Phil Hunt on dealing with the unnecessary pressures now faced by A&E departments
Peers return to the crucial NHS issue later today in a debate led by Labour’s Margaret McDonagh on the future of accident and emergency units.
The pressures on A&E are very well known and symptomatic of a near collapse in the system in some parts of our country. Add to that the inexplicable closure of walk-in centres and the replacement of NHS Direct by a wholly inadequate 111 service, and you see why poor access issues in primary care have been exacerbated. People are often being left with no choice other than to turn up at A&E, leaving hospitals very full as a result.
Of course, the discharge of patients is becoming harder because of severe cutbacks in social services. Local authorities are now less able to provide community support, with more and more old people left without the support needed to allow them to be cared for at home. In a major report, published last week, the Care Quality Commission showed that avoidable emergency admissions to hospital for the over 65s have topped half a million for the first time, and are rising even faster than the increase in the ageing population.
At a time when the NHS should be focusing its energies on getting the system to work properly, it has been forced to spend the past three years implementing a costly and unnecessary structural change. During this time, the Health Secretary has presided over a loss of over 6,600 nurses and the creation of 12,000 new bureaucrats.
To tackle the government’s disastrous stewardship, there is now a pressing need to integrate NHS and social care services to provide whole person care and prevent unavoidable hospital admissions. Urgent and emergency care is in similar need of change. Sir Bruce Keogh's recent review argues for a ‘fundamental shift' in the provision of urgent care. His key recommendation is for those with more serious or life threatening emergency needs to receive treatment in centres with the right facilities and expertise, in order to maximise their chances of survival and a good recovery. Once it has enhanced urgent care services outside of hospitals, the NHS would then introduce two types of hospital emergency department with the current working titles of ‘emergency centres’ and ‘major emergency centres’.
Of course, reform of emergency care is a necessary step forward for an integrated system of care. But it is essential that before there is a stampede of closures of current A&E departments, decisions are based on robust clinical evidence. Any signs of closure for financial reasons must be resisted.
The case of Lewisham Hospital is a clear case in point. A much admired hospital, its A&E services were threatened with downgrading so it would no longer provide emergency care for critically ill patients who did not need to be admitted to hospital. This was proposed in order to shore up the finances of a neighbouring group of hospitals which in the 12 months to March 2012 reported a deficit of £65 million. Lewisham Hospital campaigners and Lewisham Council won a historic court battle to prevent this from happening but the Coalition has since introduced an amendment to the Care Bill to make this kind of thing much easier to do in the future.
The government’s disastrous reorganisation of the NHS and failure to manage the system is putting the NHS under ever more pressure. Ministers urgently need to get a grip.
Lord Phil Hunt of Kings Heath is Shadow Health Minister in the House of Lords
Published 26th November 2013
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