Accident and Emergency waiting times reached a nine-year-high in April, with NHS England repeatedly missing its four hour waiting time target.
The latest figures from the Health and Social Care Information Centre reveal a million more people than normal using the service with the result that A&E departments are stretched to breaking point, leaving experts alarmed.
– Chris Hopson, Foundation Trust Network Chief Executive
We had ambulances queuing outside A&E departments and patients having to wait in ambulances to get into the A&E department, patients waiting on trolleys in corridors which nobody in the NHS wants to see but when the system gets overwhelmed that's what happens."
So what is causing the breakdown in our A&E departments?
Many suggest it is a combination of factors including a lack of GP out-of-hours services, failings of the NHS 111 helpline, health tourism and an ageing and increasingly frail older population.
In a special programme, Tonight has spent 24 hours at the Royal Preston Hospital, where 5,000 more patients annually visit the accident and emergency department than two years ago.
We hear that earlier this year, there were so many patients admitted via the emergency department that planned operations had to be cancelled to free up hospital beds.
Tonight carried out an audit of patients attending A&E between 3pm on Sunday 23rd June and 3pm on Monday 24th June to investigate why people were attending and to ask whether it is always the most appropriate place for them to be treated.
At 3pm on Sunday, the waiting room is full, mainly people with minor injuries, like Daniel Barkley who sprained his ankle on a drunken night out, and he is fairly jovial despite the pain.
In less than an hour we see our first emergency when 11-year-old George Solar arrives by ambulance.
George cracked a rib playing football two days ago, but is suffering stomach cramps and vomiting.
George’s mother dialled the NHS 111 helpline and they arranged for an ambulance.
NHS 111 has been the centre of much controversy since it’s launch at Easter this year, with critics saying that callers can find it difficult to get through and that in some instances, operators are mis-diagnosing conditions and sending people to A&E inappropriately.
The Health Secretary told Tonight:
– Jeremy Hunt, Health Secretary
It is true that you have new employees doing the job for the first time; the 111 service was only launched this Easter and sometimes people aren’t familiar with how things work.
I do think we need to look at whether 111 needs to be quicker at getting people to talk to a doctor or a nurse when that is what they need, but with going through all these problems it is beginning to meet some of its operational targets and we will get there.
At around 7pm on Sunday, Wali Rahman comes in by an ambulance.
He says he is an asylum seeker from Afghanistan who is suffering a spell of dizziness. He says it is his fourth or fifth visit to Preston’s A&E department and despite numerous tests, doctors have been unable to find anything wrong with him.
As an asylum seeker, Mr Rahman is entitled to free health care until his case is determined. The Government say that foreign nationals who are not entitled to free health care are costing the country £20 million and they intend to introduce legislation which will ensure that in future, they pay for their care.
Through the night we see a number of elderly patients arriving at A&E, many with chronic long-term health problems, like Joyce who has had a fall at home.
She has numerous ailments and says “I’m in and out all the time with something and for the last six years, I've seen four different surgeons here."
An ageing population and cuts in community care budgets means that more elderly people end up coming to hospital and they are staying in for longer too.
Nationally, the number of people aged over 60 attending A&E has increased from two and a half million to almost four million. Approximately 70% of the entire NHS budget is being spent on treating elderly patients.
Karen Partington, Chief Executive at Lancashire Teaching Hospitals NHS Foundation Trust, explains that there have been times at Preston Royal Hospital when so many elderly patients have been admitted that it was necessary to procure extra beds:
– Karen Partington, Royal Preston Hospital chief executive
We had a lot of patients coming through the A & E department, they were coming in very late at night, and our beds were already full with very sick, frail older patients and therefore we weren’t able to accommodate other patients."
This problem is occurring at hospitals all over the country. In the last few months, over 1,600 planned operations were cancelled in NHS hospitals in England due to bed shortages.
On the Monday morning, patients start arriving at A&E because they cannot get in to see their GP, like young Ellis Bamber who is brought in with a bruised toe by his mother.
According to the Government, four million more patients attended A&E over the past year because they couldn’t get an appointment to see their GP.
– Dr Clare Gerada, Royal College of General Practitioners chair
We are heaving under the work load.... What the Royal College of GPs is really asking for is more GPs so that we can provide better services to patients so we can spend longer with our patients and provide them with continuity which is what they need.
During our 24 hours at the Royal Preston Hospital 204 patients came through the Accident and Emergency department doors - that is one every seven minutes.
40 of those were admitted into hospital, but not everyone who turned up here needed to be seen in an emergency setting.
27 were referred to primary care to see a GP and the rest, 137, were checked, treated if necessary, and sent home. The hospital met itss target and saw every patient in less than four hours.
Watch Tonight: Crisis in A&E on ITV at 7.30pm to hear the patients' stories first hand and discover what’s really happening in our A&E departments.