Children and old people attending hospital accident and emergency departments with painful fractures often have to wait more than an hour before getting painkilling drugs ranging from paracetamol to morphine, the hospital inspectorate reveals today.
Although under-16s are usually seen slightly more quickly than adult patients, many with broken arms or wrists are having to put up with the pain for far longer than recommended by casualty doctors' guidelines.
Nearly six in ten patients with broken hips, most of them over 75, are also being offered analgesics too late in many departments, according to a report from the Healthcare Commission. In addition, only a third of such patients are x-rayed within the hour.
Results from an audit last year of 170 of England's 202 A&E units reveals huge variations in the quality of care despite the massive strides taken in meeting government targets.
Although some hospitals have updated returns, with better results, it is clear that some are still well short of standards demanded by clinical bodies and patients.
"A&E departments now have to go the extra mile if they are to deliver the care that patients need and that means focusing on quality as well as waiting," said the commission's chief executive, Anna Walker. "This report suggests serious variations in the quality of care. Monitoring standards of quality must become a core part of the day-to-day management of these units."
The commission is to replace its star ratings system of NHS trusts, which is largely based on how they meet waiting list and time targets, with one that takes far more account of patients' experience.
The report on A&E units, which treat about 13 million people each year, more than one in five of them children, represents a step along the route.
It assesses clinical care for common conditions against standards set by the British Association for Emergency Medicine (BAEM). They included the treatment of children's fractures and hip fractures.
In the average department, just over half of children in moderate to severe pain from a fractured arm or wrist received analgesia within an hour of arrival. In six departments all children were offered pain relief within 60 minutes, but in eight fewer than 20% were.
BAEM guidance says children in severe pain should get painkillers within 20 minutes of arrival and those with more moderate pain within 20 minutes of triage, when doctors or nurses assess the priority for treatment.
For older people with hip fractures, the picture was worse. In the average department just 42% of patients were offered or received analgesia within the hour. BAEM guidance suggests that those in severe pain should have to wait no longer than 20 minutes.
In spring this year, 47 departments submitted figures showing improvements. For them, the average percentage of children receiving analgesia within the hour went up from 60% to 70%.
The survey also assessed how departments coped with paracetemol overdoses and found variable results. The commission says other conditions such as asthma, major trauma or fever in children should be monitored in future.
The great majority of patients, however, were happy with overall care in A&E units - surveys showed 71% thought it excellent or very good.
