Crowded A&E? Then supply more ward beds

SIR – We read with interest your report on the reduction of NHS beds and its impact on A&E departments (September 29).

From an international perspective, there is incontrovertible evidence that a crowded emergency department is a reflection of a crowded hospital. With no beds available, emergency patients cannot be transferred to the wards. This leads to backlogs in the emergency department, its waiting room and the ambulance bay.

The scientific evidence is equally clear: a crowded A&E is a dangerous one.

Patients waiting on trolleys for admission, usually society’s most vulnerable, are at risk of delayed medical care, medical error and complications, including death. Science aside, a prolonged trolley wait robs patients of their dignity and promotes unnecessary suffering.

This problem will only get worse as the population ages with their burden of chronic disease. Successive governments have tried to solve it by blaming the patients and focusing on diversion away from A&E. This strategy is doomed to fail. Success depends on increasing hospital bed

access. Any suggestion to the contrary is simply daft. Dr Alan Drummond

Chair, Communications, International Federation of Emergency Medicine Melbourne, Australia

SIR – No longer being subject to the European Working Time Directive (EWTD) would improve productivity in the NHS, not least in A&E departments (report, September 30).

In 1992 the medical profession agreed to limit working hours for junior doctors to 72 hours a week. The EWTD cut this to 48 hours.

Apart from reducing productivity, this inevitably reduced the time available for training and educating junior doctors. It also compromised continuity of care for patients by changing to a rota system from the previous firm structure which had been so successful.

Attempts have been made in the past to gain exemption from the EWTD for the medical profession but without success. However being able to do so will be one of the benefits from leaving the European Union.

Sir Terence English FRCS

Oxford