Nine out of ten patients are seen and treated in A & E within the four hour national target. This is apparently a higher standard than in any other major western nation. This is the positive backdrop to the serious problem of hospitals struggling every year to meet winter demand from patients. This is a problem that increases year on year and, last year, was the worst ever.
What triggers the problem is winter’s cold conditions and flu bugs, particularly on our growing population of over 75 year olds. They are most at risk of developing respiratory and related conditions. Between December and February the huge volume of admission numbers means many hospitals simply run out of available beds.
As a result patients wait on trolleys in hospital corridors or in ambulances for a bed to become available, and in other hospital departments planned operations have to be postponed. The worst such situations are called “major incidents” where patients are moved to neighbouring hospitals and others are discharged early to free up beds. Last winter about 20 of England’s 160 acute trusts declared such “major incidents”.
What’s to be done? The problem appears in A &E but the solutions lie in the wider health and social care system. The way the NHS funds hospitals does not help. Hospitals are paid according to how many patients they see and treat, not how many patients they and community services prevent from being admitted in the first place. This perverse incentive is made worse by downward funding pressures on hospitals with the result that 90% of NHS Trust hospitals are now predicting budget deficits.
To reduce demand there has to be to be a sea change in the way that health and social care services are organised in the community – between GP and primary care services, hospital services, NHS 111 and the ambulance service. In addition all of us, and by that I mean family members together with health and social care services, voluntary and charitable groups, need to help prevent unnecessary emergency hospital admissions. We can do this by getting smarter and earlier at recognising and responding to the needs of elderly frail people. At the other end of the problem – the bed capacity of hospitals – there needs to be better management of staffing resources, care and beds. We need improved hospital discharge practice with social care and the voluntary sector with a view to freeing up beds and reducing urgent readmissions.
Joe Blogs 