A&E waits are the subject of newspapers again. The four-hour target is now being missed by more hospitals than at any other time in the last decade. Winter A and E waiting times are becoming a major topic in the run up to this year’s election.
Some hospitals have had to declare major incidents, calling in extra staff, cancelling operations and diverting ambulances away from A&E units. Pictures have been posted of several ambulances queuing to offload patients.
It has led to reports of patients queuing in corridors, being treated in side-rooms and ambulances struggling to drop patients off.
The 111 help line.
This deals with the majority of calls for health issues. In the past GPs would answer emergency calls; they were replaced by NHS direct which was staffed by mainly trained nurses. This role has been taken over by 111 which is operated by non clinical staff with little training who follow a computer algorithm. The computer algorithm of course does not use common sense and tends to err on the side of caution and staff do not have the medical training to over ride it. About 11% of calls result in an ambulance being sent compared to 3% when GPs were in charge of out of hours and many more are advised to go to A and E.
Often using less experienced [and cheaper] staff is a false economy. Even when it comes to choosing between doctors it has been shown that junior doctors in A and E order more tests and are more likely to admit patients for observation compared to Consultants or experienced GPs and thus lead to higher costs for the NHS.
A and E is an unpopular speciality. Most NHS consultants also see private patients and this can be a lucrative form of income. However there is little or no private work in the field of Emergency Medicine. Unsociable hours and heavy workloads also make it unattractive.
The College of Emergency Medicine says each unit should have 10 consultants with the largest trusts needing up to 16. But the average number stands at just over seven. There are also shortages of A&E nurses.
Councils have cut back on funding for caring for the elderly who can only go back home when there are support services such as carers to visit and help with bathing and shopping. If there is not good access to social care, hospitals can struggle to discharge patients – something that seems to be happening with delays higher in the lead up to Christmas than they were in previous years. These patients end up waiting in hospital till facilities are in place even though they do not need medical care. This is to the council’s advantage – they do not have to fund care while they are in hospital. However there are no beds in wards for patients from A and E to be admitted to.
Evidence suggests that it is harder to access GPs. Although the number of appointments offered by GPs has gone up substantially -[by 50% in the last 10 yrs] this has not kept up with demand. If people cannot access their GPs they may go to A and E to access health care. General Practice is short of doctors and nurses. There have been promises by politicians to train more GPs but training doctors takes many years.