NHS winter crisis looms

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.

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

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

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'.

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!

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.

@Anya

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

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.

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

QED Jess

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

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.

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

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.”

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?

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.

And it is all our fault, as well.

www.onmedica.com/NewsArticle.aspx?id=1232e6b5-2c07-4a29-b8e9-09ca6ee93409

Baby boomers to blame. We didn't ask to be born then!

Good article, daphnedill - sets out the situation (as it was in 2014/15) very clearly.

I have never wasted a GP or ambulances time, but know many do.We should always err on the side of caution though if a child is involved.

as you well know, I am totally on your side on this and agree that the NHS is being deliberately run down in order to make the public accept privatisation. It's as clear as a bell.

However, there is plenty of evidence that since GPs generally do no do their own on call- more people do call the cover agency doctors for things that really do not require this. Same for A&E - for colds, minor sprains and the like - and with this- we can play a role in helping this winter.

Playing down the fact that some people have no respect for the system and the NHS staff- is not helping in the real battle. As I've said before re benefits, etc. The real problem is with those at the top who tax avoid and evade by billions and make money out of the demise of the country, be it selling vital utilities or privatising the NHS - totally. And yet- denying abuse at the other end does not help- even if it is proportionately tons less.

No, it's not 'our' fault, dj, but it's a fact that older people, not surprisingly, use up a huge chunk of NHS funding. The social care cuts are just making the situation worse. Everybody has to face up to the reality and a solution has to be found. It's not good enough to cut services to the bone, then expect those who can afford decent treatment to pay for it, while the rest rot.

I expect there have always been hypochondriacs and I'm not sure what can be done about them. I don't agree with charging for visits to GPs and A & E. I expect the stories we keep hearing about people wasting GP/A & E time are part of a public health message. However, I do worry about people who won't go to a doctor, because they don't want to waste time. Sometimes, they really are ill and they use any excuse not to face up to the reality that they could genuinely be ill. For others, even a small amount is a significant sum, especially if a long journey is involved. In any case, it's been shown that the admin costs are more than would be collected, unless quite a large amount were charged.

From the Nuffield Report, two findings are very significant:

1 Hospitals don't have much spare capacity, so have little flexibility during winter months.

2 Social care is being starved of funds. Essex County Council spends 25% less now on social care than it did five years ago. There is bound to be a knock on affect on the people being admitted to hospital and on the quality of life of those concerned.

Addenbrookes (in Cambridge) has a huge problem with bed blocking. Not only does it serve a wide catchment area with a high proportion of elderly, but many of them live in isolated communities. Private companies won't even take on the contracts to care for some of these people at home, because the travel time makes care packages unviable. I expect other areas have similar problems.

Meanwhile, our local 'cottage' hospital lies empty. It used to have low dependency beds for people who didn't need acute care, but weren't well enough to be at home. It's nuts!

@granjura

I'm not denying it happens, but without robust evidence, nobody really knows how much it costs. We're certainly getting public health messages aplenty to visit our pharmacists, etc for minor injuries/illnesses. The trouble with that is that pharmacists are restricted in what they can sell. One of my dear children used to get regular eye infections and had to be prescribed antibiotic cream. I used to do all the right things (washing her eyes with cool boiled water), but the pharmacist always used to tell me to go to the GP. Headlines about wasting time might also get through to some.

I agree that people should take responsibility for their own health, but I have the impression that a 'blame game' is being used to hide underfunding. Yes, it does work both ways.

Yes, over the years many cottage hospitals and interim-care homes have been closed down - presumably to save money! At the time it must have seemed like a wonderful wheeze...

I was being sarcastic, daphne.

I have just been reading the STP for my area. It seems we are lumped in with Northumberland, Newcastle and Sunderland now.
On the map there is Shotley Bridge hospital, but it never gets mentioned in the whole 100 pages of the STP.
Obviously they do intend to close it down, whatever they have said to us.

The stories, true or otherwise, about people calling ambulances for a paracetemol or a tampon are a distraction from the real problems with the NHS, rather like the stories by the nastier side of the tabloid press about 'bogus' asylum seekers being housed and 'using up' all the social housing. The ageing of the population should not come as a shock to anyone who can interpret census data, or perhaps that is also down to plane loads of immigrant pensioners? I just get so bl**dy frustrated when most of us, intelligent people that we are, can see the problem,

It is not just about throwing cash at the NHS ( not that it is likely), it is about proper funding of social care to allow patients to be discharged safely to their own homes where they will receive the care and home nursing necessary. Care agencies will not accept local authority contracts, in fact many have withdrawn from massive multi million pound contracts, because it makes no financial sense to be paid £12.50 per hour by Cambridge Council ( for example) when the increased labour costs mean that each hour costs more than that. £7.20 an hour ( hardly a massive sum) plus paid 5.6 weeks holiday, plus travel expenses, plus training, plus administration, costs far, far, more than the invoiceable amount. Not rocket science is it?

Well said, GillT57.

This was originally reported in the Telegraph, but as it's behind a paywall, this is the link to a Huff Post article about the current STPs:

www.huffingtonpost.co.uk/2016/10/30/half-of-nhs-groups-plan-to-cut-beds-to-deal-with-financial-crisis_n_12725062.html

For those who don't like links, a quick summary:

Almost half of NHS authorities are planning to cut hospital beds while a third have proposals to close or downgrade accident and emergency departments.

More than half intended to close or downgrade community hospitals.

Almost as many (one in four) saying they intended to close inpatient paediatric departments.

Bearing mind that community hospitals take pressure off acute services and there was an article yesterday about the wait for paediatric emergency care, this is madness.

Children can't be blamed for taking themselves off to A&E when drunk or wasting GP time. People already in hospital can't be blamed for being too frail to go home.

Let them read links, daphne. We're all intelligent enough, after all, as GillT says.

The community hospital I was talking about was the one where Simon Stevens started his career. When he took on his present job, he said it would never close.
A top NHS bod telling lies? Never.