NHS winter crisis looms

www.onmedica.com/NewsArticle.aspx?id=94521d33-fbd2-4ed0-ada4-d828da98cce7

This isn't anecdotal.

I think exactly that, gangy5. So do lots of others who are clamouring for changes, and to stop Hunt from privatising the NHS. Once it gets anecdotal, the emphasis changes and people forget about the bigger picture - just what Hunt and friends want.

The most infuriating thing, from my point of view, is that we don't see any new initiatives announced to improve chronic situations but simply cuts , cuts and more cuts. The NHS cannot go on like this. If the organisation sinks into a bigger hole, the resultant actions will have to be drastic.
Being the cynic that I am - do any of you think that if this action (or non action) continues, the government will beable to introduce exactly what it likes and we'll be impotent to complain by then?

It is still anecdotal without evidence that the problem is getting worse or without some idea of how many patients use their GPs like this. I haven't watched documentaries about A&E, so I can't comment.

The Nuffield Trust analysed the crisis which happened during the winter of 2014/15 – what was the money spent on and why did it not help the situation?

www.nuffieldtrust.org.uk/media-centre/press-releases/nhs-will-struggle-cope-winter-new-analysis-finds

It might come as a surprise to many people used to media stories over the inappropriate use of A&E, but the Nuffield Trust’s analysis shows that the problems in winter are not caused by more people turning up at A&E. In fact, fewer attend in cold weather. However of those that do attend A&E admission rates are relatively high and there is an increase in people with breathing problems who need to spend longer in hospital.

The underlying cause of the crisis is that bed occupancy is much too high, often around 92%, so there is no flexibility in the system and it collapses quickly as more patients are admitted. The ideal rate for bed occupancy is 85% as this allows flexibility in the system so a spike in admissions is no problem.

Most notable in the analysis is that a small number (just under 4%) of patients are not discharged from hospital when they should be and this has a major knock-on effect through the hospital.

The report concludes the following:
•Winter crises in A&E are caused by blockages in moving patients through hospital beds and sending them home – not by more people turning up.

•These blockages happen because NHS wards are fuller than they should be. The Health Service is 14,000 beds short of a level that would provide reliable capacity.

•41% of extra winter funding last year was spent on simply adding additional beds and staff. But there is nowhere near enough funding to actually close the gap in number of beds.

•Instead, money and focus should be used more strategically. 3.6% of patients account for 37% of time in NHS beds. Finding ways to safely treat these people outside hospital should be a major priority.

The Nuffield Trust analysed how the £700 million provided in winter 2014/2015 was spent - £254 million (41%) was spent on extra beds and staff; £74 million (12%) of money spent on minimising delayed discharges; and seven day working absorbed £61 million.

The report noted that spending money at trying to increase capacity is just not feasible as nowhere near the number of beds actually needed (14,000) can be created to avert the crisis this year due to both time and lack of funds. Instead the report concludes that the target for spending should be the set of patients who really do not need to be in hospital.
These patients would be better cared for either in their own homes, special housing or nursing homes, where they generally do better if supported by community services. The Nuffield Trust concludes that “reducing length of stay among this group could make a disproportionate impact in controlling how full wards get. Looking carefully at how they are treated could also help to avoid the hold-ups in moving people around that tend to form the triggers for blockages and crises.”

However, adult social care is being starved of funds, despite its role in averting a winter crisis.

In early December soon after the spending review a letter signed by a number of organisations including the Association of Directors of Adult Social Services and the NHS Confederation was sent to chancellor George Osborne, health secretary Jeremy Hunt and local government secretary Greg Clarke, called for “concerted action” from the government to avoid the financial crisis currently affecting social care.

The group noted that the settlement delivered in last month’s spending review is “not sufficient”, “not targeted at the right geographies” and “will not come soon enough to resolve the care funding crisis”.

Just a few days after the Nuffield Trust reported its findings, a training scheme designed to create a career pathway for care workers and address the shortage of nurses in the care home sector was axed. The £178,000 scheme would have developed the role of care practitioner, training care assistants to take on some of the roles of nurses.

The start-up funding for the scheme had been promised by the UK Commission for Employment and Skills (UKCES), a government quango, under a £1 million programme to find “workplace solutions to the gender pay and opportunity pay gap”. But the promise was withdrawn after the spending review.

On the 12th December three days after the Nuffield Trust report, The International Longevity Centre reported that “despite a pledge from George Osborne that social care could expect a cash boost through local authorities raising council tax, there would not be enough money to meet the needs of a growing older population.”

When you go out for the third call of the night, at 4am- to be asked for paracetamol by someone who has had a headache since he came home after a drinking session and can't be bothered to walk to the all night garage shop 2 minutes away - you'll know what I mean. Just one of 100s of such experiences during his career and his partners

dd an unexpected rash with a child has to be taken VERY seriously- do the glass test first, and of course it depends if the child is unwell or not. Common sense and I am sure you have plenty.

Anecdotal? Not really. Having been married to a GP for 35 years (well 45) - int he days when GPs did on call- I could write a book, a very long book .... and of course we have all seen documentaries on what goes on in A&E and the number of time wasters there. Why anyone would want to queue for hours for ... nothing, is beyond me. Unless they are homeless and want to keep warm.

DD I had to look that up....OUCH

QED Jess

oh I do miss jingl not being here to pounce on my Latin abbreviations

I had a neighbour in her 80s "I'm going to the doctor, I hurt my knee last week in Cardiff and its getting better but I thought I'd get it checked" She walked off without a limp.

