Introduction

Have you ever been to A&E? If so, you’ll likely be familiar with the long waiting times to receive test results, speak to doctors and start necessary treatment.

The A&E crisis is one of the most pressing issues currently faced by the NHS. There are several contributing factors to this, including the effects of the COVID-19 pandemic which has placed a significant strain on our emergency services.

What is causing the A&E crisis?

Increased demand for A&E services

Population growth

According to the Office for National Statistics, the population of England and Wales at mid-year 2022 was estimated to be 60.2 million, a 1% increase from the previous year. 983,000 people were estimated to have immigrated to England and Wales from outside the UK in the year to mid-2022, while a significantly lower number (441,000) had emigrated.

With the influx of people to the UK significantly outweighing those leaving, the general population is only expected to increase exponentially, placing a significant strain on A&E services as more people will be in need of emergency medical treatment. 

Ageing population and increased numbers of those with chronic health conditions

The Centre for Ageing Better states that the number of people aged 65 and over has surpassed 10 million; this age group makes up nearly 20% of the general population. It is also predicted that the number of those aged 80 and over will double in 40 years’ time. 

Older people are typically more likely to experience medical complications. For example, the risk of cardiac events like heart attack and stroke tend to increase with age. Incidents including a fall are also more common in the older population and are a frequent presentation in the A&E setting.

If you have a long-term health condition, such as chronic obstructive pulmonary disease (COPD) or epilepsy, you may also be more prone to needing emergency medical treatment, for example due to lung infections or an injury during a seizure. 

‘Hidden backlog’ due to covid-19

The consequences of the COVID-19 pandemic is arguably one of the most influential contributing factors of the increased demand for A&E services. Many appointments and cases of non-urgent treatment were suspended during this time in an effort to reduce the spread of the virus by limiting the number of people entering hospitals and other care environments. However, the difficulty of getting a GP or hospital appointment meant that treatment was delayed and medical concerns that were seemingly minor have now escalated to more severe problems.

Primary care issues

Primary care is used to describe healthcare services that are your first point of contact. This could include GP surgeries, community pharmacies, and dental and eye health services.

The increased demand for GP appointments, due to population growth for example, means that GPs are treating dangerously high numbers of patients a day. Not only does this jeopardise patient safety, but it could lead to misdiagnoses. Consequently, an overwhelming number of patients present to A&E when their conditions have worsened after the early warning signs were possibly missed. 

Staff shortages

The number of patients requiring medical treatment in A&E far outweighs the availability of doctors and other healthcare professionals. Many people wonder why medical schools can’t just train and recruit more doctors. The answer to this is that there just aren’t enough resources and funding to match the number of prospective doctors to the current demand.  

Retention not recruitment

Rather than focusing on recruiting more healthcare professionals, the attention needs to be on retaining current staff. Too many are leaving the profession due to burnout. Doctors who work in A&E face some of the most challenging medical scenarios, for instance cardiac arrest or attempted suicide. This can be distressing for doctors to deal with on a daily basis and can have a profound effect on both their physical and mental health. This issue is particularly worrying for doctors considering embarking on speciality training in emergency medicine as the current situation could deter them from doing so, further exacerbating the staff shortages. 

Issues with funding and resources

There have been reductions to funding in primary, community and social care. As mentioned previously, this could prevent you from receiving prompt treatment and may lead to worsened problems in A&E settings that could have been prevented. Budget cuts in staffing also makes it hard to recruit a sufficient number of healthcare professionals to work in A&E settings.

There are several types of A&E services including:

• A&E (majors) – this is what most people consider an A&E department to be. Here you can receive treatment for life-threatening scenarios such as stroke, breathing difficulties and heavy bleeding
• A&E (specialities) – these departments deliver treatment for specific emergencies, including dental or eye conditions
• A&E (minors) – these consist of walk-in centres and minor injury units, and are useful for things like sprains and strains, high temperature, and cuts and bruises¹

A&E services can vary from region to region and it is thought that they are ‘fragmented’ in terms of how the services operate. You may be confused as to what type of treatment centre you should use. For non-life-threatening conditions you are likely to receive quicker and more appropriate treatment at a minor injury unit rather than visiting A&E majors. By recognising the most suitable A&E service to use, you will help to alleviate pressure on A&E majors, allowing doctors to address life-threatening emergencies more efficiently.² 

Figure 1. Lack of resources, such as care staff in the community, can have a domino effect on the A&E crisis.³ The average response time to a category 1 999 call is 7 minutes. That target now averages at nearly 9 minutes. Although this doesn’t seem like a significant increase, category 1 calls involve medical scenarios where every second counts. This delay could potentially be fatal for the patient. 

The importance of addressing the A&E crisis

Long waiting times lead to a negative impact on patient outcomes due to delayed treatment, increased risk of medical errors, and decreased quality of care.

Not only this, but the A&E crisis also has an impact on public perception and trust in the NHS. Research carried out by Ipsos for the NHS Confederation found that of the 2,695 people surveyed across England, Wales and Northern Ireland, 69% feel that the NHS does not have enough money, and the majority of people are dissatisfied rather than satisfied with waiting times and access to healthcare.⁴ 

As a result, many are turning to the private sector in an attempt to skip waiting lists and receive treatment sooner. Although this frees up space in the NHS, it creates a wider problem of health inequality. Those who can afford to self-pay or have private health insurance are receiving care before those who have been waiting just as, if not longer, for NHS treatment. This trend is particularly prevalent in more affluent areas.⁵ 

What can be done to help the A&E crisis?

• Improve access to primary care – this will ensure you can receive treatment promptly before medical conditions escalate, thus avoiding the need to go to A&E
• Investing in staffing – using available funding towards the training and recruitment of future generations of healthcare professionals will ensure staffing levels can keep up with the increased demand for A&E services
• Modern technology developments – hospitals could consider if there are new ways to manage the long waiting times in A&E departments, for example using software to implement a more efficient triage system so that you can be treated as quickly as possible
• Other healthcare professions – physician associates are a newly established role in the healthcare team; they have similar responsibilities to doctors and could help to alleviate the pressure on them 

What can you personally do to help the A&E crisis?

• Consider using other healthcare services – for minor ailments such as earache, insect bites, and sore throat, a pharmacist can help. The advantage of this resource is that you do not need an appointment
• Follow GP advice – if you have a diagnosed health condition, ensure you are compliant with advice that you have been given to manage your condition, thus avoiding complications that could require treatment in A&E
• Drive yourself to A&E if possible – if you need to go to A&E and are able to get yourself there, doing so will help to reduce waiting times for those in need of an ambulance

If you are unsure of the nature of your condition, NHS 111 is a good source of help. You can check your symptoms online or call 111 if the person is under.⁵

Summary

There are several causes of the current A&E crisis. The aftermath of the COVID-19 pandemic is perhaps one of the most influential of these. It is vital we recognise and understand how to address the situation to avoid sustaining a negative impact on patients and to maintain public trust in the NHS. Making primary care more accessible and increasing staffing levels are two ways to manage the A&E crisis. From your perspective as a patient, you can consider using services such as NHS 111 and community pharmacies for non-urgent situations and use A&E services for life-threatening emergencies only.