A&E departments face being strained to breaking point this winter, NHS leaders have warned.
The emergency care system has come under intense pressure, partly due to a rise in the number of people attending A&E, with more than one million more people attending emergency departments compared with three years ago.
Shadow health secretary Andy Burnham said David Cameron needed to "get a grip" on the real issues behind the problem, accusing the Prime Minister of leaving emergency departments "on the brink of a serious crisis".
His comments came as a survey of senior health service leaders carried out by the NHS Confederation said that misleading and ill-informed debate about the reasons behind A&E pressures is preventing the health service from addressing the actual causes.
Meanwhile a separate poll of the public found two thirds of voters believe there is a crisis and patients are being put at risk. The survey, by Survation, found 65% blamed Government cuts for any staff shortages and poor levels of care - with 75% saying doctors and nurses were doing their best while being overworked. But 65% said consultants should be forced to work weekends and nights to ease the crisis - with 43% backing pay cuts for any who refuse.
And the results from a third survey found that nine out of 10 nurses working in acute and emergency care believe current pressures on A&E services are putting patients in danger. The Royal College of Nursing said a poll of its members found that 89% of nursing staff thought the people they were meant to be caring for were being put at risk, while 85% said patient safety is being compromised by the strain on the departments. More than three-quarters (79%) cited increased attendances at A&E as the reason for increased pressure, while 74% blamed inappropriate attendances at A&E where patients could have been treated by primary care services or by calling NHS 111.
The NHS Confederation survey found that the majority of those questioned believe that the strain on the service is down to the rising number of frail older people with multiple long-term problems followed by the difficulty in discharging or transferring patients into appropriate further care. The new 111 phone service has come under intense pressure but the poll found that 79% of those asked said they did not think it a big cause of the strain on A&E departments. The results also gave an up-to-date prediction from the A&E front line about how well the NHS will cope during the coming winter. "A prolonged period of cold, a rapid increase in the acuity of patients presenting in A&Es or a lengthy norovirus season would be all it would take to bring many departments to breaking point," it said.
Professor Keith Willett, the doctor leading the emergency services reform, warned that up to 6.5 million people a year are wrongly going to A&E when they could be treated by GPs, paramedics or even chemists. Prof Willett, the national director for Acute Episodes of Care, told Sky News that 15% to 30% of people who turn up to be treated at A&E could have been treated in general practice. "They did not know that because the system did not obviously make itself available to them," he said.
Health Secretary Jeremy Hunt admitted it will be "very, very tough" to avoid a repeat of long waits in A&E units this winter despite a £500 million Government bailout designed to ease pressures. Mr Hunt said he was determined to ensure hospitals met targets and was taking action to support frontline services facing unprecedented patient numbers. "It is going to be very, very tough," he told Sky News. "But we can get through this winter. It is entirely possible to meet A&E targets, and I am determined we should. A lot of things are happening to give support to the front line. But that's not to say we are not worried about it, because it is going to be very tough, and we understand that."
Mr Cameron announced the two-year funding boost - which includes £15 million for the troubled 111 phone service - last month. In the first quarter of this year, the NHS also missed its target to see A&E patients within four hours. More than 300,000 patients waited longer than they should have - a 39% rise on the previous year. The new funding is aimed at A&E departments identified as being under the most pressure and will be targeted at "pinch points" in local services. Hospitals have already put forward proposals aimed at improving how the service works, including taking into account how other services feed into it.