A&E Crisis 'Biggest In Over A Decade'

[Wyvern]

Sky News

A&E Crisis 'Biggest In Over A Decade

A&E units are facing their biggest challenge in more than a decade due to "unsustainable workloads" and a lack of staff, a new report has warned.

The College of Emergency Medicine is calling for an overhaul of the system, which it says is struggling to cope with rising attendance rates.

Its report came as new figures showed 18,300,190 people attended A&E units in England between February 2012 and January 2013 - a rise of 1,034,802 on the previous year

Only because the Government is running the NHS down.

Safe in their hands. Yeah

I guess most members of this forum dont yet have to worry about their health, but when the time comes it may be too late. Im now too old to be marching to Parliament Square (even if I was allowed to) All I can do is rant on the internet.

 

[SS4]

Doesn't surprise me. Call me cynical but I would not be surprised if it was being deliberately run into the ground to make full privatisation a more attractive option

 

[gordonthemoron]

funny how private hospitals don't have A&E

 

[table38]

Even the Daily Mail / Mail on Sunday has been campagining about this, so it must be bad

http://www.dailymail.co.uk/news/article-2323141/Shocking-proof-Accident-Emergency-closures-cost-lives-Death-rate-jumps-THIRD-department-closes.html

http://www.dailymail.co.uk/health/article-2324065/Private-hospital-blunders-How-NHS-picks-bill.html

I have had some experience of this in the last few years whilst looking after a housebound elderly relative.

Calling the doctors surgery when she was ill generally elicited the response "if she is that bad, call an ambulance". On arrival at A&E, they wanted to know why she didn't go to her GP first

If I were cynical, I might think that if the GP/locum attended, the cost of that comes out of their PCT [1] budget!

[1] or whatever PCTs are called this week.

 

[yorksrob]

I heard on the radio that A&E departments are funded using a very strange arrangement whereby they are given a quota of people to see and they are only reimbursed 30% for any additional patients treated.

This seems particularly counter-productive since even if A&E did manage to get people to go elsewhere (not that they have much choice on who turns up through the door) they'd still pop up somewhere else on the NHS anyway !

 

[SS4]

I heard on the radio that A&E departments are funded using a very strange arrangement whereby they are given a quota of people to see and they are only reimbursed 30% for any additional patients treated.

This seems particularly counter-productive since even if A&E did manage to get people to go elsewhere (not that they have much choice on who turns up through the door) they'd still pop up somewhere else on the NHS anyway !

No doubt it'll be on someone else's ledger though. It seems to me that a lot of public sector spending is passing debits around and not caring if the amount goes up as long as it's not on your sheet.

 

[NSEFAN]

Government allows population to rise rapidly. Government cuts the number of A&E centres. I do wonder sometimes if the people we elect to run the show are either malicious or just stupid.

 

[jon0844]

Surely we can't lay all blame on the current Government? This is a problem that has been getting worse for many years.

Where I live, we've been living with the fact that most hospitals in Hertfordshire have got rid of A&E (some going for daytime only minor injuries or 'urgent care centres' or whatever they call them). This was happening before May 2010.

The QEII hospital near me still some form of A&E service, but they want to call it a local A&E (again, what does that mean) and it's closed in the evenings and can't deal with every emergency. People must now travel miles on to Stevenage, which by all accounts has had many situations where they can't cope.

Admittedly, many A&E admissions are people who have drunk too much or got into a fight. Yes, they need to be looked after, but society has a lot to answer for here.

The other plans by our hospital trust was to have single manning in ambulances, so they could have more ambulances with less staff (and the obvious issue of - if the ambulance man/woman is driving, who is looking after the patient?). Again, all planned pre-2010.

It would seem that the hospitals and doctors are arguing that they would provide better care by having fewer A&E's, not just the Government keen to make cuts. They argue that they can have all the trained staff in one place and not have to duplicate equipment, which is a fair and logical idea until you consider the huge distances some people are now expected to travel to get to hospital for even the simple things, let alone life-threatening conditions.

Finally, Labour once promised a super hospital in Hatfield on the former British Aerospace site where I now live. The site in question was earmarked for this huge project. Then the Tories took control of the county council, and suddenly out of spite the project was canned.

