A&E Crisis 'Biggest In Over A Decade'

[ralphchadkirk]

Closing so many A&E departments clearly isn't a good idea for middle acuity cases. It's silly to argue otherwise. In the area I work in they are closing one A&E department, which leaves the population of that area travelling to two other departments, some distance apart, when one of them is trying to cap A&E admissions!

However, centralising services - for example hyper-acute stoke units, coronary interventions and major trauma demonstrably does save lives.

 

[Wyvern]

Sorry. Left wing newspaper and all that . . . .

GUARDIAN: Recessions can hurt, but austerity kills

At least, though, no one in the UK has been denied access to healthcare – yet. Stuckler confesses to being "heartbroken" as what he sees happening to the NHS. "Britain stood out as the great protector of its people's health in this recession," he says. "By all measures – public satisfaction, quality, access – the UK was at or near the top, and at very low relative cost."

But that, he says, is now changing. "I don't know if people quite realise how fundamental this government's transformation of the NHS is," he says. "And once it's in place, it will be difficult, if not impossible, to reverse. We haven't yet seen here what can happen when people are denied access to healthcare, but the US system gives us a pretty clear warning."

 

[jon0844]

I do accept the argument for better facilities in a central location, but the problem is that we really need smaller gaps between them. I am sure that if you started with a blank canvas, you'd lay hospitals out differently so there weren't such huge distances.

This would need more hospitals, but perhaps less than we have now.

And once it's in place, it will be difficult, if not impossible, to reverse

Surely not? You could make some drastic changes, devastating ones even, and surely still overturn and rebuild quite easily if you wanted?

What actually happens is things change, sometimes for the worse, and the opposition moan like madness. Then get in and do sod all to fix things, and just blame the 'last lot' until we change again and it continues...

Labour could have renationalised the railway, and done it in stages if it didn't want a huge outlay in one go. That would have meant all those franchises up for renewal in the mid/late 2000s would have gone back to Government control, and then continued until DOR (or whoever) ran the lot.

 

[Wyvern]

Why is 'Dave' getting the blame when this has been going on for years? . . . . . . .
I find it rather disgusting that this is now being blamed on David Cameron.

The general message is that it has been greatly accelerated with the wholesale (and extremely expensive) reorganisation by this government.
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Surely not? You could make some drastic changes, devastating ones even, and surely still overturn and rebuild quite easily if you wanted?

THe whole structure that we know is steadily being fragmented. These are likely to come under the control of the large multinational health companies (who are likely to cost the taxpayer much more) while it will be almost impossible to replace them with public entities for all sorts of legal reasons. The best hope may well lie in co-operatives appearing, much as community banks are appearing, but can you imagine rebuilding the whole NHS from the ground up?

 

[jon0844]

I can't imagine rebuilding from scratch being easy, but at some point it will have to be looked at given how things have changed.

The location of hospitals, the longer we're living (and that's in part due to hospitals allowing us to live longer) and much more will need the sorts of radical rethinking that the railway is going to have to do too.

I can expect a lot of problems ahead, for sure, and can also expect there to be a lot of resistance. Just look at the firefighters that are now being told that they should expect changes now that they're not dealing with anywhere near as many incidents as they did.

 

[Wyvern]

THe fire people are saying that its because they have been doing a lot of work preventing fires by education etc which wont happen in the future.

Talk about doing yourself out of a job.

 

[jon0844]

I think that there are lots of reasons why there are less fires, as safety standards have risen, all new homes must have alarms (and ours are mains powered, with the battery only as backup - thus lasting 7-10 years and not letting you forget as it eventually alarms continuously!).

Of course, just like revenue protection on the railway, you can't cut all your staff as if you stop the educating (or the enforcement) the problem can come back. And then you need the excess capacity to cope with natural disasters or terrorist incidents etc.

I'd say that a single English fire authority would be a good start though, and then a gradual cut in staff through less recruitment and natural wastage or voluntary redundancies.

 

[ralphchadkirk]

The Fire service are overstaffed and over-resourced. It was only for so long they would have been able to get away with it.

