Medical Tuesday Blog

The NHS Crises

Jan 4

Written by: Del Meyer
01/04/2017 1:03 AM 

3. International Medicine: The NHS Crises

Who needs billions? I can end the A&E crisis with £5

On the first Friday in the New Year my mother, 72, who has Parkinson’s and a detailed suite of medical problems, had a bad pain in her side. She called her GP. He made a house call. Fantastic.
At 6 pm he rang for an ambulance, and spoke to a member of staff who said a surgical team would be waiting for my mother at St Mary’s Hospital in Paddington, Central London. Wonderful!
After three-and-a-half hours the ambulance hadn’t arrived. She scrambled two of my brothers (I was abroad) who got her to A&E. ‘It was like a scene from a Henry Moore painting,’ my artist mother said when I visited her in hospital last week, ‘…of the Underground during the Blitz. Drunks shouting, people lying on the floor.’
At midnight, she was placed in the Clinical Decisions Unit (the ward created after waiting targets were introduced so that A&E arrivals could be shunted into it before the four-hour target for being seen was officially breached). She lay in a booth, before being moved, at 3.30 am, into the gynaecological ward, where there happened to be a precious spare bed.
‘Please don’t write about me,’ she begged me, and insisted the staff treated her with remarkable care, humour, tenderness and compassion, given the circs.
So, I won’t, because there was anyway nothing out of the ordinary in her experience this post-festive season – she is now back home and better – when more than a dozen hospitals have so far declared ‘major incidents’ due to unmanageable pressures.
Which isn’t surprising, if you think about it. Read More. . .
There is a finite number of beds in a cradle-to-grave service, which is short of an estimated 375 A&E doctors, so the NHS has to deal with the medical emergencies of a rising and ageing population, on less money and manpower than it did five years ago.
As Dr Cliff Mann – President of the College of Emergency Medicine – says, for every patient a hospital admits in excess of the numbers it admitted in 2009, instead of being paid ‘the already inadequate tariff’ it gets paid only a third of that. The country is, he explains, in effect running a ‘buy one, get two free system, which is penalising acute hospitals’.
Now, I’ve spent a lot of time in hospitals, one way or another.
And my main feeling is relief that I don’t have small children any longer – even though A&E prioritises them – as I’d be terrified that the system couldn’t cope with their sudden life-and- death crises (my daughter had asthma, a son epilepsy) when the emergency care system’s running on empty, and our politicians don’t dare say that its users and abusers must start filling it with gas, and fast.
I spoke to an A&E consultant at Chelsea and Westminster Hospital who agreed there is abuse of the system: ‘A&E is always full of people, some of whom are properly sick, but most of whom couldn’t wait to see their GP. A tiny fee of £5 would, I guarantee, clear the waiting room.’
It seems obvious. When service and supply is free, demand is unlimited, and the only check on demand is congestion – the famous British queue. But this isn’t enough. We need even more checks on demand. So here is my five-point prescription for the crisis in A&E.
1. Everyone except the homeless should pay something for tipping up and expecting world-class treatment, bloods, scans, meds, the works. Let’s say £5 as a nominal fee for walk-ins (just think of the hundreds you’d pay privately for the same care).
2. Drunks should be fined or arrested. One drunk ‘sobering up’ under observation for up to ten hours in a bed can prevent a score of others being treated.
3. The four-hour waiting target should be retained but for only acute cases.
4. There should be separate psychiatric A&Es.
5. Those in need should access GPs, out-of-hours services and urgent care centres before calling an ambulance or going to A&E.
When my A&E consultant friend met Ed Miliband, at a lunch in the country last year, she told him her experiences in London general acute hospitals. She said in her view it was urgent that users should pay ‘something’ as the system was ‘going to bust’.
The Labour leader recoiled. ‘As soon as you bring cash transactions into the NHS it’s a catastrophe,’ he said.
‘I wasn’t sure whether he meant a catastrophe for the NHS,’ the consultant said, ‘or political suicide for HIM…’
Whatever. The system is now bust, and will remain so until patients – including Health Secretary Jeremy Hunt, who has confessed to taking his own children in as he couldn’t get a GP appointment – stop using A&E as a destination of first resort, and start treating it as the last.
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The NHS does not give timely access to healthcare, it only gives access to a waiting list.
This, in frustration, frequently results in NO CARE.
Why would single payer advocates want to direct America into NO CARE?

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