Emergency service is closer to four hour target but still lacks consultants
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《英国医生杂志》
NHS emergency departments are much closer to meeting the government's target of patients spending no more than four hours in the departments than they were two years ago, according to a report by the National Audit Office, the spending watchdog that reports to parliament. But there is still room for improvement, says the head of the audit office, John Bourn.
"There is scope in those trusts which are behind the best for further reductions in the time patients spend in A&E ," he said.
The continuing shortage of appropriately trained emergency consultants is one of a number of unresolved issues affecting performance, according to the report.
All English acute NHS trusts had to meet the four hour target for 98% of patients by December 2004. From April 2002 to April 2003 23% of patients spent more than four hours in emergency departments. That percentage had fallen to just over 5% for the three months from April to June 2004.
Changes to traditional work patterns, such as abandoning triage (where the most seriously ill people are treated first) and introducing a "see and treat" system (where the person who first sees a patient with minor injuries treats the patient rather than referring him or her to a specialist) have helped reduce the time.
However, 24% of patients who were in emergency departments for longer than four hours were waiting for a bed. A further 24% waited because it was difficult to obtain a specialist opinion in time.
109 extra consultants are needed in emergency medicine
Credit: SHOUT PICTURES
The groups of patients who tend to spend the most time in emergency departments are elderly people, who have more complex needs, and people with mental health problems waiting to see a psychiatrist.
The Department of Health undertook to provide an extra 183 emergency consultants by 2004, bringing the total to around 670, but by 30 September 2003 only 561 emergency consultants were in post.
As yet, says the report, very few emergency and acute doctors have been trained to fill the newly created posts. Many of the extra consultants were trainee doctors who were already in the system, not additional staff. Although, on average, trusts have been funded for 4.3 consultants, an average of 3.7 are actually in post.
Fifty two of the 126 trusts who responded to the audit office's survey reported a shortage in the number of permanent consultants.
In addition, 17% of 126 trusts said that they were concerned that the European Working Time Directive restrictions may create further problems in providing an adequate number of appropriately qualified medical staff.
The new GP contract, which allows GPs to opt out of providing out-of-hours services, could also have an impact on emergency department targets if alternative provision proves inadequate, the report warns.(Lynn Eaton)
"There is scope in those trusts which are behind the best for further reductions in the time patients spend in A&E ," he said.
The continuing shortage of appropriately trained emergency consultants is one of a number of unresolved issues affecting performance, according to the report.
All English acute NHS trusts had to meet the four hour target for 98% of patients by December 2004. From April 2002 to April 2003 23% of patients spent more than four hours in emergency departments. That percentage had fallen to just over 5% for the three months from April to June 2004.
Changes to traditional work patterns, such as abandoning triage (where the most seriously ill people are treated first) and introducing a "see and treat" system (where the person who first sees a patient with minor injuries treats the patient rather than referring him or her to a specialist) have helped reduce the time.
However, 24% of patients who were in emergency departments for longer than four hours were waiting for a bed. A further 24% waited because it was difficult to obtain a specialist opinion in time.
109 extra consultants are needed in emergency medicine
Credit: SHOUT PICTURES
The groups of patients who tend to spend the most time in emergency departments are elderly people, who have more complex needs, and people with mental health problems waiting to see a psychiatrist.
The Department of Health undertook to provide an extra 183 emergency consultants by 2004, bringing the total to around 670, but by 30 September 2003 only 561 emergency consultants were in post.
As yet, says the report, very few emergency and acute doctors have been trained to fill the newly created posts. Many of the extra consultants were trainee doctors who were already in the system, not additional staff. Although, on average, trusts have been funded for 4.3 consultants, an average of 3.7 are actually in post.
Fifty two of the 126 trusts who responded to the audit office's survey reported a shortage in the number of permanent consultants.
In addition, 17% of 126 trusts said that they were concerned that the European Working Time Directive restrictions may create further problems in providing an adequate number of appropriately qualified medical staff.
The new GP contract, which allows GPs to opt out of providing out-of-hours services, could also have an impact on emergency department targets if alternative provision proves inadequate, the report warns.(Lynn Eaton)