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David Cameron prepares for winter of discontent in A&E

11 November 2013

There are two important NHS stories in the papers today. First, the Times reports (£) that A&E departments are facing severe pressures because of historic staff shortages. The paper notes:

‘Half of all senior doctor posts go unfilled at accident and emergency departments, putting unsustainable pressure on life-or-death care. The College of Emergency Medicine (CEM) says that 383 of the 699 specialist registrar posts in A&E have been left vacant over the past three years, stretching emergency ward doctors beyond capacity and driving up waiting times. The shortfall in senior doctors deprives A&E departments of the ability to see 766,000 people each year, since the CEM points out that each registrar would have seen about 2,000 patients. This is broadly equivalent to the numbers that would be seen by 12 district general hospitals.’

Second, most news outlets report that the closure of 53 NHS walk-in centres is putting even more pressure on A&E departments. It must be said that there are arguments in favour of closures: walk-in centres are costly and divert funds from other local services, particularly palliative nursing. Lord Howe, the health minister, told the Guardian: ‘Patients should be able to access good-quality out-of-hours NHS services, without having to go to an A&E. Walk-in centres may be part of the answer, but this isn’t a one-size-fits-all solution. Family GPs, community services and pharmacists all have a part to play.’ On the other hand the health regulator, Monitor, says that walk-in centres are popular with patients, especially those who find their GP surgery’s booking system inflexible or inconvenient. Monitor advises against further closures, a position backed by Labour.

Both of these stories will concern government strategists as winter nears and demand on A&E will increase. It is distasteful to reduce crises in healthcare to base party politics; but the political dimension is undeniable because the Mid Staffs scandal and its on-going fallout have burnt the Labour Party. Andy Burnham, the shadow health secretary, has been making noise in the Times’s Thunderer column (£) and on the Today programme, trying to pin the blame for the A&E crisis on the government. David Cameron is overseeing the government’s preparations for what could be a difficult time. The government is understood to be searching for solutions to staff and resource shortages in A&E. Private hospital beds are likely to be used in the event of an overflow of patients. Cameron’s direct involvement, though not unprecedented, is unusual: a clear sign that the stakes are high.

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  • DWWolds

    Labour engineered a massive increase in population during their time in office whilst also allowing GPs to work 9 to 5. Is there any wonder their is a crisis in our health service?

    But looking at the bigger picture isn’t it time we begin to ask the most fundamental question about the NHS? Just how much longer can we sustain a free at the point of delivery service that is demand driven when that demand is infinite?

  • alabenn

    Most of the people in A+E are not emergencies, the waiting times have escalated because of unfettered immigration, probably ten million + more people in the last 20 years, still they pile in.
    Cameron deserves everything he gets with his net immigration lies, figures extrapolated from selected surveys that show what they want, not what is happening.
    As to shortages, the good British trained doctors are leaving, while we end up with medical staff with very dodgy credentials, poor language skills and hospitals ravaged by infections that thirty years ago were almost non existent in hospitals.
    We deserve everything that is coming to this nation, we have chosen to stick our heads in the sand, why be surprised when someone comes up and shafts you.
    Blair and Labour would have had this poisoned chalice to be remembered for, except with the British people, memory and goldfish come to mind as high opinion polls show.

    • Span Ows

      The BBC never mention Blair, Brown and New labour, the years 1997 to 2010 do not exist in their news unless something good happens (it doesn’t). What they do do is get New labour ex ministers and members on EVERY DAY to agree about how bad everything is with NEVER question as to why.

      • alabenn

        Could not agree more, Cameron is pathetic for not changing the law to stop the BBC from putting, usually single poor mothers in jail for not paying this perfidious tax.
        That alone would show how much the “much loved” BBC is actually loved, methinks bankruptcy within 5 years.

  • Russell

    “383 of the 699 specialist registrar posts in A&E have been left vacant over the past three years,”

    So were these posts ‘vacant’ in the three years before when Labour were in control?

    Strange how all this disaster scenario only started 3 years ago! Some of the press Mr Blackburn are pushing the point of view that all was wonderful before this government of only 3.5 years!

  • Ulysses Returns

    This is a familiar story to anyone, like me, who has managed change in large organisations. The fact is, the NHS is far too large, and too centralised to manage and must be broken into smaller, more overseeable units. Until this is done, and a modern, customer-oriented culture is instilled, where the cost of care falls on the consumer (through insurance), then things will go from bad to worse. The almost religious dogma, free at the point of care, must go except for the truly poor. Labour used our money to disguise the faults inherent in the NHS model but no amount of money will fill this bottomless pit. The NHS in its current form is simply not sustainable and the sooner the politicians, and the public, understand this the better.

    • dalai guevara

      Yes, queue Lord Foster’s private hospital scheme for Manchester. Will there be enough money floating around to sustain it? Or hang on, is there another option we have not yet considered?

    • Mynydd

      The NHS is broken into smaller, more overseeable units, they are called Trusts.

  • anneallan

    Our GP surgery is closed at weekends. The local walk-in centre has been a very efficient godsend as chest infections don’t wait for Monday morning, but certainly do not need A & E expertise.

  • Magnolia

    There is a crisis in Pathology staffing as well.
    Consultant Pathology posts go unfilled when they are advertised and services are suffering as a consequence of inadequate manpower planning.
    Pathology is treated as a Cinderella service and it is unattractive to the brightest and the best medics particularly those from this country. In the past it used to be an attractive specialty to a small number of science orientated high fliers but these have fallen away due to changes in the medical undergraduate course and to the restrictions that have inevitably arisen from the Human Tissue Act.
    There are not enough pathologists in the country to do the work and they are not coming to us from abroad.
    Why worry?
    Histopathologists diagnose almost everything and they determine almost all other treatment. They are vital to effective cancer care.
    My solution would be to make the GPs completely private and let hospitals run their own ‘GP’ services for those who cannot or who will not pay for the private GP.
    This would free up some funds to be spent on essential hospital services.

  • Alexsandr

    He needs to renegotiate the GP contract. they should be made to have evening and weekend surgeries, with nurse support.
    And A+E need to check eligibility for NHS and make sure those who are not UK resident pay up front.

    Our out of hours GP is 17 miles away and frequently involves long waits. WHy not just nip next door to A+E
    or better still combine them. Triage nurse sees patient. this is not a+e matter, and puts patient on list for out of hours gp. Leaving a+e to deal with the proper emergencies.
    And get more ambulances to decide to leave patients at home. Make a proper decision whether A+E is appropriate for an elderley person..

  • RavenRandom

    Another day another pressure on A&E story and thus the national religion of the NHS rolls ever on.

    • Makroon

      Quite so. With Andy Burnham leading the charge – you couldn’t make it up.
      As Labour get more desperate, the frequency and randomness of these stunts will increase.

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