Hello everyone and welcome to this episode of TMG podcast. The NHS’s own guidelines state that 95% of patients should be seen within the first 4 hours of their admission. This means they have to be either discharged, transferred to a different provider or admitted to a specialised hospital ward. Let’s start exploring the usual problem with NHS waiting lists. I am your host Makeen and let’s go.

As mentioned above, the NHS’s target is that 95% of A&E visitors should be seen within 4 hours. However, this is a very ambitious percentage to aim for. There are many reasons why this is not possible to achieve. For example, understaffing, lack of resources and people attending to A&E when they don’t need to.

It is estimated that if the NHS was to fix this problem, 3.8-5.2 billion pounds are needed. This is not something the NHS can afford with its budget.

Types of A&E facilities

Type 1 These are led by consultants. They run on a 24/7 basis. They include full resuscitation services and accommodation beds in case patients need to stay.

Type 2 This is a single speciality facility led by a consultant.

Type 3/4 This is the more common and well-known type of A&E. walk-in centres, urgent care centres and minor injury units, even units for severe toothaches. These are usually led by either consultants or nurses. They are usually found in the community.

Which type is behind?

It is usually type 1 A&E facilities that are behind their targets. They constantly fail to meet their targets.

Initially, the guidelines stated that 98% of patients needed to be seen within the first 4 hours. In 2010, this was reduced to 95% to help meet targets and boost the morale of A&E doctors. However, this target was rarely met. By the end of 2018, the percentage reached was84.4%. Even though that was higher than the previous year, it still was not high enough.

The percentages of targets met changes seasonally. For example, usually winter seasons have the worst number of targets met where healthcare services are usually strained the most.

This will be bad in many ways if it continues in the future. Firstly, patient safety will start being compromised. If a patient presents with a minor injury/complaint, it might develop into something more severe and complex if it is not seen and sorted soon. Secondly, the NHS is usually presented in a negative way because of these long waiting times and packed emergency departments.

And finally, we can all see why such problems would be of higher concern during the coronavirus pandemic circumstances where hospitals are fully packed already with COVID-19 patients.

How can this problem be solved?

The NHS chief executive, Simon Stevens , suggested a triage scheme to help A&E departments meet their targets. Basically, those with minor alignments are forced to wait longer whilst priority is given to those with higher risk injuries. That way the chances of survival for someone with an acute injury will increase, and their recovery will be maximised.

This sounds good overall. However, there are some concerns about the sort of priority that will be given to low-risk injuries. Some believe that people with minor injuries will now have to wait even longer than they used to before. This is especially true since it is proposed that the minor injury unit can be used to see people with high risk injuries. And as we mentioned before, there is the additional risk of a minor injury developing into something serious if not seen soon enough.

Another option that’s been suggested is charging people for A&E attendances. It is suggested that this will make people think twice before going into A&E. As a result, there will be much shorter queues in A&E departments, reducing waiting times. However, people who oppose this solution remind that this goes against the NHS’s principle of healthcare for all available for free at the point of delivery.


Well everyone that was an overview of a common problem that faces the NHS. I hope that you have found this episode helpful. If you have any questions drop us a message on instagram @themedicalgeeks. Alternatively you can visit our website themedicalgeeks.com. Stay tuned for more episodes, until then stay safe. I am your host Makeen and goodbye!

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