The fault lines may appear in A&E but the causes are complex and run deep
Few things in life stimulate and stir emotions and debate more than a "crisis" in A&E. Recent years have witnessed a steady and relentless focus on A&E provision by politicians, campaigners and the media. According to the Press, the good ship NHS is sinking before our eyes.
Demand for A&E has increased and it is generally depicted as a system in meltdown, limping from one disaster to the next. Multiple problems from elsewhere in the health and social care system tend to coalesce in A&E and cause delays and disruption, the fault lines appear here but the causes are complex, multi-faceted and run much deeper.
There are three main reasons for the difficulties. Firstly, A&E continues to be used inappropriately. Health and social care services should be intuitive and easy to navigate and this is currently not the case.
People turn up at A&E because they believe it to be their best or indeed their only option. Other services such as walk-in centres, GP out-of-hours, urgent care centres, minor injuries units and NHS helplines need to be expanded and better understood. Figures from the King's Fund, the leading health and social care think-tank, reveal nearly 40% of patients attending A&E leave without requiring treatment.
Second, bed-blocking in hospitals has a knock-on effect for emergency departments. The key challenge for A&E is the flow of people in and out of hospitals. More than two-thirds of hospitals beds are occupied by those admitted in an emergency. When wards are full, people who need to be admitted end up queuing in A&E. Patients cannot be discharged because of a combination of factors; such as waiting to see a consultant, for tests, or for a social care package. If they do not secure appropriate support they may end up in a cycle of readmission.
Finally, staff shortages remain a perennial issue. The issue is not the total number of staff, but securing the appropriate combination of staff, particularly senior doctors. Hospitals are struggling to recruit to these posts and often end up relying on temporary, more junior staff.
The truth is that A&E is surrounded by myths, hysteria and confusion. However, simply throwing more money at the issue is not the answer. Against a backdrop of unprecedented demographic change, increasing expectations and a challenging fiscal environment, we must ensure the development of an accessible, well understood health care system which makes the best use of resources and ensures care is accessible, appropriate and closer to home.
Transforming Your Care set out a roadmap for change, its implementation is crucial to securing a sustainable health and social care system, but the fundamental changes it advocates require leadership, political courage and long-term strategic vision.
- Professor Heenan was involved in the development of Transforming Your Care