Saturday, 17 January 2015

How to solve the crisis in London’s A&E departments

Conservative cuts to NHS budgets and rebranding of services are leaving doctors and nurses frustrated and exhausted, says MP

London's A&E departments are facing an ever-growing crisis as patient numbers mount up this winter. Photograph: Ik Aldama/Corbis

Across London’s accident and emergency departments tonight history is repeating itself. Patients will suffer and doctors and nurses will be frustrated that they cannot give their best. It need not happen.
Twenty-three years ago, A&E across London was in crisis. As a new MP I made late-night visits to departments across the city. What I saw that winter will stay with me forever: frail, elderly people lined up on trolleys in holding areas, exacerbating dehydration and bed sores; ambulances queueing; nurses often weeping as they finished their shifts, exhausted.
After 1997, Labour applied the lessons of failure to ending the inevitability of the winter chaos. We did so by building greater capacity – more doctors and nurses, greater access to GPs, specialist walk-in centres, and the creation of NHS Direct. When we left office in 2010, 98% of patients were seen within the four hour A&E target. But new solutions are always needed; what worked then would not be enough today. And now we are back where we were – in crisis.
How? Well, first, the Tories’ disastrous re-organisation of the NHS has undermined public confidence that help is there when they need it. A&E is open 24 hours a day. No other service is.
Second, ministers took the successful NHS Direct, scrapped it and replaced it with 111. Now just 20% of callers manage to speak to a nurse – under Labour’s system it was 60%. That’s not rebranding a vital service, but ruining it, leaving those in need unsure, so they turn to A&E.
Third, almost one in four walk-in centres have closed.
And short-sighted cuts to social care (up to 20% in some London boroughs) means once again that those who need help are forced elsewhere. That means they turn to A&E, too.
The result is that demoralised, demotivated and overworked doctors and nurses are feeling like they have just had enough, leaving trusts such as Barking, Havering & Redbridge struggling to find the staff it needs. Last week, King’s College Hospital had the equivalent of a whole ward full of elderly people ready to go home, another full of people who need never have been admitted in the first place.
The doctors, nurses and carers know how to put this right: sensible decisions, from short-term changes to long-term planning. First, we need 24-hour facilities: patients are arriving at A&E for simple but time-consuming procedures because the services they need are closed. They shouldn’t be.
Next, we should be boosting community alternatives like @home, where nurses provide community-based care across Lambeth & Southwark, helping many patients avoid hospital completely.
Third, we need to build public confidence that being looked after at home is as good as going to hospital – in fact it’s often far better for those patients where comfort is key.
Finally, we have to create care which is seamless, to support the range of human need. It is cheaper and better.
These are simple, straightforward steps to ease the pressure – not just on our health service, but on our health professionals as well. After all, doctors and nurses enter their professions motivated by a sacred vocation to care and to make people better. The frustration expressed by so many through stress or by leaving the health service is because they are being denied the ability to exercise their professional calling to give people the care they need.
Tessa Jowell is the MP for Dulwich and West Norwood

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