A and E admissions

Excellent letter - will anyone take any notice?

Excellent letter, whitewave. It's here for anyone else who wants to read it without going on the DM website..

www.dailymail.co.uk/health/article-2900798/Just-busy-performing-Crisis-like-Outraged-E-consultant-blasts-David-Cameron-s-lies-state-NHS-challenges-debate-escalating-crisis.html

Not like me to link to a DM article!

The NHA party was set up by a group of doctors who are fed up of what's happening to the NHS. I wonder if Rob Galloway is in the NHA?

I've lost touch with the People's Assembly but that's a good link, durhamjen.

I was talking this morning to someone heavily involved in her CCG and she said the big silence is around reduced staff numbers so there are fewer medics to deal with a small increase in A&E attendance. It's such a mess of un joined up thinking, all of it. I mean it's so predictable that the 111 service would err on the cautious side and send people to A&E. We need properly funded walk in clinics for minor ills.

durham you are good at links. Can you pick up the Rob Galloway letter in the Daily Mail - really worth a read.

Here's an interesting game to look at.
People's Assembly, Eloethan.

www.thepeoplesassembly.org.uk/the_ae_crisis

It seems extraordinary to me, that while you're in hospital having your op or medication sorted or whatever, you are the responsibility of the health service but as soon as you leave the ward, you become the concern of social services. I expect they separated the two and closed down all the NHS convalescent homes and community hospitals to make it easier to fudge the budgets. Also, if you are suffering from any mental illness or brain disorder except dementia, you are still an NHS patient. If dementia, somehow it's not an illness.

I've just been looking at the other spreadsheet, which covers a longer timescale, and the picture is different. It shows that A&E attendances did go up substantially after GP out of hours service ended, but the increase stopped in about 2011. The biggest increase was in minor cases.

So the increase in demand was a story, but less so for the last three years. Prior to the discontinuation of GP out of hours service, demand had been stable for at least 16 years.

There doesn't seem to be much sign of the surge in demand each winter, in 2010-2014, none of the ten weeks with the highest demand are in winter.

Community hospitals used to take patients from the Acute hospitals for ongoing rehab. The NHS cut them from 8 to 2 in neighbouring county, more than 300 beds, 6 day hospitals gone as well as the Council shutting day centres from 5 to none.
Add that to Councils raising eligibility criteria for services from substantial to critical (at immediate risk) and it isn't surprising that the emphasis shifted to the Acute sector, nowhere else to go when GP practices can't cope.
The Government is increasingly expecting the voluntary sector to pick up the load, relying not only on volunteers but also their seeking funding elsewhere to survive and to provide the missing services.
All the while the emphasis is to prevent unnecessary admissions and get people out as soon as deemed medically stable. If you go to A+E and are assessed, investigated and given medication you will be sent back home c/o your GP, who probably sent you in there in the first place. That's fine if you can manage at home, if not it falls on relatives to look after you.
I agree hospitals should be for those needing acute intervention but there aren't the services in the community to support this.

durhamjen: www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2014-15/

It's interesting to look at that isn't it? Over the five years on the spreadsheet, the annual increase in A&E attendances is 1.58%, but the percentage of minor admissions has remained constant at an average of 31.6%. That suggests to me to that there hasn't been a huge increase in frivolous time wasters.

What happened to convalescent homes? MIL went into a convalescent home on two occasions to 'build her up' after leaving hospital and before going home. That would have been in the mid 1990s.
We would not have the problem of 'bed-blockers' so people who needed to go on to a ward from A&E could do so more quickly.

The issue of drunks clogging up A&E (or anyone else abusing the service) has gone on too long and needs addressing, but it is hardly a new phenomenon.

My feeling is that the following extracts of reports from a variety of news sources amply demonstrate why six English hospitals have declared major incidents and why it would appear that the NHS emergency services are approaching breaking point.

Guardian Oct. 2013
GPs have received £943m less over past three years, according to survey that challenges claims over the NHS by ministers

Mail Online Feb. 2014
Three-week wait to see your doctor: Millions of patients are denied a prompt appointment to see their GP

(An inability to get a timely GP appointment can lead to a patient's condition deteriorating and perhaps requiring a hospital admission or a hospital referral. It can also lead to people turning up at A&E for treatment of conditions that are not emergencies.)

