Skip to main content

Nuffield Trust issues stark warning on A&E

With the general election fast approaching the NHS remains at the top of the list of issues of most concern to voters. Now a new policy briefing by the Nuffield Trust has warned that continued financial squeeze on the NHS will accelerate the pace at which the urgent care system reaches breaking point. The report concludes that the most significant issue is not the numbers of people presenting at A&E, but the ability to discharge patients safely and quickly from the hospital
as a whole. That is, it is not A&E as such where the problems lie. A&E is part of an integrated system  and the four-hour target for waiting can distort behaviours inside hospitals and health systems in ways that are not in the interests of patients or staff.

Understanding the real problems through the chain is vital to resolving any issues and they make the key point that

 "the complexity of the system and the highly politicised nature of A&E have impeded progress. Problems will not be solved if policy-makers, political leaders and regulators continue to micro-manage A&E. With changeso urgently needed, it is imperative that there is a cross-party consensus on how to move forward and that action is not postponed or delayed for political reasons."

The report chimes well with the BMA campaign calling for an end to 'political games' with the NHS. The authors point out that problems in A&E are complex and difficult to solve and many of the solutions proposed are 'overly simplistic'.

They make the point that the 4 hour waiting  target has played an important part in improving patients’ experiences of care at A&E. Before the target was introduced, 12-hour waits were
not uncommon. The improved performance was maintained for the best part of a decade.  But performance has slipped since 2012,  and the target has not been met since the summer of 2013.

This increased pressure on A&E is demonstrated by some key fact. There has been a sizeable increase in the number of A&E attendances, from 16.5 million in 2003/04 to 21.8 million in 2013/14; a rise of 32 per cent,  was almost exclusively to do with minor A&Es (for example, urgent care centres, minor injuries units and walk-in centres).

The report puts forward several proposals to deal with the problems.

Focus on getting things right in primary care to enable prevention to work – but be realistic about how much can be achieved. Policy-makers can help to boost primary care through supporting moves to build up the skills and capacity of health care professionals to provide high-quality urgent care services outside hospital.

Remove some of the complexity of different services that has been built into the system, and which confuses the public and NHS staff. Creating a single point of access to community services for patients and GPs would be one way to achieve this.

Focus on the way patients move through hospital – and be realistic about what policy-makers can and can’t do. Policy-makers can help by investing in care outside hospital, but they must let providers find solutions that work for their patients.

Foster a better understanding of the way that local systems work.
Promoting better data outside hospital and encouraging the development of systems modelling in individual trusts would be an important start.

Take a longer-term and broader view of performance in A&E – and consider clustered randomised controlled trials of alternative performance measures. Policy-makers should encourage the adoption of a set of richer performance indicators to sit alongside the four-hour target, which could be trialled in certain areas.

The report concludes with a clear warning that our urgent care system is 'near breaking point'. The continued squeeze on resources will accelerate the pace at which it reaches that point. 'Sticking-plaster solutions will not solve the problem'.


Comments

Popular posts from this blog

Ian Duncan-Smith says he wants to make those on benefits 'better people'!

By any account, the government's austerity strategy is utilitarian. It justifies its approach by the presumed potential ends. It's objective is to cut the deficit, but it has also adopted another objective which is specifically targeted. It seeks to drive people off benefits and 'back to work'.  The two together are toxic to the poorest in society. Those least able to cope are the most affected by the cuts in benefits and the loss of services. It is the coupling of these two strategic aims that make their policies ethically questionable. For, by combining the two, slashing the value of benefits to make budget savings while also changing the benefits system, the highest burden falls on a specific group, those dependent on benefits. For the greater good of the majority, a minority group, those on benefits, are being sacrificed; sacrificed on the altar of austerity. And they are being sacrificed in part so that others may be spared. Utilitarian ethics considers the ba

Prioritising people in nursing care.

There has been in recent years concern that care in the NHS has not been sufficiently 'patient centred', or responsive to the needs of the patient on a case basis. It has been felt in care that it as been the patient who has had to adapt to the regime of care, rather than the other way around. Putting patients at the centre of care means being responsive to their needs and supporting them through the process of health care delivery.  Patients should not become identikit sausages in a production line. The nurses body, the Nursing and Midwifery Council has responded to this challenge with a revised code of practice reflection get changes in health and social care since the previous code was published in 2008. The Code describes the professional standards of practice and behaviour for nurses and midwives. Four themes describe what nurses and midwives are expected to do: prioritise people practise effectively preserve safety, and promote professionalism and trust. The

When Finance Drives Destruction

Tackling climate change means stopping the funding of rainforest destruction, says a significant study commissioned by the World Wildlife Fund.  The UK's financial services have provided directly over £8.7 billion to 167 different traders, processors, and buyers of forest-risk commodities (cocoa, rubber, timber, soy, beef, palm oil, pulp & paper) from 2013 to 2021.   With direct and indirect investment,  the figure rises to a staggering £200 bn.  Whilst not all that investment is in destructive projects,  the study concludes there is little transparency on the risk.  Finance is the oil in the economic machine.  But it also drives decisions. We all know the importance of money. We borrow to invest. So much depends on it, such as company pensions.  Do we really know what our pension pots are doing? We invest for the future. But what kind of future? Is all investment good?  Much investment is bad. Investment drives the nature of our economy. It drives our decisions as individuals,