An unhealthy situation

IN 2010 a new coalition government set its own target for hospital accident and emergency (A&E) departments: 95% of patients were to be dealt with within four hours of their arrival. Since July 2013 the mark has not been hit. February brought A&E’s worst miss yet (see chart): 18.4% of patients waited more than four hours to be treated, transferred or discharged.

This can be blamed on various bottlenecks, but the worst restricts the passage from hospital to social care. Old people stay longer in hospital than they need because there is no one to look after them at home and no place available in a nursing home. In early 2015 the inability to sort out subsequent social-care arrangements to free hospital beds accounted for around a quarter of the delays in transferring A&E patients. It now accounts for about a third.

Growing demand has not helped. In 2005-06, 18.8m people went to A&E; by 2014-15 the total had risen to 22.4m. Numbers were flat the following year but John Appleby at the King’s Fund, a think-tank, reckons A&E departments had already reached a tipping point. When a hospital has filled almost all its beds, small fluctuations in demand make a big difference.

Solutions seem far off. The current government’s pre-election promise to smooth the path between health and social care has yet to have much effect, says Andrew Haldenby of Reform, a think-tank. The proportion of people struggling to get help from a GP surgery rose from 12% of those surveyed in 2011 to 15% in 2016, making the “worried well”—37% of those turning up at A&E just need advice—harder than ever to shift.

Some ideas show promise. Lakeside Healthcare, a large GP surgery in Northamptonshire, has a new urgent-care centre giving appointments at less than a third of the cost of an equivalent A&E visit. It has cut overnight stays in local A&Es by up to 50%. Such measures are sorely needed: A&E will not cure itself.