Leading Article: Time to declare a state of emergency

Arriving at a casualty department cradling an injured child, most of us expect to be greeted by state-of-the-art health care, a hospital with plenty of skilled doctors and nurses. The NHS might have queues for operations, but it is meant to be ready for accidents and emergencies.

Yet the reality is alarming. At night, there are usually more drunks than doctors in casualty departments: you can sit for hours untreated as overworked nurses try to cope. There have been instances of people lying for 24 hours on trolleys before being formally admitted.

These problems are long-standing. Later this year, the Audit Commission is expected to make fierce criticisms of the care offered by casualty departments. Its report will stir a national debate into a growing scandal.

And the situation is about to get worse. As we reveal today, there is a serious shortage of junior doctors. Next month, more than a quarter of all A&E junior doctor posts in England will be unfilled - nearly 300 out of a total of 1,300. That means that emergency admissions will get even slower and the log jams of patients blocking cubicles and spilling into corridors will increase.

The main cause of the problem has been the Government's policy to cut the long hours worked by junior doctors. Now that junior doctors are working shorter hours, more are needed. But poor planning means that the extra staff have not been trained and are simply not available.

No one seems to have anticipated the looming crisis, least of all the medical establishment. Indeed, the Royal College of Surgeons has made matters worse. In 1994, it dropped its requirement that would-be surgeons should have six months' training in A&E medicine. As a result, many surgical trainees are happy to avoid six months of setting broken limbs and stitching minor wounds. There was no consultation with the Department of Health about the college's decision, even though the change has compounded the already serious shortage of doctors.

Demand for health care is notoriously hard to predict. Nobody, for example, has been able to explain properly why there has been a steady increase in admissions to casualty departments over recent years. Suspicion has fallen on some fundholding family doctors, said to be saving on their budgets by sending patients into hospital as emergency cases. But the evidence is inconclusive.

Whatever the reason, such unpredicted changes demonstrate that hospitals must keep spare capacity so that they can cope with the unexpected, especially emergencies. They must ensure that they maintain healthy levels of staffing.

Gerald Malone, the health minister, is at last taking some action: more non-consultant senior doctors are to be appointed to casualty posts and nurses will be drafted in to perform more tasks. But this is not enough to deal with the crisis.

The answer is to require all juniors, including those going on to be surgeons, to spend six months working in A&E medicine. This may sound like press-ganging, but urgent measures are needed. In any case, we might all feel better if every new doctor was trained to cope with an emergency.