A&E wait times: Rise in under-twos waiting more than four hours to be seen

Science Editor Deborah Cohen spent time at Leicester Royal Infirmary's emergency department

It seems that barely a week goes past without headlines describing worrying waits for ambulances and emergency departments.

We’ve heard about hospital flow - how problems in social care mean that people can’t be discharged from hospital, and this in turn has a knock-on effect on the ability to admit new patients, meaning they may be waiting far too long in A&E.

There’s currently a four-hour target to be seen.

But how do these waits break down by age? An exclusive analysis for ITV News by health think tank the Nuffield Trust breaks this down.

Older people do consistently wait much longer than younger people, with the longest waits for the over 90s.

A&E waiting times for children: a breakdown

"We’ve had this real challenge with pressure across the NHS that’s continued across the summer months, which we would normally only expect to see at the worst points in winter,” Sarah Scobie, deputy director of research at the Nuffield Trust told ITV News.

“One of our worries is that longer waits have sort of become normalised which is going to ultimately lead to safety concerns, I think.”

Some of the delays for older people may be explained by the fact that they’re more likely to need admission to hospital.

But what about the kids?

There has been a significant drop in the number being seen within four hours, with almost one in five under-twos waiting more than four hours. Things are not much better for older children.

Experts have told ITV News that the issues facing children have perhaps been overlooked.

ITV News spent time with Professor Damian Roland, consultant in paediatric emergency medicine at Leicester Royal Infirmary.

“Children don't choose to attend an emergency department themselves. They're brought there. And actually some adults who are in an emergency department for a long period of time kind of can understand and rationalise that, but, but if you're a young child, you can't. And it's quite distressing,” he says.

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There may be several reasons for the increase in waits. Like in adult care, there are staffing issues.

“Over the last year, we are seeing much increased volumes, but also more severe presentations [of illnesses],” Professor Roland says.

“I think there are challenges with flow. Because we've got more children with complex needs, they are more complex to treat, so spend longer in hospital and if you've got more patients spending longer in hospital, there's less bed availability. And that produces crowding in the emergency department itself.”

Paediatricians have also told us that patterns in respiratory viruses and mental health issues are contributing to the waits.

“There's more children in hospital, in a medical institution with a mental health problem than there's ever been before,” Prof Roland says. And the waits for these children can be particularly distressing for them and for others, he says.

“That's why getting on top of this mental health crisis is so important,” he adds.

A previous analysis by the Nuffield Trust found that access to mental health and other health services was severely disrupted by the pandemic and it says it has stored up significant pressure on health services.

They also found that children with mental health issues face the longest waits.

Professor Roland says they’re also seeing a change in the pattern of seasonal respiratory viruses. They’ve seen more than they usually would in summer. The change makes it difficult to predict when the impact will be felt in A&E. And children with respiratory problems can take time to treat.

Nine-and-a half-month-old Leila had one of those winter viruses, called RSV, in August. It usually causes a mild cold-like symptoms.

But Leila developed a respiratory illness called bronchiolitis, which can make it difficult to breathe.

RSV accordion

What is RSV and does it require hospital admission?

RSV is common in babies and children, and almost all children will have had it by the time they are two-years-old. The virus may cause a cough or cold. But for some it can lead to bronchiolitis – an inflammatory infection of the lower airways that can make it hard to breathe.

What are the symptoms?

The early symptoms of bronchiolitis are similar to those of a common cold, but can develop over a few days into a high temperature, a dry and persistent cough, difficulty feeding, and wheezing. While many cases clear up in two to three weeks, a number of children need hospital admission.

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It was her change in behaviour and drowsiness that concerned her parents, so they brought her to emergency. She’s now come back with a wheezy cough.

RSV levels are now comparable to what they were before the pandemic at this time of year. But flu is also increasing, so some are worried about the impact of both on emergency services.

“I think the public have a really important role to play here. The vast majority of viruses are simple self-limiting illnesses,” Professor Roland says.

"As long as they stay hydrated, you don't need to seek any more help. What emergency services are here for is the children who aren't really feeding at all, or that you are really worried that their breathing is so laboured that they're not able to walk about or mobilise.”

Professor Roland consults a parent who's brought their baby to hospital with RSV

Dr Conall Watson, consultant epidemiologist for the UK Health Security Agency, said: “If parents are concerned about an infant that has cold symptoms plus noisy or fast breathing, irritability or difficulty feeding, then they should get advice from 111 or their GP. If your child seems seriously unwell, trust your judgement and get emergency care.”

The agency has issued advice for parents and carers.

With the NHS bracing itself for a difficult winter, the DHSC said that it has “plans to rapidly boost capacity and resilience ahead of winter, including increasing the number of NHS 999 and 111 call handlers and creating the equivalent of at least 7,000 more beds.”