Now we have a massive Arla dairy distribution warehouse where the hospital would have been, and the nearest hospital many miles away once QEII is decimated.

But, hey, let's lay all the blame on the coalition!

 

[SS4]

Government allows population to rise rapidly. Government cuts the number of A&E centres. I do wonder sometimes if the people we elect to run the show are either malicious or just stupid.

A self-fulfilling prophecy might be in order, shutting A&E centres will make us feel that we have too many people and an almost xenophobic attitude towards foreigners both in general and in healthcare will be backed by the public.

I'd say neither malicious nor stupid but a cross between "I'm all right Jack" and cynicism.


As jonmorris0844 said successive governments have to take some of the blame, NHS policy lasts over years. Society must also bear some responsibility especially with alcohol related injuries. We also call ambulances when it might not be necessary, especially from businesses where they cannot take a risk lest they get sued.

 

[NSEFAN]

But, hey, let's lay all the blame on the coalition!

Until now, nobody has mentioned the coalition. The government may have moved between Tory and Labour over the past few decades, but they have all suffered from the same short-termism, which is now starting to bite back in the form of public services being pushed to breaking point.

I'd say neither malicious nor stupid but a cross between "I'm all right Jack" and cynicism.

You and jonmorris0844 are quite right. I made my previous post in a moment of anger and should not have generalised so much. Problems like these frustrate me greatly as they have been allowed to descend into such a state over many years, meaning they were probably avoidable to some extent. It's like nobody in power really gives a damn about the people they are meant to serve. No wonder the voter turnout is so low.

 

[jon0844]

There is a big problem with the NHS and it goes beyond the way it is funded.

We had the last Government wanting to get waiting times down, and that's all that seemed to matter and by the looks of it, they fiddled it massively by having people seen to and then sent back to wait (or come back another day) which wasn't counted.

As is always the case, people find ways to bend rules. It's not unique to the NHS or the Government of course. I do certainly think MPs are, frankly, idiots or complicit if they can't see how things will be fiddled - but it happens all the bloody time and frustrates me (having family working for, or having worked for, local Government).

We now have hospitals trying to save money, as they always have, run by managers that don't seem to care so much about patient care. These are the ones, along with primary care trusts and all the other organisations that I really haven't a clue what they do or why they exist, who seemed to prefer the idea of fewer hospitals.

The fact that many sites are in ideal locations for housing developments isn't a coincidence either. The QEII has had lots of its land sold off for, yup, flats. Very expensive flats I'd imagine given the scenic location in a garden village, and on a railway line that gets commuters into London in 25 minutes.

Sometimes I do think that some politicians are not deliberately trying to screw us over, but are simply too naive and ignorant. That's just as bad at the end of the day of course!

 

[Wyvern]

Finally, Labour once promised a super hospital in Hatfield on the former British Aerospace site where I now live. The site in question was earmarked for this huge project. Then the Tories took control of the county council, and suddenly out of spite the project was canned.

Now we have a massive Arla dairy distribution warehouse where the hospital would have been, and the nearest hospital many miles away once QEII is decimated.

Ten to one it would have been a PFI. So you had a lucky escape.

http://scriptonitedaily.wordpress.com/2013/05/14/all-in-it-together-how-government-is-handing-ownership-of-our-schools-and-hospitals-to-banks/

. . . the only people who are not benefitting from PFI are the people actually paying for it.

 

[jon0844]

Yes, I suspect it would have been.

What was the hospital that ran out of money before it even opened?

Of course, PFI is perfect for politicians. They've long gone by the time the s**t hits the fan.

 

[Xenophon PCDGS]

I heard on the radio that A&E departments are funded using a very strange arrangement whereby they are given a quota of people to see and they are only reimbursed 30% for any additional patients treated.

I don't know if this still applies, but was there not a similar parallel to what reduced-rate of hourly pay that hospital doctors were paid, after a time-governed "cut off" point when a number of hours worked was passed ?

 

[ralphchadkirk]

The QEII hospital near me still some form of A&E service, but they want to call it a local A&E (again, what does that mean) and it's closed in the evenings and can't deal with every emergency. People must now travel miles on to Stevenage, which by all accounts has had many situations where they can't cope.

It's an A&E from 08:00-20:00 and a MIU from 20:00 to 08:00 - I think!

