Congested A&E and low bed count: what do these symptoms tell us of the NHS’s current condition?
Edmund Stubbs, 18 December 2014
This week we have once again been informed that A & E departments all over the country are experiencing real problems of “over demand”, we have also seen yet another hospital: Gloucestershire’s hospital trust, reporting a major “service provision crisis” due to lack of available bed space.
In two respects, problems of accessibility to A&E services are more “noticeable” than that of the general quality of care on hospital wards and in the community. Firstly, the A & E “four hour target”, that is the percentage of patients being either seen, treated, admitted or discharged within 4 hours of walking in to an A &E department is highly visible and therefore easily assessable, as is the second, a lack of available bed space where hospitals can no longer accommodate patients sent from A and E on the wards. We have to ask if these two measures might act as “warning symptoms” for a timely assessment of the state of the NHS’s health?
Statistical evidence from the four hour targets is collected regularly and can therefore, in theory, objectively indicate the stress that A and E departments find themselves under. As we have seen recently, extra money has been pumped into the A and E departments of those hospitals declaring “major incidents” and can thereby have extra staff provided to them; and routine scheduled operations have been cancelled to produce extra bed space.
Worryingly, recent statistics reveal a general reduction in treatment rates according to the four hour targets and also indicate an increasing frequency of bed shortages. This is particularly alarming simply because of the non-subjective nature of measurement which is not easily available for other aspects of NHS service. It is obvious that issues such as falling standards in patient satisfaction, safety, and the quality of treatment are much less objectively assessed, making any deterioration in them much harder to identify.
It seems likely that if highly visible areas of care such as that offered by A & E departments are “creaking under pressure” this would also suggest that similar pressures might have caused significant damage to other less visible areas of care. The quality assessment of these less visible areas of service, has been much debated since the founding of the NHS, and many different criteria of measurement have been utilised, but these, often necessarily subjectively based measures, have often suggested contradictory conclusions.
Thus in diagnosing the degree of infirmity of the NHS, perhaps we should not think of this winter’s slipping A & E targets and bed shortages as particularly obvious symptoms of immediate crisis, but instead think of them as the outward signs of a disease that has been slowly progressing, largely unseen, for many years.
In the light of a projected funding gap of £30bn by 2020, it may be that now is the clinically critical time for a life saving injection of significantly increased funding into an evidently failing system. How this extra funding is to be sourced and administered to the patient is a matter for our politicians, but it is undoubtedly urgent, the patient’s condition is now critical.
Edmund Stubbs, Healthcare Researcher, Civitas
The problems with A and E and insufficient beds in hospitals tells us this:
1, You cannot import 5-7 million new people to a country in a few years and fail to increase resources proportionately and still have the same service as existed before.
2. GPs make it so difficult to get an appointment quickly that A and E is the only resort many people have. The old system of patients going to a GP without an appointment, waiting their turn on a first come first served basis with the GP waiting until all patients had been seen was infinitely preferable to the present appointment only system except for real emergencies.
3. Care provision for the elderly and disabled is seriously inadequate.
4. Privatisation of services leaves hospitals without clear chains of command. For example, fairly recently I was in a London hospital which had PFI contracts for the ward cleaning, the provision of food and the cleaning and maintenance of multi-media installations (TV, Internet etc). It was chaos with dangerously low levels of hygiene. The harassed sister of the ward told me nothing could be done beyond making a complaint to the contracting firms if work was substandard.
5. GPs have been given too generous a regime with home visits and out of hours advice over the phone going by the board ,while at the same time their pay has been considerably inflated.
6. The incessant upheavals caused by governments of different ideological hues are severely disruptive.
7. The cutting back of training of British doctors and nurses .
8. The inefficiencies caused by employing in hospitals foreign staff at all levels who have wholly inadequate English. I have recent personal experience of this.
7.