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“A&E pressure is the biggest NHS challenge”

The pressure on A&E is the biggest operational challenge facing the NHS currently and the “disastrous” GP contract is largely to blame, the health secretary said in a speech on the ageing population.

While Jeremy Hunt acknowledged that dramatic rise in the number of people with complex long term conditions was also playing its part, he blamed poor out-of-hours GP services.

“When I have been visiting A&Es in the last few weeks, hard-working staff talk about the same issues: lack of beds to admit people, poor out of hours GP services, inaccessible primary care and a lack of coordination across the health and social care system.

“The decline in the quality of out of hours care follows the last government’s disastrous changes to the GP contract, since when we now have 4 million more people using A&E a year compared to 2004. We must address these system failures – and look at the causes.”

He said at the Age UK event that half of GP appointments and two thirds of outpatient/A&E visits are now for people with long term conditions.

“Indeed this group are now responsible for 70% of the total health and care budget, over £70 billion every year. And that number is growing – which is why a recent review by Professor Carol Jagger said the way we care for people with long-term conditions is unaffordable and unsustainable.”

He outlined a four-pronged approach that includes treating the person and not the condition; rethinking the role of primary care in delivering emergency services;  improving the dignity and respect involved in care; and improving dementia diagnosis and care.

The BMA said, however, that the government is promoting an “overly simplistic and inaccurate” picture of the current pressures facing hospital A&E departments.

Dr Mark Porter, chair of BMA Council, said: “There is no doubt that the NHS is under intense pressure. Spending on healthcare is squeezed, patient demand is rising and staffing levels are often inadequate. The government’s analysis of where responsibility lies for the huge and increasing pressure on emergency care is completely simplistic. Singling out individual parts of the health service and engaging in a blame game is unhelpful and misses the point.

“Ministers should be engaging positively with healthcare professionals to improve and maintain services for patients, rather than demoralising NHS staff who are working harder than ever with fewer resources, wherever they are in the service.

“GPs are undertaking increasing numbers of GP consultations and hospitals are facing similar levels of high demand that is only likely to rise in the years to come, and become more complex as the population grows and people live longer. These pressures are coming at the same time as health budgets contract in real terms.”

The BMA said it had written to the secretary of state asking for an urgent meeting to discuss how the crisis can be tackled.

However, Dr Linda Patterson, clinical vice president of the Royal College of Physicians,  said: “Jeremy Hunt is right to identify pressure on A&E departments as the biggest operational challenge facing the NHS right now. Pressures are often worst out-of-hours, where hospitals treat patients who could have been cared for in the community. Currently, out of hours care does not meet the need of patients. This has to change.”

Hunt cited the example of integrated working in West London as the way forward, and called for a more bold approach elsewhere. “Hammersmith & Fulham, Kensington & Chelsea and Westminster councils are working together with local NHS clinical commissioning groups to change what they describe as a ‘perverse, costly and uncoordinated’ status quo. Council officials, clinicians, social workers and others have reformed services for the one-fifth of local people who take up almost four-fifths of care costs,” he said.

“By doing more around prevention, they reduce falls. By changing their IT, they identify people who are at risk. By re-evaluating their hospitals, they discharge people much faster.”

Read the full speech.

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4 Responses to ““A&E pressure is the biggest NHS challenge””

  1. Clare says:

    How does integrated care fit with competition and any willing provider Mr Hunt?

  2. james jollingworth says:

    Doctors may be seeing more patients and doing more work but they are showing less ability to make decisions and are increasingly doing so only when it cannot be avoided. This results in crisis managment at the end of the pathway even when a reasonable clinical care plan has been decided. Think elderly patient with DNR directive sent from nursing home to ED to die in hospital as an example. Unrealistic expectations by patients and doctors in end of life care is a major contributor to our hospitals receiving too many admissions both emergency and elective. We need fewer doctors showing more courageous decision making supported by a healthcare system that embraces a culture of delivering what society needs rather than ‘individual magic thinking’ to deliver what society and politicians wish to happen.

  3. Paul Ancill says:

    In 1950 my farther (then a houseman) told a GP trying to admit a patient that “he was not a carpenter he could not make beds”
    I have now worked in hospitals for 34 years there have never been enough beds.
    they need to grasp the nettle and increase the beds available so that the occupancy is between 80 and 84%. And not pretend that the whole problem can be resolved by community care!

  4. Jane Bradshaw says:

    Both Government and bodies such as RCP and BMA need to realise that most of the work the NHS does these days is around long term conditions in middle aged and older people- that includes heart disease, diabetes, COPD, cancer and dementia.
    Instead of complaining about having older people in hospital and visiting their GP they need to redesign services and training with their major ‘customer base’ in mind, instead of complaining about them. Older people have as much right and often greater need of hospital services but they need those services to be designed appropriately, not being endlessly transferred from ward to ward to ensure delerium, and rapid discharge to prevent hospital aquired infection-which implies prompt social services.

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