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Letter: 20 years on we face the same crisis in emergency care

Gary Jones asks how much longer we must endure the annual prospect of winter pressures on emergency departments

Gary Jones asks how much longer we must endure the annual prospect of winter pressures on emergency departments

Here are a couple of quotations on the parlous state of our emergency departments: 

 ‘An RCN A&E Association survey Still Waiting for a Bed shows the situation has not changed in two years. The report urges trusts to prepare for the extra pressure on beds envisaged for the winter. Meanwhile a high-level summit with all political parties and the Department of Health has been initiated to discuss the issues, highlight concerns and move to a plan to prevent a similar situation occurring next year’.


‘Now the RCN, the Department of Health and others have submitted evidence to a Commons Health Committee inquiry into planning for winter pressures on emergency departments. For the past five years, ED winter performance against the four-hour target has been in decline.’

To read the two paragraphs above one would think they both relate to 2016. In fact, the first paragraph was published in the RCN Emergency Nurse journal in 1997 reporting on a survey conducted by the RCN A&E Association in 1996. The second paragraph comes from a news analysis in Nursing Standard on the 31st August 2016.

In 20 years, the problem of bed shortages and emergency departments under pressure has only changed in its intensity and I expect that will continue to increase. In the August 2016 analysis, key issues include staff shortages, insufficient skill mix, insufficient funding and lack of investment in community and social care.

Over 25 years ago when the seeds of today’s problems were sown we were told by the then politicians, trust chief executives and many others that it would be ok to reduce beds and increase bed capacity because the community and social services would be improved so patients would not be waiting for discharge.

Of course, what we have seen is a continuous reduction of hundreds, if not thousands of beds. Yet the development of community services has been severely lacking.

This crisis will only be resolved if there is the political will, and money, to increase the community and social care services, increase inpatient capacity (more beds) and increase staffing and skill mix. Unfortunately of any sign of this is sadly lacking.

I will keep the first two paragraphs of this letter to hand and if I am still fit and able I will publish them in a letter again in 20 years’ time when I am sure we will still be debating the same problems.

Gary J Jones CBE FRCN



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