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Problems in A&E are a symptom of deeper problems

The publication of the weekly figures on A&E waiting times once again demonstrate the strain on the NHS.  This is not simply a problem of first line care. It is a symptom of a deeper malaise.  It is the result of £20 billion of cuts since 2010 and of a senseless top down reorganisation.

To dismiss the £20 billion as 'efficiency savings' won't do. They are cuts and these cuts have impact on front line services.

Politicians need to look at the NHS as a whole to address pressure on A&E. We need more than sticking plaster to repair the damage done.  Doctor and health care organisations have warned repeatedly of the problems in the NHS - a service at the brink of failure.

We have a health service that still delivers at the highest levels. It is a service in large part free at the point of delivery.  But we cannot take the service for granted. It needs resources and staffing. As the BMA say today, the government cannot address the problems in the NHS without looking at the system as a whole. Delays at the front door are related to problems at the back door.

Responding to the publication of weekly figures on A&E waiting times Dr Mark Porter, BMA council chair, said:

“Another week, another set of damning figures from emergency departments - but we must remember that behind the figures is a lack of the necessary investment to give every patient the treatment they deserve, in the emergency department or elsewhere in the system. Patients should be treated on the basis of need, rather than arbitrary targets, but there’s no getting away from the fact the NHS under extraordinary pressure, trying to cope despite inadequate resources. Staff are working flat-out, under extreme pressure but the system is struggling to keep up with the sheer number of patients coming through the door.

"These figures point to NHS services under stress across the UK. This shows that this issue goes beyond one party and one government – all politicians of all colours need to wake up and look at the system as a whole. We need to move away from political point scoring and come up with a long term plan to address these problems.

“Politicians can’t address problems in A&E without looking at the system as a whole. Problems at the hospital front door are linked to delays at the back door. This is because a shortage of social care beds creates ‘exit block’ in hospitals, meaning patients who no longer need to be in hospital can’t be discharged because there is simply nowhere for them to go. This, together with a shortage of beds, leads to delays in admissions and patients being forced to wait on trolleys or admitted to an inappropriate ward. Outside of hospitals, investment in general practice is declining while demand is on the rise and more care is moved into the community - this simply isn’t sustainable.

 “We can only get to grips with pressure on A&Es if every part of the system – from our GP surgeries, to hospitals, to community care – is fully supported and working well, and this includes urgently addressing the shortage of A&E staff and GPs. We must ensure NHS 111 is improved to make it a doctor and nurse-led service which will prevent patients being unnecessarily directed to A&E.”

A flawed and unnecessary top down reorganisation together with cuts in funding have cause the problem. This needs to be addressed. We need a ten year strategy for the NHS to deal with the underlying problems so that it can provide the flexible service we need. We need a ten year strategy that brings together health and care facilities. Setting targets is not the answer. Dealign with the underlying infrastructure and how it works must be the way forward. We should end the sticking plaster approach to the NHS.

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