Do only 1 in 6 A&E units have enough consultants?

24 July 2013

"Just one in six [A&E] units has enough consultants during busiest times."

Daily Mail, 24 July 2013

The past few months have been busy ones for doctors and nurses across the country. After the hotly-debated Health and Social Care Act came into force this spring, the NHS has endured criticism for delays in Accidents and Emergency units. Meanwhile, in response to the Keogh Mortality Review, the government has put 11 hospitals into special measures in a bid to improve their mortality rates.

The latest piece of bad news arrived this morning in the shape of a report from the House of Commons Health Committee, whose report into emergency care found "broader failure resulting from fragmented provision of emergency and urgent care and a structure that is confusing to patients".

To illustrate the problem, the Daily Mail pointed to one striking statistic in its headline: that just one in six A&E units were sufficiently staffed with consultants.

This is a figure that was itself reported in the Health Committee's findings, which note that "only 17% of emergency departments in England are able to provide 16 hour consultant coverage during the working week".

However the source of the claim is the College of Emergency Medicine, which surveyed 131 Emergency Departments in 2011 and 2012. It found that 17.5% had at least one consultant on duty for 16 out of 24 hours of a weekday, and 14.6% could say likewise for weekends.

Whether the 16-hour mark represents a level of coverage that is "enough" is more contentious. It's the benchmark recommended by the College, although there isn't an official target set by the Department of Health, who instead ask for "an appropriate mix of consultants, middle grades, advanced nurse practitioners, major nurse practitioners, physician assistants and extended role HCAs (Health Care Assistants)".

If we were to use a different benchmark however, such as 12 hours, the picture changes markedly, with 77.1% of emergency units crossing this threshold on weekdays, and 30.2% doing likewise at weekends.

(Data graphed by NHS England.)

There is some solace for those concerned by a lack of consultant presence in emergency units.

The College of Emergency Medicine also found that the number of consultants in A&Es has increased over the past five years. As its report notes:

"The average number of whole time equivalent (WTE) consultants per [Emergency Department] is now 7.4, compared to 3.8 in 2007/8."

The Daily Mail is correct in its claim that only one in six A&E units currently has "enough" consultants, so long as we take the College's definition of enough as covering 16 hours of the day. However, the larger picture suggests that there are now more consultants than in previous years.

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