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A&E doing better but missing target

Accident and emergency departments in England saw 89.8% of patients within four hours in the week ending January 11, again failing to meet the 95% target.

The latest figures represent an improvement on the previous week, when just 86.7% of those attending A&E units were seen within four hours, but are a further sign of the continuing "unprecedented" pressures facing the NHS this winter.

Meanwhile, new figures show that A&E units in Wales saw 81% of patients within four hours in December, while in Northern Ireland the provisional figure was just 76.7% for that month.

The crisis in A&E has been at the centre of a bitter political row between the Tories and Labour, with Ed Miliband failing to deny that he had privately discussed wanting to "weaponise" the NHS to benefit his party in May's election.

Health Secretary Jeremy Hunt seized on the December figures from Labour-controlled Wales and said the figures made Mr Miliband's reported comments "all the more hollow".

Writing on Twitter, he said: "Eighty-one per cent of Welsh patients seen within four hours in December; 90%-plus in England, yet Labour only say 'crisis' in England. Will make English patients cynical and Welsh angry.

"Year-on-year fall in December A&E performance more than 50% higher in Labour-run Wales than England. Makes 'weaponising' in England all the more hollow."

Across England, s ome 389,377 patients attended A&E units in the week ending January 11, almost 18,000 lower than the previous week but around 6,000 more than in the same period 12 months ago.

There were also high levels of emergency admissions, with a total of 105,200 - up 3,400 on the same week last year.

The number of patients waiting more than four hours for admission after attending an A&E unit was 11,980, down from 16,324 in the previous week.

The latest figures show that on average more than 4,000 hospital beds a day were occupied by patients whose discharge was delayed, the highest point this year and worse than at any point last winter.

The NHS 111 service took 255,000 calls for the week ending January 11, down from 323,000 the previous week and a dramatic reduction from the peak of 439,000 for the week ending December 28.

Dame Barbara Hakin, NHS England's national director of commissioning operations, said: "We continue to see and treat the vast majority of patients in England within four hours, and performance improved this past week.

"Although we have seen a slight easing in the number of attendances and emergency admissions to A&E, the NHS continues to face unprecedented pressures on its frontline services - particularly A&E, NHS 111 and ambulance services.

"In light of the latest weather warnings across the country, we would urge people - particularly the elderly - to stay in the warm, ensure they have proper medication, get their flu jab if they have not yet done so, and seek advice from their pharmacist or their GPs for colds, coughs and minor ailments."

The release of weekly figures followed the publication of draft guidelines from the National Institute for Health and Care Excellence (Nice) on the number of nurses required in A&E units.

The organisation said there should be enough nursing staff on duty to have one nurse for every four cubicles but two registered nurses to one patient in cases of major trauma or cardiac arrest,

There should also be a registered children's nurse on each shift, or at least one A&E nurse with education and training in children's nursing.

Because demand in A&E can change rapidly, the guidelines recommend that departments, in planning, should allow for enough nursing staff to care for higher than the average number of patients who attend the department on a daily basis.

By increasing weekly nursing staff hours to cover above-average attendance numbers, staff can deal with unexpected peaks in the demand for services and be moved around the department flexibly to respond to changing situations.

The chief executive and general secretary of the Royal College of Nursing (RCN) said thousands more staff should be recruited for A&E departments.

Dr Peter Carter told BBC Radio 4's Today programme: "The reality on the ground is even if these guidelines are implemented, which we hope they will be, we are a long way from having the requisite number of staff in many A&E departments. Not all, but there is certainly a significant number of A&E departments that are woefully short of the requisite number of nursing staff that they currently need."

He added that RCN analysis due to be published shortly will "demonstrate that you will still need to recruit several thousand nurses across the country in A&E departments" to meet the guidelines, which would inevitably require staff to be brought in from overseas.

Professor Mark Baker of Nice told the programme that better planning and "anticipatory" recruitment would reduce the dependency on agency staff, potentially balancing out any cost to the NHS.

"If you plan to staff your departments at average demand, you will be understaffed half of the time," he said.

"What we are proposing is that managers should plan to staff their departments so that they are only short of staff, on the random variation of demands on A&E, one day a week and that will reduce the dependency on agency staff.

"So even though there will be more staff available, it won't cost the service more."

Shadow health secretary Andy Burnham said: "Last week, A&E got so bad that 95% of England's hospitals failed to hit the Government's own waiting time target.

"The number of patients waiting too long has doubled since January last year. It is more proof you cannot trust the Tories with the NHS.

"David Cameron triggered the A&E crisis by taking social care support away from hundreds of thousands of vulnerable people."


From Belfast Telegraph