YOUR article (April 9) comments on the fact that, in the week ending March 30, only 70.3 per cent of patients attending the A&E Department at GWH in Swindon were “seen within four hours”. But the actual target is that 98 per cent of all patients should be seen and treated (i.e. sent home or admitted) within the four-hour period.

Although I have been retired for several years, I am well aware of the many reasons why staff may be unable to meet this ideal – most of which are outside their control. Here are some: 1. We have an ageing population who are more likely to become ill.

2. There is increased pressure on GPs, so there is a waiting time to get an appointment; and the ‘out of hours’ cover by GPs has been reduced in recent years.

3. The increased pressure on social services and community nurses (partly due to more people living alone) so there is inadequate ‘care in the community’.

4. Thus, it is more difficult for the hospital staff to discharge patients who no longer need ‘acute hospital care’, but need support at home.

5. There are very few convalescent homes or ‘half-way houses’ (‘intermediate care’).

6. Thus, we have the so-called ‘bed-blockers’ who occupy a hospital bed into which a patient in A&E needs to go – hence the delay in ‘finding a bed’.

7. Also, sometimes, there are delays in getting X-rays or blood tests (and their results) due to increased demand on these services, which delay decision-making in A&E as to what treatment (or care) may be necessary.

8. This, in turn, ‘blocks a bed’ (or trolley) in A&E; thus delaying the new arrivals being seen.

Whatever sort of Government we get after the election, they are going to have to face up to the basic problem facing the whole of the NHS (and social care) – demand exceeds supply.

What is needed is an independent enquiry to look beyond party-political dogma. The members of the panel must include representatives of all political parties, all the professionals who see and treat patients, and members of the public (who use the service). It should be set up speedily and must report quickly; for the ‘front-line staff’ are currently under such severe strain that the service is in danger of collapse – as the figures in your editorial demonstrate.

MALCOLM MORRISON Retired orthopaedic surgeon Victoria Road Swindon