• A&E is under sustained pressure and improving patient flow is important but not sufficient.
• Report focuses on issues that hospital trusts faced in meeting the four hour emergency care standard in winter 2014/15.
• Frontline staff worked hard to maintain safe effective care but we urgently need a more coherent solution to staffing and funding pressures A&E is experiencing.
• NHS Providers established the Right Place, Right Time commission to share evidence from across the NHS on how delays in care can be minimised through collaborative working.  

Monitor have published a report which shows that acute trusts struggled to meet the four-hour emergency care standard last winter because hospitals were too full. With an average 6% rise in the A&E attendances last winter, a bottleneck occurred when it came to finding beds for patients being admitted to hospital. Inpatient wards lacked capacity impacting the exit flow from A&E which had an adverse effect on the ability of A&E to care for patients.

Reducing A&E waiting times is a shared responsibility of a whole local health and care system

The report’s findings suggest that among the best ways to make sure patients receive emergency treatment in a timely fashion this coming winter is to concentrate on smoothing the flow of patients through inpatient wards, to the point of discharge and beyond. That also makes capacity in social and community care important, as the report highlights, and this is beyond the control of hospital trusts. But there are many ways to free up acute capacity that hospital managers can consider, from schemes to provide care to patients closer to home and more standardised management of non-complex elective patients, to smaller-scale but continuous operational improvements across the board.

Commenting on Monitor’s report, A&E delays: why did patients wait longer last winter?, Siva Anandaciva, head of analysis, said that the analysis from Monitor adds to the evidence base on why emergency departments are under such sustained pressure throughout the year: “The NHS frontline has risen to the challenges of improving patient flow, handling delayed transfers of care and caring for patients with multiple morbidities and long term conditions. However, a challenging winter with high bed occupancy, a backlog of elective patients, and increasing emergency pressure from norovirus, influenza and respiratory exacerbations can create a tipping point for performance.

Siva explained that reducing A&E waiting times is a shared responsibility of a whole local health and care system. NHS Providers has established the Right Place, Right Time commission to share evidence from NHS providers, social care, housing providers, families and patients on how delays in care can be minimised through collaborative working. The report on the commission is due to be launched in November at the NHS Providers annual conference and exhibition.