Guardian July 2013
111 helpline has fundamental flaw, say critics
..... lay call handlers, who are cheaper, follow a script of questions that leads them to a decision about where to send the caller. Handlers have no clinical experience, the system has to default to the least risky option – which means sending people to A&E or calling an ambulance if there is any doubt.

Mail Online Aug. 2014
A&E closures 'affect death rates'
Closing hospital accident and emergency (A&E) departments has knock-on effects that lead to more patient deaths, a US study has shown.

They found that A&E closures had a "ripple effect" that extended out to nearby hospitals. The problem was caused by closure increasing pressure on nearby emergency departments (EDs) that found themselves forced to cope with more admissions.

BBC News Online Sept. 2014
Cuts forcing English councils to limit social care

Guardian March 2014
Cuts have left 250,000 older people without state care, report says
A quarter of a million older people have lost their state-funded help with carrying out everyday activities such as bathing, dressing and eating in the past four years as council budgets have been slashed.

The number of vulnerable older people receiving "meals on wheels" services dropped by over half, while care services carried out in the home or in day centres were cut by a fifth

(It seems fairly obvious to me that if elderly people are not eating properly and are unable to attend adequately to matters of personal care, then it is much more likely that they will succumb to a variety of illnesses that may well require admission to hospital. The cuts also mean that, even if people are well enough to be discharged from hospital, the lack of rehabilitative/convalescent support means they often have to stay in hospital, thus reducing the number of beds available)

They're saying it's partly due to the lack of social care in the community. In other words, local councils have had their budgets drastically reduced and so have had to cut social workers, carers, meals on wheels and the like in order to save money. This means that elderly people who live on their own can't be sent home from hospital as there is no-one to look after them. Now we are back to that horrible phrase 'bed blockers' but, of course, the knock-on effect is people waiting on stretchers in A and E corridors until a bed in a ward becomes vacant.

I quite like Jeremy Hunt ever since he was referred to as 'Jeremy C*nt' on the Today programme and he laughed like a drain. Perhaps a sense of humour is not the first requirement for a politican in the current circumstances, though!

I think that's just his face, although I don't like him either!

A&E waiting times are even worse in Wales (Labour). I didn't catch the Scotland figures, but NI has the worst record.

It's not just English patients who are suffering, folks!

I don't like that Jeremy Hunt. He just looks so pleased with himself even though he's commenting on a case where a woman lay on the floor, collapsed, for eleven hours, waiting for the ambulance. And was still on a trolley this afternoon! Hunt was actually smiling whilst he was talking about it.

And if you look at the link afterwards that is from Fullfact, a company which is trusted by the government and other parties alike.

This is the link, soontobe, from the NHA article.

www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2014-15/

As you can see, the figures are from nhs England.

All NHA figures are referenced on the site after the articles.

Are NHA figures reliable?
Are they likely to be biased?

They're saying it on the BBC news just now - the 'very elderly' especially, apparently...

The feature on pressure on A&E's on PM on Radio 4 kept saying that the problem was the number of old people. Hmm.

durhamjen: Thanks for the links. They make interesting reading.
Until now, I've tended to take everything I've heard on TV about the NHS at face value, but I really should know better by now!

Fullfact fact check about A&E figures.

https://fullfact.org/health/accident_emergency_waiting_times_record-38058

This is what the NHA say.
The number of people going to A&E in the winter has been less than in June and July, but they coped then.

nhap.org/abysmal-government-failure-avert-ae-crisis/

Just a thought: who is actually putting out the current reports blaming drunks and timewasters for the crisis in A&E? Is it genuinely the hospitals themselves, or is it government sources?
I had assumed that it was the hospitals, but it's just occurred to me that as the Government regularly issues, and gets away with, blatant lies regarding other issues, they wouldn't think twice about exploiting these problems as part of a deliberate and cynical attempt to deflect blame away from themselves and their polices.

I don't have the answer, and am probably being silly, but now it's crossed my mind I might have to do some digging around to try to find out a bit more!

I think Herefordshire started an integrated health and social care service in 2010 - but I am not sure it still exists.