Hindsight and foresight: what has caused this winter’s A&E crisis?
Edmund Stubbs, 29 January 2015
Today, Civitas has published a report which identifies 11 factors ranging from an ageing population to an inappropriately staffed NHS 111 phone line as being principle causes of so many A&Es missing their waiting targets, sometimes to the point of declaring major incidents, this winter.
The report also holds the efficient running of emergency departments to have been hampered by inappropriate funding mechanisms and a lack of responsible senior staff. Efficiency has further been compromised by community and social care services failing to provide adequate care for both physical and mental health patients outside hospital, causing their health to deteriorate to a “crisis” point that forces them to seek urgent treatment at A&E.
Whether blame for the current situation can also, in part, be attributed to the attitude of a ‘right now’ generation; younger adults who use A&E services much more readily than older patients is also investigated. As Britain now has the longest average working hours in Europe (at 43.6 per week), it may be that younger people in employment find it difficult to obtain convenient appointments with their GPs outside of working hours. Many work a considerable distance from their homes, and, until the start of this year, patients were required to register with a GP in their residential catchment area, often far away from their place of employment.
Linked with this factor, the report suggests that the closure of walk in health centres (where no prior appointment is required) might have acted to encourage attendance at A&E; just as GP surgeries are becoming more accessible due to the implementation of less rigid surgery hours and wider registration.
Lastly the report discusses whether the targets A&E departments are missing were appropriately set in the first place, and looks at the example of Wales to see if the healthcare policies implemented by the Welsh Labour administration have contributed to the even poorer A&E performance recorded in the principality.
The full report is available at: https://www.civitas.org.uk/pdf/majorincidents
Missed A&E targets might indicate slipping standards in other, less observable areas of healthcare. To safeguard the future of A&E, and indeed of the whole NHS, it is important that we ascertain and evaluate the varied causes of the current crisis. We must also look to what might be done in the future to remedy the situation. The report highlights the possible future collaboration of GPs, hospital specialists and community providers in order to provide off-site emergency care, or teams of paramedics and nurses able to treat patients experiencing minor health crises in their own homes.
Edmund Stubbs, Healthcare Researcher