A&Es across the country continue to experience one of the toughest winter periods on record. Waiting time breaches reached record highs, emergency admissions to hospitals soared and thousands of patients faced long waits on trolleys for admission.
This ongoing crisis has affected Yorkshire as much as anywhere. We have seen a major incident declared at Scarborough Hospital, while both York and Sheffield hospitals missed the 95 per cent A&E waiting time target every week this winter.
For many, the pressure on emergency departments has been simply too great. With services stretched to breaking point and doctors and nurses unable to move patients through to appropriate wards, some found themselves on ‘black alert’ – where a hospital reaches capacity and has to turn patients away.
A new survey undertaken by the British Medical Association has found that 29 per cent of respondents reported ‘black alerts’ at their place of work, a huge increase from the seven per cent at the same time last year.
The same survey found that 48 per cent of doctors experienced breaches in A&E targets and a staggering 65 per cent across both primary and secondary care reported an increase in waiting times.
Patients should always be treated on the basis of their need rather than arbitrary waiting time targets; yet rising demand on services, coupled with ongoing spikes in demand, will have left patients facing increasingly unacceptable delays throughout the year.
Breaches in A&E targets are highly visible and widely reported. However the crisis in our emergency departments reflects what’s happening across the NHS. The A&E crisis is a high-profile part of the bigger picture about just how much pressure our health service is under: one of rising demand, chronic under funding of services and a growing recruitment and retention crisis.
Uncertainty and underfunding results in it being impossible to plan for the longer term, and near impossible to recruit staff willing to work under such conditions.
Just one example can be found in Sheffield where £28m was spent on agency staff in only 17 months to deal with the recruitment pressures they face. And, whilst workload for hospital consultants continues to spiral – most recent surveys finding that 41 per cent of consultants reported unmanageable or unsustainable workloads – GPs too are facing burnout as they attempt to deal with in excess of 40 to 50 patients a day.
Finding solutions isn’t easy. However, the political response has for too long been a series of headline-grabbing sticking plaster policies to bail out emergency departments, rather than developing long-term, sustainable solutions.
The result is that the NHS lurches from one winter crisis to another. Worse still, a recent report found that less than one per cent of this winter’s emergency funding actually made its way to front line A&E services. When funds for patient care are so tight and, in the name of so-called efficiency, all flexibility removed, it is inevitable that when activity and demand for urgent care rises all but the most essential care has to stop in order for a hospital to just get through the day.
This non-urgent care doesn’t disappear; it is simply shifted elsewhere in the system. It can often mean that someone who is waiting for planned surgery has their operation cancelled moments before they are due to be taken into theatre; or a long-awaited out-patient appointment or investigation is postponed whilst staff are diverted to other duties. Not only does this cost more, it causes tremendous anxiety and inconvenience for patients who have waited months for treatment and can take months to resolve.
This is nothing short of game playing with our health and patients are paying the price through longer wait times, delays in treatment and, ultimately, the quality of care being compromised.
Resolving the problems of urgent and emergency care needs us to look at health and social care systems as a whole knowing that cuts to local authority social care have a direct impact on the NHS including delays in getting patients safely back home when there is simply nowhere appropriate for them to go. Insufficient resource in community and social care also creates a revolving door between hospitals and the community as many who might not need hospital find themselves with little option.
The NHS has proven to be the best, most sustainable and most efficient healthcare system in the world. Despite its many problems one only has to look at other countries’ systems to see that it is worth saving. But it has reached a crossroads where the game-playing has to stop.
This is why the BMA has launched its No More Games campaign calling for an end to political game playing with the NHS; calling on politicians to not repeat the mistakes of the past, but commit to having an open and honest public debate to find real, long-term solutions.
Dr Ian Wilson is the BMA representative body chair and a consultant in West Yorkshire.