A&E delays reach a new record

In the news today, A&E departments underperformed for the second month in a row. They were unable to see 95% of all A&E patients within four hours. Which seems an awfully long time anyway until you look up the target, which is to “see”, “treat”, “admit” or “discharge” in four hours. Hospital administers are citing the lack of doctors as the reason they are unable to meet their targets.

Prof Mark Pugh, of Chorley NHS Trust, said: "We simply cannot staff the rotas and it is an unacceptable risk to patient safety to attempt to provide an emergency service with no doctors available to see people."

The target of 95% in 4 hours, is just a figure plucked out of the air anyway. So there are lots of ways round it if you are just trying to meet a target and not save lives. So you could leave anyone who is nearing the 4-hour mark to basically rot. Then focus on just clearing 95%. However, there are lots of other options. 4 hours is a very long time to make a change if you are getting too busy. Let’s face it, our local hospital is Newark in Nottinghamshire, which is about 140 miles from London, or about 1 hour 20 minutes by train. They could ship a doctor from a London hospital to Newark, and back again, in 4 hours!



So what do you do when you have a staff shortage in a critical skill set?

As a shift pattern consultant, I am often asked how to cover a temporary shortage while they recruit more people onto the team. There are lots of options available to managers who face this problem. The first step is to estimate the short fall and then see how much resource you have available. This can be a lot harder than you might think if your workload changes on a daily basis.

Once you have estimated the shortfall, you can then take steps to hire more people. This takes time, in the case of doctors, then it takes years to train more to cover a whole country’s short fall. So you need to use your current resource to cover the shortfall in the short term and then give them more time off in the future. So you can use overtime, agency workers or over staff them now and give them time off in lieu in the future when you can spare them.

One of the issues with using agency workers in hospitals, is that there is a cap of 55% above normal shift rates set on locum staff. Normally overtime rate (for industry within the UK) is about 50% above shift rates with double time on weekends and Bank Holidays. Now this means that on average if you work overtime you get an average of 65% above normal shift rates assuming that the requirement is evenly spread. It is very unlikely that the spread would be even in the first place as most staff shortages occur on nights and weekends because holidays will skew the distribution. This means that if you have a doctor who is willing to work overtime, then if they work for another hospital they will be taking a pay cut to work those hours without the agency fees being taken into account.

Hence hospitals are running short. Hospitals are limited by their current staffing levels. So what they need to do is use their current resources more effectively. This means that they need to over roster their current staff. This causes all sorts of issues in and of itself. Over rostering, means that you have to be careful of fatigue and run specialist shift patterns to limit their fatigue. In the past we have created shift patterns that allow people to work an average of 20% more hours than their basic working week. This can be a great temporary boost.


The other option is of course to use your current staff more effectively. So you change the way they work, or use assistants where ever possible to lower their workload. If the NHS had more GPs for example that were more readily available, then the workload in A&E might be reduced. The fact is if you can’t see everyone in four hours, there is a buildup. We are not talking about a large accident here; we are talking about a consistent under resource. So you know when you are busy and the four-hour target means that you would have to be consistency busy for at least 8-hours. That is an entire shift. So a simple easy to implement solution is that you have flexible shifts, where the person on the next shift can be called in two or four hours early. Often just one more person for a few hours can make the difference.

If you are currently failing to meet your workload or targets, then perhaps a different approach is needed. Please contact us at alec@visualrota.co.uk or call us on (+44) 1636 816466 to find out how we can help.