Wednesday, 3 December 2014

Don’t add to the A&E health crisis, minister — cure it

There used to be a huge sign outside the A&E at King’s College Hospital. It was a reminder that the service is for “real” emergencies and that A&E “won’t kiss it better”. When you consider some of the reasons people have turned up in emergency departments — hangovers, bad hair days, dog poo on a shoe — the banner seemed like some much-needed hypochondriac-shaming. For A&E is the doormat of the NHS: abused and over-used.
It’s partly a victim of its own success. Thanks to the four-hour target for waiting times, the public know they will usually receive swift treatment. That treatment will commonly be of a high standard too. Which is great for patients but means A&E becomes a magnet, drawing in those who should really be going to their GP.
Including, it seems, the Secretary of State for Health. Jeremy Hunt told the House of Commons this week that he took his children to A&E one weekend because he didn’t want to wait to see a GP. I can’t attack him for that decision. We don’t know the situation that brought his family there and it can be terrifying to have a sick child; no one wants to be the parent who misses meningitis. It’d also be hypocritical of me. I once ended up in A&E (a source of guilt to this day) after being turned away twice elsewhere. I was in considerable pain and pretty desperate but far from my deathbed.
Hunt does still deserve criticism, though. For his comments will encourage the public to skip straight into A&E for any problem that the scandalously over-diagnosing Dr Google suggests they may have, at a time of year when services are already stretched. And Hunt was using this personal experience to promote his political cause: he wants GP surgeries to stay open seven days a week. But that’s a pledge for 2020; it’ll do little to ease the pressure on the NHS now.
His statement also perpetuates a belief that emergency departments — since they never close their doors — are an infinite resource. But they’re actually one of the more expensive places to provide primary care. So instead, Hunt should be trying to publicise and improve other available services such as walk-in centres. Unfortunately, under his government, a quarter of those have shut.
To help the day-to-day running of emergency departments, the government also needs a strategy to remove “exit blocks” in hospitals, which are created by a lack of social care ready for patients being discharged. This particularly applies to the elderly, who often have to wait for places in nursing homes or respite care. With other wards clogged up, doctors can’t move patients out of A&E beds.
The situation is only likely to get worse, with consultants warning of an impending A&E crisis. Hunt should be busy trying to stop that; instead his comments could have the opposite effect, making it an even bleaker winter in A&E.

Updated: 12:35, 27 November 2014 

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