Panorama: What has labour done for the NHS? BBC One, Sunday, 20 February 2005, 22:15 GMT

During filming at Bedford Hospital we learned that A&E attendances were on the increase. The trend is repeated nation-wide. Panorama asked the experts what was going on. There seem to be several reasons.

According to Mike Harley, health service performance analyst and Director of Inter-Authority Comparisons and Consultancy based at Birmingham University

"For the last few years the attendances have been pretty much the same from year to year, but suddenly last year they went up about 18% in England as a whole. GPs are referring more patients to A&E rather than deal with them themselves."

GPs are referring more patients to A&E rather than deal with them themselves. Mike Harley, IACC

"Their out of hours service has been reduced so again patients may be going themselves to A&E, and the waiting time in A&E because of the government's targets is now below 4 hours where they might have to wait a couple of days to see their GP, so that might be causing the increase."

Professor John Appleby, Chief Economist at the King's Fund, believes there's an additional reason: NHS Direct - the government's innovation of a 24 hour telephone advice service (which is also available on the internet). According to him

"There's also another source of demand which is NHS Direct... there's some research to suggest that that's also generating extra demand for A&E."

"The activity and the calls are all monitored for NHS Direct, so we know what the recommendation is by the nurses who are speaking to people who phone up NHS Direct. We know those statistics are collated in terms of their final recommendation which may be don't worry, or it may be go and see your GP or go to an A&E or dial 999 now."

the graph shows a rise in A&E attendances across England

"The increased A&E attendances have resulted in a huge increase, 40% increase in the last 5 years in referrals that go through A&E into their main departments, and that's going to have a big effect on their bed use."

Despite this growing demand, A&E departments are still treating people quickly. In his annual report to the NHS (December 2004), Chief Executive Nigel Crisp says that by October (2004) 96.4% of people were spending less than four hours in A&E from the time they arrived to the time they were admitted, transferred or discharged.