ONE of the region's largest hospitals is having to ask consultants to work later because of an unprecedented surge in out-of-hours admissions.

Bosses at the James Cook University Hospital in Middlesbrough have noticed a significant increase in the number of patients coming through the accident and emergency department in the evening and through the night.

To respond to this trend the South Tees Hospital NHS Trust board is being asked to invest an extra 250,000 a year to ensure senior doctors are available in A & E after hours.

Adrian Clements, a consultant in emergency medicine, who is also the A & E departments clinical director, said a number of factors could be to blame.

The changes to the GP out-of-hours contract may have something to do with this. There is no doubt that it has had an impact on attendance in the early evening, said Mr Clements.

People may also be confused how to access out of our primary care services. They come to A & E because they know we are always open, he added.

The surgeon also suspects that the changes to the licensing laws may play a significant role.

We used to be busy after the pubs closed then when the clubs closed but now they are coming in throughout the night.

The A & E department used to go quiet at 3am but we are still busy at 6am. We have become a 24 hours culture, he added.

Mr Clements said the sustained overnight surge of patients was putting a strain on the unit in terms of the time it took to treat people and the quality of care provided.

The majority of breaches of the four hour waiting time target now occur during the evening and weekends, said Mr Clements.

A national report recently concluded that patients presenting at night in A & E were subjected to a lesser standard of care without the presence of a consultant.

Apart from people injured because of accidents and fights around one in four chronically ill patients present for treatment during the night.

In 2006-07 the A & E departments at James Cook and The Friarage in Northallerton treated 117,000 people. In 2007-08 that figure reached 121,000, a record for the South Tees trust.