to A&E don’t need to be there.
“The NHS is better prepared for winter than ever before, funded by £400m to cope with the extra pressure, and is performing well despite being busy. In fact, over 27,000 more people were seen within four hours in A&E compared to October 2010,” a spokesman said.
NHS hospitals facing toughest winter yet, say health experts
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