ONLY half of all children and elderly patients with broken limbs receive adequate pain relief within an hour of arriving at accident and emergency departments.

Research by the Healthcare Commission, the health inspectorate, revealed that few A&E departments come close to achieving the government target of providing pain relief within 20 minutes. Even after an hour, only 53 per cent of children and 42 per cent of elderly patients in moderate or severe pain had been given pain-relieving drugs.

However, the researchers found that 71 per cent of A&E patients rated their overall standard of care as excellent or very good. There were “disconcerting” variations between hospitals, the commission found. Staffing is not the reason, it concluded. Many departments have acquired extra staff without any improvement, suggesting that investment in services has been wasted.

“Extra staff are only likely to yield beneficial results when the purpose of the extra staff is very tightly focused — for example where a problem or bottleneck has been identified,” the commission concludes.

The report was based on information about three conditions: children in pain from a broken elbow or wrist, elderly patients with a hip fracture and also patients who had taken an overdose of paracetamol. Standards for treatment were laid down by the British Association of Emergency Medicine.

So few met the standards that the commission had to modify them to make a meaningful comparison. But even when A&E departments were allowed an hour to provide pain relief, many failed.

In some hospitals only a fifth of children and a seventh of elderly patients had been given painkillers within an hour. Some managed to treat 100 per cent of patients within an hour.

Anna Walker, Chief Executive of the Healthcare Commission, said: “A&E departments have overall made great strides in improving services, in particular on waiting times, which are very important to patients.

“They now have to go the extra mile if they are to deliver the care their patients need, and that means focusing on quality as well as waiting.”

For patients with a broken hip, X-rays should be taken within an hour. Only a third of patients were treated within the target. Only about 65 per cent of patients who arrived at A&E within eight hours of a paracetamol overdose were treated within the stipulated eight-hour target.

The results of the December 2003 audit were shown to hospitals which were then audited again in February 2005. Only 50 out of more than 200 were able to respond in the time given, and these hospitals showed some improvements.

The commission also carried out patient surveys, which showed that the great majority were satisfied, saying that their care had been excellent or very good. Waiting time was the main key to patient satisfaction.The report found no clear correlation between staffing levels and performance of A&E departments. Since 2000 the average department has 20 per cent more nurses, 27 per cent more doctors and 37 per cent more consultants.

Lord Warner, the Health Minister, said: “A&E services have been making excellent progress over the last two years, and we are pleased that this report reflects this. Our A&E management data shows week-in-week-out since March the NHS has seen 98 per cent of patients within four hours.

“Not only is the NHS improving access, but it is working hard to deliver consistently high standards of clinical care in A&E. The four-hour target is helping to raise clinical standards and we are developing new measures for the quality of care patients receive. These new benchmarks will be used to secure even more improvements and greater consistency across the NHS.”

The NHS Confederation, which represents more than 90 per cent of NHS organisations, said the commission’s report showed that A&E services have improved, despite the very large challenges placed upon staff in terms of increased patient demand.

Nigel Edwards, the confederation’s director of policy, said: “The majority of patients are happy with the care that they receive. As more improvements are made it is likely that demand will increase further.

“It is important now to try and build on the fact that 71 per cent of patients rated the care they receive in A&E departments as excellent or very good and make further improvements.”

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