Saturday, 17 January 2015

The Guardian view on the crisis in A&E: only part of the story

Too few GPs, not enough consultants, flawed bureaucracy. They all make it worse

A patient is taken from an ambulance outside the A&E department at St Thomas’ hospital, London. ‘This week alone, more than a dozen trusts have declared major incidents, a device to allow them to call in extra staff and resources.’ Photograph: Dan Kitwood/Getty

Domestic political affairs are unavoidably diminished by the enormity of an attack like that on French satirical weekly Charlie Hebdo in Paris. Some MPs argued that politicians too should have marked the moment by suspending hostilities at prime minister’s questions in the Commons, which began barely an hour after the news from Paris first broke. But to allow terrorism its power of disruption is to award it a kind of victory.
The crisis in accident and emergency which has erupted this week in all parts of the UK should never have happened, not least because the government scrambled so desperately to avoid it. In England, since June last year, £700m has been poured into averting it, as the health secretary, Jeremy Hunt, told MPs. Everything has been done that could have been done, averred NHS England boss Simon Stevens. Even so, more waiting targets were breached in December than at any time since the information was first collected. This week alone, more than a dozen trusts have declared major incidents, a device to allow them to call in extra staff and resources.
What happens in A&E does not happen in isolation. The shortage of emergency care consultants, like the crisis in GP provision, is important, but it’s only a part of the story. The shadow health secretary, Andy Burnham, is right to argue for more integrated care. But as the respectedKing’s Fund recently found, social care cuts are less to blame for bed-blocking than bureaucratic cock-ups in the NHS.
The King’s Fund study reveals complex causes: 2,500 more people every day go to A&E, partly because of a surge in numbers going to walk-in centres or minor injuries units. But waits there tend to be well within the four-hour limit, which helps to disguise the gravity of the crisis in major emergency units that, by December, had been off target for an astonishing 73 consecutive weeks.
The shape of the big changes implied by the NHS five-year forward view is uncertain. Mr Stevens wants to see what works. It could be a GP-led option for groups of local providers – a victory for the bottom-up approach. Hospitals want the vertical integration that GPs fear would leave them at the bottom of heap. Either would mean a remodelled NHS and, in theory, a more efficient route through the system for the patient. But it will be a slow process, requiring strong nerves and firm purpose. With healthspiking near the top of the political agenda in an election year, both of those will be in short supply.

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