@Anya

Your BiL's GP should send him for a sigmoidoscopy - without anaesthetic!

Yes...but...Ana and I are intelligent human beings (well, Ana is). I think we forget that half the population is of less than average intelligence and some are very anxious. Especially when dealing with children, I'd rather be seen as over-anxious than neglectful. I think most of us know that sore throats are usually viral and, therefore, antibiotics are useless, but there are some children who have died from untreated strep throat.

When my former GP took early retirement, the reason he gave me was the paperwork and extra targets set by the government and not because patients wasted his time. GPs are also being expected to take on work which would have formerly been done by consultants.

My GP's surgery has recently employed more nurse practitioners, supposedly to save money. They're supposed to be the first line of call and they're fine for routine health tests and minor injuries, but whenever I'm fobbed off with one for something more serious, I invariably get told to make an appointment with the GP anyway. Therefore, I'm actually taking up two appointments and wasting my own time.

I think there's enough there to make the point. Plus there have been reports, confirmed by the ambulance service (and these are recorded) of many stupid call outs for 999. My uncle was a GP and told us many a tale and my cousin who has just retired fro his GP practice had even weirder tales to tell.

I know that sensible people like yourself DD and Ana will find it hard to credit some of the reasons behind visits, because it's not something that you or your family would ever do. But believe me it's quite common.

My BiL is there almost weekly. Constipation this week!

To be fair, if you look at the comments below the article, a number of people point out that some funny reasons aren't really research and don't give any indication of whether the problem is getting worse.

If I put my mind to it, I could make a list of ridiculous phone calls I had with parents when I was teaching. People get anxious and, let's face it, doctors and teachers are supposed to be experts in their particular fields. I don't expect all the 'time-wasting' is as funny as those comments. I used to regard it as part of my job to put people's minds at rest. Not everybody is as savvy as GNers, who all know how to use the internet to look up symptoms. To be honest, I've sometimes seen people asking for health advice on the net and been given cr*p advice. I've wanted to scream at the posters to go and see a GP. Hopefully, there's little wrong, but that's not 'time-wasting'.

Then have a read of This list of inappropriate demands on GPS.

If it wasn't so long it would be funny!

I've never gone to my GP, let alone A&E, with a minor cold or ailment. No member of my immediate family has done either.

I can't comment, because I don't know. Evidence seems, at best, anecdotal.

You don't waste GPS time DD but there's plenty as does.

@granjura

I hope I've never wasted a GP's or A&E's time, but it's really not that easy. If you have a child with an unexplained rash, what do you do? It could be just a reaction to a new washing powder or it could be something much more serious. Jeremy Hunt recently suggested that parents should diagnose meningitis by doing an internet search, which I find totally unacceptable.

Health and education can't avoid being political issues. Both cost significant amounts of money, have finite resources and almost infinite demand.

Demand will always outstrip supply, which is why economic and political decisions have to be made.

Conservatives claim:

1 Both can be provided more efficiently by the private sector (very questionable, especially when so many MPs and their frinds have financial intersts in both, although I think the private sector does have a useful but minimal role to play);

2 The state is only responsible for basic provision. People can then choose to top up services from their own resources (this, of course, means that essential treatment can become unaffordable).

The Health and Social Care Bill, academisation and free schools have cost the country billions, without any noticeable improvement. I would also add the Work Programme to the list of whacky programmes which have achieved nothing for an awful lot of money.

I don't actually know what the current Labour Party plans for the NHS :-(.

Exactly, same for education. The UK chooses to spend much smaller % of GDP than many other neighbours. A choice.

The cynical in me thinks it is totally deliberate in order to make people accept privatisation by the back door as the only way to improve. In fact, for reasons I cannot divulge, I know it is the case as I know people involved in the process.

It will take huge discipline from patients this winter to not over-clog the system by using Gps and A&E with minor colds and ailments which should be self-treated for the first 5 to 7 days with common sense measures.

As has been mentioned before NHS is mainly funded, 80% by general taxation and rest by NI contributions. We CAN afford to fund it, it is a political choice not to.

It's already a problem all over UK even in Scotland. Now (yes NOW) there are too many patients and too few staff - staff retiring/retired - pointed out as a problem years ago and nothing done. People living longer often with health care issues, people with conditions caused by obesity etc. Not enough staff or money to cope with it all. We do not pay enough NI contributions to support all of this and we are nearing a crisis. No-one listens to the staff at ground level and sadly it will become unsupportable in the next few years!

I think one of the reasons we need immigrants is because of the slowing of the birth rate. It's happening all over Europe.

It's also happening elsewhere, gradually.

I think the NHS would still need more cash now than it did some years ago because treatments have got more complex, and there are simply more things being treated, more lives being extended, etc.

jess, big oops!

Labour MSP, Jackie Bailey is currently very vocal about the SNP pulling health services, e.g. they closed A & E at the Vale of Leven Hospital. Mind you, I suppose free prescriptions have to be funded somehow.

Surely not

Mind you, trisher, a recent thread on Gnet made it clear that a number of us who have had practically lifelong benefit from the NHS aren't particularly bothered about future generations enjoying the same benefits.

Apparently they did MaizieD which only makes you think that people believe anything they are told and have very short memories. The Tories record on the NHS has always been terrible, but of course that nice David Cameron promised he cared about it didn't he?