A&E data reveals widening hospital disparities

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HUGE disparities in performance at A&E units across the region have been exposed in new figures revealing significant differences in demand for care depending on where people live.

In Wakefield, where attendance rates were among the highest outside of London, 378 people per 1,000 used major A&E services in 2012-13 but in neighbouring Leeds demand was 20 per cent less, while in the East Riding people were half as likely to require care.

Further significant differences are revealed in performance within A&E units linked to a target to discharge, admit or transfer 95 per cent of patients within four hours.

At Bradford Royal Infirmary, the decision to admit patients for further care took place in two in five cases in the 10 minutes before the key four-hour target time was reached in 2012-13. In Hull, a third of all admissions through A&E also took place in the same 10-minute window, compared with only one in 10 at the NHS trust running York and Scarborough hospitals.

Overall 25 per cent of all admissions in England and 22 per cent in Yorkshire took place in the same time 10-minute timeframe indicating clinical decisions are being taken to fit in with targets.

Further analysis shows one in seven patients being seen in A&E at the Hull and Bradford NHS trusts were either discharged, admitted or transferred in the same 10-minute window. At the York trust, this happened in only one in 25 cases, according to figures by the Health and Social Care Information Centre.

Over the 12 months, five of the 17 NHS trusts in Yorkshire – Barnsley, Doncaster and Bassetlaw, Leeds, Sheffield and York – missed the four-hour target. The Bradford and Hull NHS trusts were among those which met it, with the best performance in Harrogate.

The figures show the proportion of people visiting A&E in Wakefield is among the top 10 per cent in England. Rates of attendance at A&E in Barnsley, Bradford, North Lincolnshire and the Calderdale and Huddersfield area were at least 10 per cent above the regional average but in Wakefield people were 20 per cent more likely to go to A&E.

London had the highest rate of A&E attendance at 312 per 1,000 people, but Yorkshire was not far behind with 302 per 1,000 people, compared with the lowest rates in central southern England where only 189 people per 1,000 people sought A&E care – fewer than two thirds the Yorkshire figure.

Officials in the Wakefield area yesterday said they had joined other NHS organisations in West Yorkshire to fund a campaign telling local people about where to get the right treatment if they were ill. They said local publicity aimed to reduce numbers requiring emergency help by urging people to seek treatment earlier.

Adam Sheppard, urgent care lead for NHS Wakefield Clinical Commissioning Group, said: “Many people who attend hospital A&E departments don’t really need to go to hospital. They could be treated more quickly by their GP, their local pharmacist who can offer advice on common illnesses and the best medicine to treat them, or even by themselves with basic self-care, first aid and advice.

“We need to make sure that everyone knows about the range of NHS services that are available. Many people don’t realise how much time and money they cost the local NHS when they use A&E services unnecessarily.”

Helen Barker, chief operating officer at Bradford Teaching Hospitals NHS Foundation Trust, said: “We are reviewing our emergency care pathway to ensure that we are able to transfer our patients to wards as quickly as possibly when demand for beds is high.”

Figures show GP referrals accounted for 5.3 per cent of attendances in A&E units in Yorkshire, in line with the national average, indicating family doctors are not referring excessive numbers to hospital for urgent care.

Overall there were 18.3 million attendances in A&E units, walk-in centres and minor injury units in England in 2012-13, up four per cent on the year before. Monday at 10am was the busiest time.

A third of patients were discharged with advice or guidance only, indicating they did not need to have gone there.

Problems affecting A&E units have come under heavy scrutiny in recent months.

Numbers of major emergency units providing specialist care are likely to be cut significantly under plans backed by NHS England medical director Professor Sir Bruce Keogh who has warned the existing system is under “intense, growing and unsustainable pressure” causing by more people turning to A&E, an ageing population and “confusion” over existing services.

A second tier of emergency centres for assessing patients and starting treatment is being proposed.