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| NHS 'misses A&E waiting time target' | NHS 'misses A&E waiting time target' |
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| The NHS in England missed its A&E waiting time target in the first three months of the year, researchers say. | The NHS in England missed its A&E waiting time target in the first three months of the year, researchers say. |
| A total of 313,000 patients waited more than four hours, up 39% on the similar period in 2012, the King's Fund said after analysing official statistics. | A total of 313,000 patients waited more than four hours, up 39% on the similar period in 2012, the King's Fund said after analysing official statistics. |
| That represented 5.9% of patients when the NHS is allowed a leeway of 5%. | That represented 5.9% of patients when the NHS is allowed a leeway of 5%. |
| Labour is blaming cuts in social care, especially for the elderly, but Health Minister Dan Poulter said "a very difficult winter" had caused the spike. | Labour is blaming cuts in social care, especially for the elderly, but Health Minister Dan Poulter said "a very difficult winter" had caused the spike. |
| A&E waits are now at their worst level for nine years, and evidence is also emerging that hospital performance in areas such as infection control and cancer care could be deteriorating. | A&E waits are now at their worst level for nine years, and evidence is also emerging that hospital performance in areas such as infection control and cancer care could be deteriorating. |
| The government says extra money is being made available to help the hardest-hit hospitals, but the news points to what many experts have been warning about. | The government says extra money is being made available to help the hardest-hit hospitals, but the news points to what many experts have been warning about. |
| Last month both doctors and managers claimed the system was heading for a crisis as hospitals were struggling to cope with rising demand amid pressures on funding and staffing levels. | Last month both doctors and managers claimed the system was heading for a crisis as hospitals were struggling to cope with rising demand amid pressures on funding and staffing levels. |
| Budget squeeze | Budget squeeze |
| There have been reports of temporary waiting areas being set up in car parks and store rooms to help some units manage demand. | There have been reports of temporary waiting areas being set up in car parks and store rooms to help some units manage demand. |
| The King's Fund used official government statistics to get the full picture for January, February and March. | The King's Fund used official government statistics to get the full picture for January, February and March. |
| Patients should be seen, diagnosed and treated within four hours, but the analysis showed 5.9% had waited longer than that, although the figures since then show improvement, the think tank said. | Patients should be seen, diagnosed and treated within four hours, but the analysis showed 5.9% had waited longer than that, although the figures since then show improvement, the think tank said. |
| In a review it published earlier this year, it found that from October to December 2012 more than 232,000 A&E patients had waited more than four hours. | In a review it published earlier this year, it found that from October to December 2012 more than 232,000 A&E patients had waited more than four hours. |
| That was a rise of 21% compared with the similar period in 2011 but, at 4.3% of patients, still within the government's target. | That was a rise of 21% compared with the similar period in 2011 but, at 4.3% of patients, still within the government's target. |
| This is the first time the target has been missed since the target was relaxed to 95% in 2010. Before that it was 98% and tended to be missed each winter. | This is the first time the target has been missed since the target was relaxed to 95% in 2010. Before that it was 98% and tended to be missed each winter. |
| John Appleby, chief economist at the King's Fund, told the BBC there was no single explanation for the "spike" in waits, but an ongoing squeeze on the NHS budget was "one of the key reasons". | John Appleby, chief economist at the King's Fund, told the BBC there was no single explanation for the "spike" in waits, but an ongoing squeeze on the NHS budget was "one of the key reasons". |
| While the government has ring-fenced the budget from cuts, the NHS is expected to find efficiencies of £20bn by 2014. | While the government has ring-fenced the budget from cuts, the NHS is expected to find efficiencies of £20bn by 2014. |
| "The other thing to remember is that these emergency departments are not working in isolation - they work with other parts of the hospital," Mr Appleby added. | "The other thing to remember is that these emergency departments are not working in isolation - they work with other parts of the hospital," Mr Appleby added. |
| "If you haven't got the beds for people flowing through then you very quickly back up into A&E." | "If you haven't got the beds for people flowing through then you very quickly back up into A&E." |
| 'Heaving' | 'Heaving' |
| The King's Fund said the actual number of people presenting at A&E had not increased significantly and the issue was more a question of how the demand for care was being handled. | The King's Fund said the actual number of people presenting at A&E had not increased significantly and the issue was more a question of how the demand for care was being handled. |