I remember when the London Fire Brigade opened their new Control Centre in Merton, it was noticed by a London Ambulance representative that they had one open call in the whole of London at that time. Apparently the remark that the London Ambulance Service could have found them a desk somewhere in the ambulance control room for far less didn't go down too well

 

[Wyvern]

Getting back to the NHS:

Surely not? You could make some drastic changes, devastating ones even, and surely still overturn and rebuild quite easily if you wanted?

OPEN DEMOCRACY: Lord Owen condemns “conspiracy of silence” on the EU-US trade deal

The Prime Minister writing in the Wall Street Journal on Monday made no mention of health nor the alarming prospect of investment protection being extended to the whole raft of private health contracts in the UK that American health care companies and consultancies expect to be awarded to them in the next few years.

Such protection could have the effect of health contracts being virtually retained in perpetuity with no democratic right for an incoming government to discontinue the contracts once their term had expired without being able to prove gross negligence and risking very heavy compensation payments. Ominously, the Prime Minister suggested that “everything must be on the table” in the negotiations.

 

[Manchester77]

It's disgusting that such an amazing public asset is being run down in such a way that it is. Attlee must be turning in his grave! And surely the way the NHS is being shaped under the current government defies one of its original core principals to be 'based on clinical need, not ability to pay'

If like to think that the NHS isn't ever fully privatised. Surely it'd be a catastrophic PR disaster by the political party that its done by. Regardless of how much we complain about it I'm sure we'd all notice it if it weren't there

 

[Greenback]

The same thing is happening in Wales, which does not have a LIb Dem/Conservative coalition, so I think that the political factor in what is happening to the NHS in England is overstated by some.

There are certain medical specialties that have a shortage of doctors. It is difficult to recruit emergency doctors, and I can see why it is one of the elast attractive options for newly qualified doctors. It must be an unpleasant area of work compared to the alternatives on offer in other areas of medical specialism.

In the long term, something does need to be done about the way medical services ar eprovided to an ageing and increasing population. Although not everyone will agree with the concept of regional centres of excellence, it may be worth remembering that Fabrice Muamba was not taken to the nearest A&E when he collapsed, but was taken to a specialist coronary unit much farther away.

The outcome was good in Muamba's case. The concensus of medical opinion is that had he been taken to the nearest facility, he would not have made it as the necessary expertise and equipment was not there. Unless we ar ewilling to fund the NHS so that every hospital has the latest and best equipment available, then regional centres are inevitable. And that means that some A&E departments will close.

 

[ralphchadkirk]

Unless we ar ewilling to fund the NHS so that every hospital has the latest and best equipment available, then regional centres are inevitable. And that means that some A&E departments will close.

It's not so much equipment, but expertise. To become an expert in a particular area, you need to be doing that work day in day out. A cardiologist at a coronary lab may, for example see 4 or 5 heart attacks a day, because all regional heart attack patients are brought there. Put the same cardiologist in an A&E and he will see nowhere near that number as not all heart attacks in the region are brought to his department, as they will be going to the closest. He therefore becomes less proficient.

I heard Professor Sir Keith Porter speak the other day who put it very well: "If your water pipe bursts, you don't want the plumber who last fixed a burst pipe in 2003. You want the plumber who did one yesterday, and one the day before."

I'm not a supporter of closing A&E departments. I am a supporter of centralisation of some services though.

 

[Greenback]

It's not so much equipment, but expertise. To become an expert in a particular area, you need to be doing that work day in day out. A cardiologist at a coronary lab may, for example see 4 or 5 heart attacks a day, because all regional heart attack patients are brought there. Put the same cardiologist in an A&E and he will see nowhere near that number as not all heart attacks in the region are brought to his department, as they will be going to the closest. He therefore becomes less proficient.

Yes, that is a better word - I should have included some of that in my post!

I heard Professor Sir Keith Porter speak the other day who put it very well: "If your water pipe bursts, you don't want the plumber who last fixed a burst pipe in 2003. You want the plumber who did one yesterday, and one the day before."

Yes, that is the crux of the matter, although some might say they would prefer the nearest plumber so that the problem is fixed speedily, though with a higher risk of the work going wrong.

Though I'm sure their answer would be different if a loved on was involved and it was a life or death situation rather than a pipe!

I'm not a supporter of closing A&E departments. I am a supporter of centralisation of some services though.

I am a supporter of centralisation of A&E. Though I'd prefer downgrading to LAC's or MIU's in preference to complete closure.

