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A&E is not a one-size-fits-all sticking plaster
Chris Mair, a retired newspaper editor and NHS volunteer, issues a word of warning over the use – and abuse – of A&E departments:
What do we want from our NHS? To be looked after from ‘cradle to grave’? That’s likely where it began, but is that where it is now?
Are we, the people who use it, also the people responsible for destroying it? Yes is my answer. We have become greedy. We want what we want and we want it now and completely on our terms. Oh, and on our doorstep.
Look, don’t get me wrong. There is a lot not right within the NHS. Like budget cuts with poor ‘management’ losing telephone number sums by being scammed and failing to fight hard enough to get the best deals. We use the failures as a big stick with which to beat our NHS, but how about facing the realties we are creating?
Now rural GP practices are, say the BMA, under threat of closure. Larger GP surgeries get the financial cream, but unlike 24-hour A&E, GPs pretty much work Monday to Friday. Brand new surgery buildings are shut and bolted at weekends. All that investment sitting idle for around 120 days a year if you include public holidays. The lobby on GPs to run the sort of shift systems that for decades has been part of a factory worker’s life is growing.
So, if your GP surgery is shut at weekends and you need a doctor what are your choices? Minor Injuries’ hospitals? Yes, these are open weekends until around 21.00. But, illness and injury don’t recognise any timetable that suits. Do you dial 111, or three nine’s? Well, 111 is for non-emergency advice, so it’s down to the blue light teams of fast response paramedics or the ambulance service.
But, what then? Where to take you? The local A&E or a larger trauma hospital?
We’re back to: we want what we want and we want it on our doorstep. Notwithstanding the local A&E may be clogged with ‘paper cuts’ and broken toenails plus genuine cases – in line with the ‘Is A&E for me?’ initiative – we are now demanding that all local A&Es should offer a one-stop shop for every eventuality. A broken arm to multiple injuries from a multi-vehicle pile-up. A minor head laceration needing a couple of stitches to someone with life-threatening head trauma.
The blue light teams have a tough job. Under pressure most of us can’t imagine. They have to make choices. Where to take their patient? They use judgement, because they want the best outcome. Working for you as well as their patient. So if that choice is a major trauma hospital 30 or so miles away instead of the A&E 25 miles closer, I ask: where would like to be taken if your life depended on the right choice?
We have got to stop using A&E as a one-size fits all sticking plaster. Are we, as I said, destroying what we claim we value and support? Again, yes is my answer.
The NHS would be first to agree it needs to work smarter. Cut out what doesn’t work. Fund what does and can work. Efficiency isn’t always about losing something. Efficiency is about learning and applying that learning to understand that change is natural as well as necessary. Benjamin Disraeli once said: “Change is inevitable in a progressive society. Change is constant.” That was in the 19th Century; this is the 21st Century.
“So, if your GP surgery is shut at weekends and you need a doctor what are your choices? ” Well the GP Out of Hours Service actually, which believe it or not is available 365 days a year. You seemed to omit to mention its existence, whether through ignorance or deliberately I’m not sure. Of course it is far harder for patients to access it now, since those responsible for making such decisions have chosen to put NHS 111 in the way. Except that is, for patients of those practices that have chosen to retain 24hr responsibility, of which, despite the lies propagated by politicians and the media, there are many.
And it would be a nice surprise one day to hear something about reducing inappropriate demand for GP services.
A funding, workload, and workforce crisis is bringing general practice to its knees; that will be a disaster for the entire NHS .A and E struggles, it gets demand management,more cash and GPs get the blame. General practice struggles, it gets its demand fuelled, less cash and GPs get the blame.
Chris : I am also an older person and had the privilege of serving in the NHS for many years.
As a textbook “older person with multiple chronic ailments “costing the tax-payer much expenditure it irks me to read the judgmental remarks attributed in the public media to NICE chiefs about the low value of such expense to the society .
You have accurately listed numerous problems confronting our NHS but I wonder why ? My world-wide travels have convinced that despite its faults frequently talked about by “the glass is half empty ” brigade, it is by far one of the best health services in the world.
The NHS certainly needs constant TLC and protection against political micromanagement .