This week and last, the media has been widely reporting major incidents being declared at hospital A&E departments up and down the country - and a state of affairs normally associated with rail crashes, riots or sinking ferries is now presented nightly on TV as massive over demand for emergency healthcare services and the forced closure of many leading hospitals leading to new admissions. Patients are being seen waiting and sometimes dying in corridors and on trolleys because the hospital just hasn’t got the resources to care for them.
We all know that going to casualty can mean hours waiting to be seen and treated – it’s one of the reasons numbers attending have remained manageable for so many years. If you don’t want to sit on a hard seat being serenaded by the local town drunk into the early hours, you do all you can to be seen during office hours at your local GP surgery. So why now is the system suddenly unable to cope?
The truth is that today’s overloads are the result of many years of mismanagement of local health and social services by successive governments.
The first nail in the emergency department door was when the Labour government scrapped out-of-hours work for GPs and gave them a new contract AND a lot more money. Whereas in the past you could call out your own doctor if you had a pain in the tummy at 3 o’clock in the morning, now that’s simply no longer an option. General practice is increasingly acting as a mere staging post for a longer and frequently pointless journey to the local hospital.
With demand increasing, the second hammer blow has come from recent cuts in social services provision for the elderly in the community; if you are in hospital and want to come out, there’s often no place to go if you are old and infirm with no nearby relatives. That means the bed is blocked - and those teaming masses in Casualty won’t get access to it for days or even weeks.
And with the worst of the winter weather still to hit us, it seems unlikely that anything is going to get any better any time soon.The temptation for any new government formed after the General Election in May might be to reverse some of the changes introduced in the past - or worse, to introduce yet another major reorganisation of primary care. But although seemingly sudden in their appearance, the issues at the root of these major incidents will be anything but quick to fix.
In truth some of the solutions are already on the drawing board and contained in the recent Five Year Forward View announced before Christmas by NHS England. Trusts and CCGs must be given the ability to integrate in a far more effective way than they are at the moment. But for now the answer must lie in better communications and public health education – a role in which all UK health stakeholder organisations can play a part.
Like so many crises, this one may represent a unique opportunity for state and independent commercial health groups to get some fundamental messages across about disease, risk and good management..