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| Demand soars at busiest A&E units | Demand soars at busiest A&E units |
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| London's busiest accident and emergency departments are already facing the volumes of patients seen during the peak of the winter crisis of last year, according to a leaked document that discloses the scale of the challenge facing NHS hospitals. | London's busiest accident and emergency departments are already facing the volumes of patients seen during the peak of the winter crisis of last year, according to a leaked document that discloses the scale of the challenge facing NHS hospitals. |
| The flood of patients into A&E has seen waiting times rise across the capital, leaving almost 10% of people waiting for more than four hours in London's biggest hospitals. Normally this level of long waits in the NHS in London does not occur until well into December. | |
| The emergence of the document, leaked to the Health Service Journal, follows the recent disclosure that the Royal London hospital in Whitechapel, east London, could not admit even emergency patients for two days earlier this month as it struggled to reconcile demand with a shortage of beds. The hospital was forced to operate a one-in/one-out policy. | The emergence of the document, leaked to the Health Service Journal, follows the recent disclosure that the Royal London hospital in Whitechapel, east London, could not admit even emergency patients for two days earlier this month as it struggled to reconcile demand with a shortage of beds. The hospital was forced to operate a one-in/one-out policy. |
| In a stark email message to staff, Len Richards, chief operating officer of Barts Health, the NHS trust that runs the Royal London, wrote: "No beds available for emergency patients. No beds available for elective patients. An extremely poor discharge picture." | In a stark email message to staff, Len Richards, chief operating officer of Barts Health, the NHS trust that runs the Royal London, wrote: "No beds available for emergency patients. No beds available for elective patients. An extremely poor discharge picture." |
| Across the capital almost 5% of patients were found to be waiting four hours or more to be admitted or discharged in the week ending 8 September, touching but not breaching the government's target. But the leaked document showed "type one" NHS hospitals, which operate full A&E services, were seeing 91.9% of patients within four hours. | |
| Last winter was a turning point for the NHS, and such was the pressure that medical staff reported patients attending accident and emergency wards had to be left on trolleys in other parts of hospitals without nursing supervision because there was nowhere else to put them. | Last winter was a turning point for the NHS, and such was the pressure that medical staff reported patients attending accident and emergency wards had to be left on trolleys in other parts of hospitals without nursing supervision because there was nowhere else to put them. |
| There is a political argument over what has caused the higher demand for A&E, although most experts blame patients' inability to access alternatives such as good out-of-hours GP services and hospitals being unable to discharge ill patients into the community. Both require large sums of cash in a system that is meant to be making billions of pounds of savings. | There is a political argument over what has caused the higher demand for A&E, although most experts blame patients' inability to access alternatives such as good out-of-hours GP services and hospitals being unable to discharge ill patients into the community. Both require large sums of cash in a system that is meant to be making billions of pounds of savings. |
| In a short-term response, the government this summer announced a two-year, £500m injection of cash to tackle winter pressures on the worst performers. Labour says the sum seriously underestimates the problem, noting that since last September 980,068 patients had waited longer than four hours to be seen in A&E units. Between 2009 and 2010 the figure was 353,617. | In a short-term response, the government this summer announced a two-year, £500m injection of cash to tackle winter pressures on the worst performers. Labour says the sum seriously underestimates the problem, noting that since last September 980,068 patients had waited longer than four hours to be seen in A&E units. Between 2009 and 2010 the figure was 353,617. |
| Shadow health secretary Andy Burnham said the government had shied away from tackling the crisis and claimed that funding to deal with the A&E crisis had been cut by the health secretary, Jeremy Hunt, despite government claims of providing extra cash for the NHS. | Shadow health secretary Andy Burnham said the government had shied away from tackling the crisis and claimed that funding to deal with the A&E crisis had been cut by the health secretary, Jeremy Hunt, despite government claims of providing extra cash for the NHS. |
| Burnham said last year an emergency £330m had been made available to NHS A&E units, while only £250m would be made available next year. "David Cameron used smoke and mirrors to claim he was helping hospitals – but he's been found out," Burnham said. "Ministers have actually cut the support for A&E. It is little wonder they've found themselves on the brink longer before winter sets in." | Burnham said last year an emergency £330m had been made available to NHS A&E units, while only £250m would be made available next year. "David Cameron used smoke and mirrors to claim he was helping hospitals – but he's been found out," Burnham said. "Ministers have actually cut the support for A&E. It is little wonder they've found themselves on the brink longer before winter sets in." |
| Experts said Labour had a point about the shrinking pot of cash but warned that the problem had been allowed to fester for decades. Michelle Drage, the GP chair of Londonwide Local Medical Committees, said the funding "was a smaller sticking plaster than last year but it is still a sticking plaster". | Experts said Labour had a point about the shrinking pot of cash but warned that the problem had been allowed to fester for decades. Michelle Drage, the GP chair of Londonwide Local Medical Committees, said the funding "was a smaller sticking plaster than last year but it is still a sticking plaster". |
| Drage said the problem was that 90% of funding went to hospitals, when to prevent patients from needing to go to A&E there should be "more money for social care, GPs and community health". | Drage said the problem was that 90% of funding went to hospitals, when to prevent patients from needing to go to A&E there should be "more money for social care, GPs and community health". |
| Others described the internal report, by NHS England, as a "wake-up call". "There is clearly a pattern of warning signs of the pressures likely to come this winter," said Chris Hopson, of the Foundation Trust Network, which represents NHS hospitals. | Others described the internal report, by NHS England, as a "wake-up call". "There is clearly a pattern of warning signs of the pressures likely to come this winter," said Chris Hopson, of the Foundation Trust Network, which represents NHS hospitals. |
| "Our members are doing all they can to prepare for next winter but there needs to be a recognition our population is getting older and more ill while the NHS faces a difficult financial squeeze." | "Our members are doing all they can to prepare for next winter but there needs to be a recognition our population is getting older and more ill while the NHS faces a difficult financial squeeze." |
| A Conservative health spokesperson took issue with Burnham's figures, saying that any "attempt to spin £250m extra funding as a cut is ridiculous, and shows just how desperate Labour's NHS scaremongering has become". | A Conservative health spokesperson took issue with Burnham's figures, saying that any "attempt to spin £250m extra funding as a cut is ridiculous, and shows just how desperate Labour's NHS scaremongering has become". |
| The Department of Health did not respond to calls for comment. | The Department of Health did not respond to calls for comment. |
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