| Clare Gerada, chairwoman of the Royal College of GPs, said GP surgeries and hospitals were "heaving under the workload" and the whole NHS was at risk of "grinding to a halt". | Clare Gerada, chairwoman of the Royal College of GPs, said GP surgeries and hospitals were "heaving under the workload" and the whole NHS was at risk of "grinding to a halt". |
| She agreed that a rise in admissions was not a significant factor, adding: "I suspect that it's the cuts we've seen in services. It's the workload issues, the workforce issues. | She agreed that a rise in admissions was not a significant factor, adding: "I suspect that it's the cuts we've seen in services. It's the workload issues, the workforce issues. |
| "And the elephant in the room, we don't have enough social care beds and social care facilities so patients can be looked after in more appropriate places." | "And the elephant in the room, we don't have enough social care beds and social care facilities so patients can be looked after in more appropriate places." |
| But Conservative MP Chris Skidmore said rising demand was an important issue, citing both the UK's ageing population and immigration as key factors. | But Conservative MP Chris Skidmore said rising demand was an important issue, citing both the UK's ageing population and immigration as key factors. |
| "Migrants routinely visit A&E instead of going to their GP," he told the BBC. | "Migrants routinely visit A&E instead of going to their GP," he told the BBC. |
| 'Difficult winter' | 'Difficult winter' |
| Shadow health secretary Andy Burnham said the situation would get worse unless urgent action was taken. | Shadow health secretary Andy Burnham said the situation would get worse unless urgent action was taken. |
| "I would use around half of the (£2bn) underspend in the NHS to provide emergency support to shore up councils' social care services," he said. "We need more home-based care to keep older people supported at home and out of hospitals." | "I would use around half of the (£2bn) underspend in the NHS to provide emergency support to shore up councils' social care services," he said. "We need more home-based care to keep older people supported at home and out of hospitals." |
| The government has in part blamed a "disastrous" legacy from Labour, including the renegotiation of GPs' contracts which allowed them to opt out of providing out-of-hours care. | The government has in part blamed a "disastrous" legacy from Labour, including the renegotiation of GPs' contracts which allowed them to opt out of providing out-of-hours care. |
| But Mr Burnham said that was "pure spin", adding: "The pressure is being created by the policies of this government." | But Mr Burnham said that was "pure spin", adding: "The pressure is being created by the policies of this government." |
| Meanwhile, a separate analysis by Monitor, which regulates the elite foundation trusts accounting for two-thirds of NHS services, found evidence that performance in areas such as cancer care, non-emergency operations and infection control could be deteriorating because of the growing pressures. | Meanwhile, a separate analysis by Monitor, which regulates the elite foundation trusts accounting for two-thirds of NHS services, found evidence that performance in areas such as cancer care, non-emergency operations and infection control could be deteriorating because of the growing pressures. |
| Sir Richard Thompson, president of the Royal College of Physicians, said: "This is no surprise - patients are presenting at emergency departments in increasing numbers because there is nowhere else they can go. | Sir Richard Thompson, president of the Royal College of Physicians, said: "This is no surprise - patients are presenting at emergency departments in increasing numbers because there is nowhere else they can go. |
| "Patients arriving at the 'front door' of the hospital have an impact on acute services throughout the hospital, and we need to redesign emergency care systems around the patient, while making sure that clinicians' workloads and working practices are safe and sustainable." | "Patients arriving at the 'front door' of the hospital have an impact on acute services throughout the hospital, and we need to redesign emergency care systems around the patient, while making sure that clinicians' workloads and working practices are safe and sustainable." |
| Health Minister Mr Poulter blamed flu, norovirus and an increased number of trips and falls over the winter for the spike. | Health Minister Mr Poulter blamed flu, norovirus and an increased number of trips and falls over the winter for the spike. |
| He said data from the last five weeks was "very good", but more effort did need to go into improving the treatment of patients within the community, especially the elderly and those with chronic health problems. | He said data from the last five weeks was "very good", but more effort did need to go into improving the treatment of patients within the community, especially the elderly and those with chronic health problems. |
| "The NHS is performing well, but we've got to start thinking about how we stop people who don't need to be in hospital arriving there," the health minister added. | "The NHS is performing well, but we've got to start thinking about how we stop people who don't need to be in hospital arriving there," the health minister added. |
| Over the longer term, he said the government was also working to recruit more GPs and community nurses to cope with demand. | |
| A&E units have to see only 95% of patients within four hours, to reflect the fact that some flexibility is needed to allow doctors to prioritise the patients with the greatest need. | A&E units have to see only 95% of patients within four hours, to reflect the fact that some flexibility is needed to allow doctors to prioritise the patients with the greatest need. |