4 Nov 2013

Where are the radical solutions, as winter closes in on a struggling NHS?

Any day now, NHS England’s medical director Professor Sir Bruce Keogh will deliver his report on the way urgent care is delivered.   It cannot come soon enough.   The pressure A&E departments are feeling has been in the headlines for what feels like months now and for all the wrong reasons.

Government Pledges Increase In NHS Funding

NHS England’s own figures show that in September 43 per cent more patients waited longer than four hours in A&E compared with the same months two years ago.  Trolley waits of more than four hours and less than 12 hours were also up by 89 per cent over the same period.

Winter woes

Now the Health Service Journal, trawling the same data, has found that the number of trusts missing the government’s four-hour waiting time target over the first two quarters of the year has more than doubled, from 35 in 2011-12 to 78 this year.

The importance of these figures is that they are not in the winter.  These were April to September when the snow has cleared.  These are the months that the NHS has traditionally been able to take a deep breath.

So the fact it has not happened this year does not augur well for the winter, especially if there are high flu levels around.

NHS England and the Department of Health have taken notice of all this.  After all, what health secretary wants patients waiting on trollies in corridors on his watch?

Cash injection

Planning started earlier than usual and struggling A&Es have been given some money to help.

But as the President of the College of Emergency Medicine, Dr Cliff Mann, said when I spoke to him at the weekend, this is a problem that is not going to be resolved by a quick injection of cash.

Their own figures show that over the last three years, 383 higher specialist registrar posts have been unfilled and it is getting worse.  So far this year, 61 per cent of those posts haven’t been filled.

Why this matters is this simple.  Each registrar would have seen around 2,000 patients each.  The College says this is 766,000 patients each year which is broadly equivalent to the number of patients seen in 12 district general hospitals.

Dr Mann said that emergency medicine is now considered such a pressurised job, doctors just do not want to specialise in it.

Radical solutions?

There are, of course, the other now well-rehearsed problems of too many people going through the doors of A&E and of too many delayed discharges, so patients are in hospital beds instead of at home or being cared for in the community, which in turn blocks beds for people being admitted through A&E, which in turn means longer waits.

The thing is we have filmed in several A&E departments over the past few months and I have even been in one with my daughter after she hurt her head in an accident. Without fail they were busy and there were a few staff shortages.  But in each one, whether we were filming or being treated, the staff coped so fantastically well and were (with only one exception that I can think of) helpful and calm and reassuring.

It is hard not to feel sorry for them as the winter approaches because they already seemed to me to be working as hard as they possibly can.  It can only be hoped that Sir Bruce has some radical solutions up his sleeve.

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