The other plans by our hospital trust was to have single manning in ambulances, so they could have more ambulances with less staff (and the obvious issue of - if the ambulance man/woman is driving, who is looking after the patient?). Again, all planned pre-2010.

Single manning ambulances was never a plan, and would not be acceptable.
(And, the term ambulance man - really!).


GP's need to work out of hours. There needs to be a better out of hours service. From an ambulance perspective, I need more pathways available to be to refer people to rather than taking them to A&E. Ambulance staff need to get better at saying no to people.

 

[table38]

There is quite an interesting article here about Hinchingbrooke NHS Hospital, one year on after the PCT was outsourced to a private company.

Also predictably the Daily Mail think it's all going well, the BBC think maybe not so good

 

[yorksrob]

I don't know if this still applies, but was there not a similar parallel to what reduced-rate of hourly pay that hospital doctors were paid, after a time-governed "cut off" point when a number of hours worked was passed ?

They may have mentioned it but I was drifting in and out of consciousness at the time

 

[Simon11]

If this is the biggest crisis in a decade, what was the last major crisis?

 

[Xenophon PCDGS]

If this is the biggest crisis in a decade, what was the last major crisis?

I have tried to find who it was who used the words "the biggest crisis in a decade" that is the banner headline of the Sky News link that was included in the first posting on this thread. Can anyone oblige, please ? What was this judgment made in comparison with that could have been a crisis somewhat less important ?

 

[Wyvern]

FRom the apostrophes around the words I assume its a quotation. Most likely from the report by The College of Emergency Medicine.

I've clicked the link but it only takes me to their home page.

Nevertheless I would say it is the figures that are important particularly when the staff reductions are taken into account and reductions in funding.

Other problems are likely to be that hospitals that are in debt and being supported by their PCT may not find help from CCGs that have a lot less money and have priorities of their own. THis is exemplified by Weston General Hospital Admittedly it is a very small hospital but there are many around the country that, if nothing else, are weighed down by PFI debt.

 

[radamfi]

If it is the 'biggest crisis in a decade' then A&E is no worse than it was in 2003.

 

[jon0844]

Single manning ambulances was never a plan, and would not be acceptable.
(And, the term ambulance man - really!).

I was referring to them as that, to make it clear that it was someone driving an ambulance, rather than a car or a paramedic on a bike - obviously working alone.

If you say it was never a plan, why was it being talked about so much? The local papers reported on the plans to have ambulances only staffed with a single person (not ALL ambulances, but enough to have more ambulances in operation without more staff).

Was it a clever Michael O'Leary style deception then? To get everyone outraged about something that was never serious and make us miss what was really going on with the QEII and Lister?

 

[PHILIPE]

The only way problems could be overcome a by paying for extra doctors and nirses in A & E but, of couse, this would entail spending more money so not on. It could be achieved by transferring money from Managers Budgets, i.e. the people making cuts at the front line. The NHS is far too bureaucrativ and bureaucracy only breeds more bureaucracy by "empire building2. An example of this is the newly created posts of Police Commissioners who want want lots of assistants who, in turrn, will want assistants themselves and then a pay rise due to differentials.

 

[SS4]

The only way problems could be overcome a by paying for extra doctors and nirses in A & E but, of couse, this would entail spending more money so not on. It could be achieved by transferring money from Managers Budgets, i.e. the people making cuts at the front line. The NHS is far too bureaucrativ and bureaucracy only breeds more bureaucracy by "empire building2. An example of this is the newly created posts of Police Commissioners who want want lots of assistants who, in turrn, will want assistants themselves and then a pay rise due to differentials.

I've always found this argument an odd one. Managers seem like an easy target and as far as I can remember politicians have always used cutting back on bureaucracy as a way of delivering funding for their schemes. Rarely has it worked, perhaps in part because those who'll lose out are fighting it but also because it isn't practical.

From my (albeit brief) experience in the public sector (second lowest grade fwiw) there is a lot of top down micromanagement and infeasible targets and goals combined with a lack of flexibility. My manager was pressured by their manager who in turn was pressured by the site manager and so on up to Ministerial level. When I left they were talking about merging regional managers though.