 

[ralphchadkirk]

Yes, that is the crux of the matter, although some might say they would prefer the nearest plumber so that the problem is fixed speedily, though with a higher risk of the work going wrong.

Though I'm sure their answer would be different if a loved on was involved and it was a life or death situation rather than a pipe!

Indeed - it's hard to make objective decisions about healthcare as it generally changes when loved ones are involved!

I am a supporter of centralisation of A&E. Though I'd prefer downgrading to LAC's or MIU's in preference to complete closure.

Yes, WIC's or MIU's are preferable to a complete closure. However the problem is that people generally don't know how to or don't want to access them.

 

[Greenback]

Yes, WIC's or MIU's are preferable to a complete closure. However the problem is that people generally don't know how to or don't want to access them.

Quite. I think there needs to be more done to explain the real issues. But it's diffcult when local media starts to campaign to 'save our hospital' and local politicians realise they can also jump on the bandwagon to help them get re-elected next time. (I have being trying to explain to a local councillor that if he suffers a heart attack he would not be taken to the local Emergency Dept anyway, even though it is still open).

Perhaps what we really need are to call regional A&E's 'Major Trauma Centres' as opposed to anything else, and ensure that people realise the differences between such things and a Local Accident Centre or Minor Injury Unit.

 

[Wyvern]

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

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

The Mirror has this today

Jeremy Hunt's claims {that record waiting times are caused by 'overwhelming pressure' on A&E departments} are sunk as leaked report reveals A&E numbers are FALLING

The report reveals 89,215 fewer emergency patients in the first three months of this year compared to the same period in 2012

The figure will raise fears over whether the Health Secretary has a grip on the crisis which experts say will worsen. The report says A&E performance has “deteriorated significantly” over Mr Hunt’s six months in charge.

It reveals 94 out of 152 NHS trusts fail to see patients within four hours – TWICE the number missing the Government target a year ago.

 

[ralphchadkirk]

Perhaps what we really need are to call regional A&E's 'Major Trauma Centres' as opposed to anything else, and ensure that people realise the differences between such things and a Local Accident Centre or Minor Injury Unit.

Interestingly, in my area, they've started calling them all Emergency Departments. I wonder if that's a deliberate ploy to get rid of people who have had minor accidents.

We already have major trauma centres and trauma centres, although the meaning is important internally to the NHS, it's not outside the NHS. The issue with that is to become a TC/MTC you already need an A&E, and those hospitals generally have enough "business" to merit keeping the A&E open.

 

[Wyvern]

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

This from a group caled "Wear Red" I believe puts the problems in a nutshell. (NB Before anyone complains this is not a left wing venture in spite of its name.)

Its not just A&E facilities that are closing but there has been a gradual but significant reduction in wards , beds and other facilities.

We read this morning that hospitals may have to close and hospital waiting lists are increasing due to the need to make 'efficiencies' (in reality budget cuts) imposed by the government.
Wasn't it Mr Cameron who said the NHS is safe in his hands and that he would 'cut the defecit not the NHS'?
We wonder how many hospitals and lives could have been saved if Cameron hadn't and wasn't wasting billions on an unnecessary top down 're-organisation' he assured us before the election would never happen.
Mr Cameron also had the bare faced cheek to try and blame Labour yesterday, conveniently ignoring the fact that under the last government waiting times fell dramatically and satisfaction in the service rose to an all time high.
We strongly believe the current problems have been deliberately engineered by the tories as a smoke screen for back door privatisation .....after all a considerable number of them have vested interests in private healthcare.

 

[Oswyntail]

One problem is that, in some areas of the country (chiefly London and the SE) where there is vast over provision of hospitals. The recent troubles in the Lewisham area were directly caused by this, exacerbated by the PPI builds in the area. But, as press coverage shows, one cannot simply close a hospital. Then there is the similar question of provision of specialist facilities. Take the recent review of child heart surgery. Across the country there is more service provision than is needed, by a long way, with the result that the specialist teams are not getting enough experience, and the costs are being pushed up. But, if you try to match supply and requirements more closely, you get the brouhaha surrounding Leeds. Yes, it would be lovely if every specialist service were available at every hospital, within a 20 minute drive of every household. But we on this board know that ideal provisions cannot be funded - there have to be priorities and sensible organisation. What is needed is a rational debate on what needs providing, where, and at what cost, and not an emotive fog of blather about "privatisation", "Tory cuts", "think about the children".

