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hunt and A&E
Jeremy Hunt, credit getty images. A&E credit Swindon Advertiser

Last week, leaders of 60 NHS trusts were told to attend a meeting in London with Health Secretary Jeremy Hunt because they were failing to meet the four-hour target for waiting times in A&E.

At the meeting, which was also attended by Simon Stevens – the head of the NHS in England – those present were divided into regional groups. Then, in relation to meeting A&E targets, those in the group led by NHS England’s Regional Director for the Midlands and East of England, Paul Watson, were forced to chant:

“We can do this!'”

Unsatisfied with their performance, Watson told the group that they weren’t chanting loud enough and should shout louder and:

“Take the roof off!”

One of the NHS leaders present said:

It was awful, patronising and unhelpful, and came straight after the whole group had just been shouted at over A&E target performance and told that we were all failing and putting patient safety at risk.

The NHS Constitution contains a number of pledges on waiting times, including that ‘patients wait no longer than four hours in A&E from arrival to admission, transfer or discharge.’ Hospitals are expected to achieve this four-hour wait time in 95% of cases.

However, according to the King’s Fund, this 95% target was missed in each of the 17 months up to December 2016. Between October and December 2016, only four out of 139 hospitals with major A&E departments managed to meet the required standard.

The number of people going to A&E has increased markedly in recent years, but the King’s Fund states that ‘attendances at A&E departments is not the main factor affecting performance’.

Instead, they point to other factors, including that whilst attendances are actually lower in the winter, those attending tend to be older, sicker and more likely to need to be admitted. However, there is a huge problem with lack of beds – over the winter of 2016/17, bed occupancy was almost 95%, a level described by the Royal College of Emergency Medicine as ‘unsafe’.

The independent scrutiny group Quality Watch has also looked at the figures and their graph of how long people wait to move from A&E into a hospital bed shows clearly that the long term trend since 2010 is upwards:

Credit: Quality Watch

If people are stuck in A&E waiting to be admitted, not only is there no room for incoming patients, but staff have to continue to care for those waiting, which inevitably causes further delays.

The British Medical Association has said that the NHS is ‘at breaking point’, whilst a report in the Journal of the Royal Society of Medicine has blamed NHS cuts for 30,000 excess deaths. Yet the government continues to shift the blame: it’s not lack of funding that’s the problem, it’s lack of commitment by staff.

Paul Watson apparently saw group chanting as a way of helping staff feel more committed. In fact, it left them feeling utterly humiliated. He later issued a somewhat half-hearted apology:

“If anyone found my session on Monday inappropriate in any way then I can only apologise – it was meant as light relief rather than brainwashing”

But went on to say that:

“The biggest single determinant of whether a struggling service is turned round is the confidence, optimism and determination of local leadership to do this and follow it through.”

Others might suggest that the ‘biggest single determinant’ of being able to provide timely and safe care for all patients is adequate funding of the NHS.

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