No denying the PCC is a farce though

 

[ralphchadkirk]

I was referring to them as that, to make it clear that it was someone driving an ambulance, rather than a car or a paramedic on a bike - obviously working alone.

Unfortunately that term really grates with me - even Teresa May called my colleagues 'ambulance drivers' the other day (and Ken Clarke did it in 1989/1990). I'm doing three years at University - not just a driver!

If you say it was never a plan, why was it being talked about so much? The local papers reported on the plans to have ambulances only staffed with a single person (not ALL ambulances, but enough to have more ambulances in operation without more staff).

The papers say lots of things. Not all of it is the truth. I am aware of a few isolated incidents where it has happened (usually with an Emergency Care Assistant and not a paramedic, where they are single that day). However it was never, and will never be an official policy. Any paramedic caught doing it, regardless of what their employer says, would be up in front of the Health and Care Professions Council misconduct panel faster than you can say fitness to practise.

In any case it doesn't solve a resourcing problem because if a single ECA turns up on an ambulance, the paramedic or technician comes off the car in order to travel into hospital. They then need to be taken back to the car. And then you've got two resources off the road for a few hours unnecessarily.

 

[jon0844]

Unfortunately that term really grates with me - even Teresa May called my colleagues 'ambulance drivers' the other day (and Ken Clarke did it in 1989/1990). I'm doing three years at University - not just a driver!

I did presume you'd know I wasn't calling them just a driver. Someone coming out in an ambulance that can only drive it wouldn't be a lot of us.

My point was clear; if you're on your own and driving, there's nobody to deal with the patient on the day.

The papers say lots of things. Not all of it is the truth. I am aware of a few isolated incidents where it has happened (usually with an Emergency Care Assistant and not a paramedic, where they are single that day). However it was never, and will never be an official policy. Any paramedic caught doing it, regardless of what their employer says, would be up in front of the Health and Care Professions Council misconduct panel faster than you can say fitness to practise.

I can't see anyone doing it off their own back, so to speak, but it wasn't just in the papers. I'm on a forum for Welwyn Hatfield that had people stating it was an idea considered by the trust, not individual members of staff.

 

[ralphchadkirk]

I can't see anyone doing it off their own back, so to speak, but it wasn't just in the papers. I'm on a forum for Welwyn Hatfield that had people stating it was an idea considered by the trust, not individual members of staff.

It may have been considered by the trust - I'm not privvy to their board meetings, but it would be quickly rejected I would hope!

The only place I am aware of where it is permitted by policy is in South Central, where it can only happen in exceptional circumstances and cannot respond to the full range of 999 calls (if ECA crewed).

 

[jon0844]

I do suspect such ideas were probably then part of a plan to cover up what else was being planned, namely changes to the A&E in WGC and many other changes.

I guess they also need to do whatever they can to distract people from talking about the Surgicentre...

I should say the new maternity facilities, where my son was born last year, is fantastic even though it seems an extremely energy inefficient building!

 

[Wyvern]

The only way problems could be overcome a by paying for extra doctors and nirses in A & E but, of couse, this would entail spending more money so not on. .

Instead of closing down 1 in every 4 A&E departments you mean?

https://www.facebook.com/NationalHealthActionParty?hc_location=stream

From Marcus Chown (@marcuschown), New Scientist magazine's cosmology adviser:

"Why is there an A&E crisis? No, Dave, it's not because of old people, immigrants, killer bees or aliens. IT'S BECAUSE YOU ARE CLOSING A&Es."

And he's right. 1 in 10 A&Es has been earmarked for closure, with similar plans for wards, beds and staffing. These aren't "efficiency savings"... this is decimation of our NHS.

 

[jon0844]

Why is 'Dave' getting the blame when this has been going on for years?

Aren't hospitals and trusts able to make their own decisions, whereby many figured they could save money by centralising A&E departments to save money not just on staff, but also equipment.

And that sounds sensible until you consider the time factor, and how many more people might now die having to travel a further 10, 20 or 30 miles to a hospital that hasn't doubled or tripled its A&E department because it is now taking in people from further afield.

I find it rather disgusting that this is now being blamed on David Cameron. Even if you hate him, hate the Tories, you would be better off venting your anger with the hospital staff and even doctors who still think this is a good idea (but I bet will now be pretending to have nothing to do with it).