 

[Wyvern]

. . . . not an emotive fog of blather about "privatisation", "Tory cuts", "think about the children".

Not an emotive fog, but an alternative view of what's going on.

I leave it to the individual readers to research the issues for themselves if they are so minded.

 

[jon0844]

I have had my opinion changed a little about centralising A&E where possible, but the issue for me is that in many cases we're talking about immediate threats to life. Because of the geographical location of existing hospitals, there are going to be many people now too far away from their local A&E. That's a problem - as has been talked about loads in the local press/forums where I live in Hatfield.

If we had thought it better to have super hospitals all those years ago, we'd probably find them positioned in better locations so that there would be less hospitals than we have/had, but not as few as we might end up with.

However, for routine surgery and things that aren't life-threatening then there's less of an issue with having people travelling further to keep specialists and equipment in one place. However, hospitals need to be accessible for both patients and visitors - and that means cheaper car parking, better bus/rail access, or perhaps subsidised travel for patients?

I do think that some people are just concentrating on bashing the Tories, when it seems that many people within the NHS itself acknowledge that there need to be changes. However, since this thread was created, it seems Labour is now realising it needs to be more realistic in its claims to stand any chance of winning in 2015.

It will be interesting to see what happens as a result.

 

[ralphchadkirk]

Agreed - even with centralisation of some services there still needs to be a scatter of A&E departments. For example, major trauma patients get taken straight to a major trauma centre. However if that patient also has a unmanageable airway problem (usually the case in rural areas like Yorkshire) then they will be taken to the nearest A&E for immediate management and packaging for onward transfer.

 

[Oswyntail]

Not an emotive fog, but an alternative view of what's going on.

I leave it to the individual readers to research the issues for themselves if they are so minded.

Of course - but they will have to cut out a lot of biased opinion to get at the facts. So often the reports do consist of little but "emotive fog", as do statements from politicians and pressure groups. They do not offer an "alternative view" - that would consist of constructive dialogue, which is significantly missing.
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Agreed - even with centralisation of some services there still needs to be a scatter of A&E departments.....

I think we need more than a "scatter". A&E and Maternity services are IMHO the ones that should be provided for all communities. But we have to understand what constitutes "A" or (especially) "E". For instance, if your child is running a temperature, that is not necessarily an "E" (though, of course, might turn into one); a large number of visits in the January crisis were with people with either flu-like or vomiting symptoms. Neither is an "E", but is better treated with GP advice.

 

[Greenback]

But we have to understand what constitutes "A" or (especially) "E". For instance, if your child is running a temperature, that is not necessarily an "E" (though, of course, might turn into one); a large number of visits in the January crisis were with people with either flu-like or vomiting symptoms. Neither is an "E", but is better treated with GP advice.

Quite right. At least part of the problem is that NHS Direct (as was?) and the out of hours service are not really much help. They err on the side of caution, understandably in today's media conscious and litigous society, and tell people to go to A&E when they don't really need to.

As you say, people are often too quick to go to A&E, when the best treatment they can have is resting and letting nature take its course. The winter flu season and vomiting bug are good examples of that.

One thing is becoming ever more apparent; the current system is increasingly unsustainable due to a number of factors.

 

[Butts]

One thing is becoming ever more apparent; the current system is increasingly unsustainable due to a number of factors.

Which of course includes the advancement of Medical Technology, with ever more costlier treatments prolonging and improving patients lives at vast expense.

Some form of rationing is inevitable.

 

[Greenback]

Which of course includes the advancement of Medical Technology, with ever more costlier treatments prolonging and improving patients lives at vast expense.

Some form of rationing is inevitable.

That's right. The ageing population is one factor. The increasing numbe rof conditions that can now be managed but which used to be fatal or severely life shortening is welcome, but is putting a strain on other services as well as hospitals.

Increasing specialism in treatments is also a factor. As is the diffculty in recruiting doctors in certain fields. The concept of a General Hospital where a number of doctors can treat a broad spectrum of illness and emergencies has gone now. Too much specialised knowledge is required to perform duties in a safe manner.

And of course, money is also involved!