What's to blame for the A&E crisis in our hospitals?

The evidence is clear from Daily Echo reports this week – patients waiting in draughty corridors, an 82-year-old woman having to lift her top in semi-public to be examined, managers pleading for volunteers from non-medical departments to help feed the sick on the wards in Winchester; and non-urgent operations cancelled.

There is much less agreement on what has caused the problems that has resulted in units across the country missing targets of treating 95 per cent of admissions within four hours.

Nationally the figure last Sunday was 89.8 per cent; at the Royal Hampshire County Hospital in Winchester the figure is only 81.1 per cent; at Southampton General it is 79.5 per cent; and in Portsmouth, 77.6 per cent.

Across England, some 389,377 patients attended A&E in the week ending January 11, almost 18,000 lower than the previous week but around 6,000 more than in the same period a year 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 cause of the surge in demand depends on who you speak to. All are agreed the problems are complex.

The population is getting older and the elderly obviously need hospitals more. The GP out of hours service has failed to inspire trust, with younger people more likely to go to their nearest A&E than wait. Increased drinking is seeing more people attending as a consequence of alcohol.

On top of that, a severe new strain of flu that is immune to current vaccinations has led to a surge in admissions.

But health professionals are pointing to a deeper issue within the NHS.

Dr Chris Roseveare, consultant in acute medicine at Southampton General Hospital, is one who highlights the chronic issue of delayed discharges, better known as bed blocking. It has been a problem for 20 years but is now compounding the crisis.

Nationally, 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.

“Hospitals are under huge pressure at the moment due to a surge of admissions, particularly relating to respiratory illness,” Dr Roseveare said.

“This is a common problem at this time of year; however this year’s pressure has been compounded by bed capacity issues across the UK.

“Recent reductions in social services funding has led to delays in establishing home care for patients who require this prior to discharge. As a result the number of patients whose discharge is delayed has risen dramatically, which means that beds are not available for patients when they need to be moved out of the emergency department.

“This needs to be tackled urgently. There are many patients in hospitals across the UK who are well enough to be discharged. If community placements or social care could be delivered for these patients this would make a huge difference in solving the current pressures being felt in our emergency departments.”

County councillor Martin Tod, who sits on Hampshire health and adult social services select committee, agrees that delayed discharges create a blockage that affects whole hospitals.

“NHS healthcare is supposed to be ringfenced (from cuts) but adult social care is not. If the county council cuts back on community spending it creates effects in other parts of the system.”

But Cllr Tod also said local NHS management was to blame in not planning for the increased pressure on A&E in Winchester.

“There has been a lot of time, money and effort spent on a new super-duper A&E (planned for near North Waltham). The question is whether that has meant they have dropped the ball in the management of the A&E unit at Winchester.”

Cllr Tod, who runs the Men’s Health Forum charity, added: “Winchester has a growing population and it is ageing, so you should expect an increased demand on A&E. The duty of the NHS is to prepare and be ready for it. They should not be surprised more elderly, frail people need A&E. They were there last year. It’s like saying there are more schoolchildren, but we forgot to build enough schools. It is not an excuse.”

At the RHCH in Winchester, a whistleblower has told the Daily Echo the problems have worsened since 2012 when the Winchester and Eastleigh Healthcare Trust merged with North Hampshire Hospital in Basingstoke to form the Hampshire Hospitals NHS Foundation Trust.

“Most of the managers who manage in Winchester are based in Basingstoke. They are never normally in Winchester. Postmerger it is very target-driven, very financedriven.

“We know savings have to be made, but it should not be at the expense of patient care.”

The whistleblower said hiring agency staff since Christmas would have made a “huge difference” in A&E.

“There has been a ban on any agency staff regardless of whether wards have safe staffing or not.

“If we are short-staffed we just have to deal with it.”

Steve Brine, Winchester and Chandler’s Ford MP, disputes that Winchester’s problems stem from the merger: “No, I don’t think this has anything to do with the new organisation. The A&E problems we are experiencing are nationwide in England right now.”

Health unions believe increased funding will help and are calling for an investment in staff to work in A&E units.

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

Dr Peter Carter said: “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.”

The crisis in A&E has been at the centre of a 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 the General Election in May.

At Southampton the pressure has eased.

Previously bosses had issued a black alert with some non-urgent operations cancelled, but the trust has since de-escalated to red, with all surgery going ahead as planned.

A spokesman said: “The hospital remains very busy with medical admissions, which are up by six per cent since Christmas compared to the same period last year and have the additional pressures of lost beds due to delayed discharges.”

The number of patients requiring a care package before they can be discharged has risen by 11.7 per cent on last year, he said.

Despite requests from the Daily Echo, managers at the Hampshire Hospitals NHS Foundation Trust have not commented on the volunteer appeal, the number of postponed operations or the hiring of agency staff.