07.01.15
Patients and staff being let down by an NHS in crisis
Hospitals are scrambling to cope with a surge in demand with at least 16 enacting emergency measures, evidence that “patients and hardworking staff are being let down by a system in crisis” the Royal College of Nursing have warned.
Hospital A&E units recorded their worst-ever performance in the week before Christmas as NHS emergency care services struggled to deal with an unprecedented number of patients, NHS England figures released on Tuesday showed. The figures vary widely between hospitals, with many struggling to deal with the pressures they face.
The crisis is on the front pages of most newspapers today and is at the heart of a major political row ahead of May’s general election.
Dr Peter Carter, chief executive and general secretary of the RCN believes that what is happening in A&E departments is evidence of patients and staff being let down by a system in crisis.
“Hospital trusts trying to recruit more staff have been hamstrung by the short-sighted cuts to nurse training places, which mean there simply aren’t enough nurses in the system,” he said.
“This is made worse by chronic under-resourcing of community services and social care, which means more people end up in A&E who could be better treated elsewhere.”
Dr Cliff Mann, president of the College of Emergency Medicine, said the figures showed "a very disturbing pattern" and that "all bets are off" about how the NHS would cope as winter continues.
He added that hospitals were "full to bursting" and housing far too many patients who could not be sent home because there was no help to care for them in the community.
Speaking to the BBC, Dr Mann also said part of the reason for the surge in demand was the NHS non-emergency line 111 advising an increasing proportion of people to seek emergency care.
He said: "My concern is the daily intolerable pressure is starting to have an effect on staff - they are more likely to become sick, become unable to work, burn out and choose to go into other professions. That means it is not a sustainable situation".
At least 16 hospitals have declared major incidents, where they step-down focus on non-urgent activities to focus on emergency admissions. This leads to clinics and scheduled operations being cancelled as staff are redeployed to help in A&E and assessment units and deal with emergency admissions.
Dr Mark Porter, chair of the BMA, believes that the pressures on A&E will lead to “fallout” in other parts of the system.
He wrote in a blog post: “Extreme pressure on one part of the system leads to fall out in others: the internal incidents declared by some hospitals as a means of dealing with excessive workload leads to patients being diverted to elsewhere in the NHS – dragging in GP practices and other hospitals not themselves on alert but picking up the pieces as the crisis ripples outward.”
He continued: “Doctors should be able to treat the patient that’s in front of them based on their individual needs rather than an arbitrary target. We need to move away from a system which prioritises targets for targets’ sake and turns waiting rooms into conveyor belts.
“And if we are to have an NHS that does not just lurch from crisis to crisis, politicians must work with those in the service to address the underlying issues: investment in services and staff, finding a long-term solution to social care, supporting the delivery of more care in the community.”
David Cameron admitted the NHS was under pressure but dismissed claims that the health service was “on the brink of disaster”.
The PM said there was a “short-term pressure issue which we need to meet with resources and management”.
“We’ve got a longer-term issue which is making sure that there are named GPs in your local area which are responsible for every single frail, elderly person. A lot of the pressure on A&E is coming from frail, elderly people, often with many different health conditions and the best place for them, frankly, is not A&E.
“They should be being looked after by the family doctor or in other health settings and I think the long-term challenge is to make sure those sorts of settings are more available.”
NHS Providers, which represents trusts and foundation trusts, said that while the health service was facing unprecedented levels of extra demand on the system, hospitals, ambulances, GPs and community services are all doing everything they can to meet the demand.
Chris Hopson, NHS Providers chief executive, said: “Many hospital chief executives are having to make difficult decisions about how best to meet this challenging situation – should they cancel elective operations so staff can help in A&E; should they divert ambulances to other hospitals; should they close their A&E Departments to new patients? The imperative is to provide a safe service and we know that some hospitals believe the best way of doing this is to declare a major incident – this is nothing particularly unusual, and a number of hospitals have done this in similar situations over the last few years, when required.
“The NHS is facing unprecedented demand, but it has prepared better and earlier for this winter than ever before – the government has put in an extra £700m winter pressures funding and thanks to the work of hundreds of thousands of dedicated frontline staff, the NHS is by and large keeping its head above water. Lurid headlines about ‘third world A & E’ don’t help when the NHS is actually doing a remarkable job of treating the vast majority of a significantly larger number of patients to the standards required by the NHS constitution.”
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