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Treating the NHS

Last week in Prime Minister’s Questions Ed Miliband claimed that the NHS is in crisis, quoting the President of the Royal College of Emergency Medicine who had said, “There are almost daily instances in most A&E departments of patients facing extended trolley waits”. 

Miliband went on to suggest a shortage of nurses, beds and senior A&E doctors. The Prime Minister disputed these claims and said that there now more A&E consultants than five years ago. Emergency units are now treating 1.2 million more patients and doing so with an average waiting time of 50 minutes, 20 minutes less than under Labour. Nevertheless he has ordered contingency plans for using private hospitals if the NHS cannot cope and he wants weekly reports on the situation in A&E units. 

Whatever the reality in A&E there is a deeper underlying problem in the NHS. Despite the fact that NHS budgets were protected from the Chancellor’s austerity measures, the NHS is said to be facing a deficit of £200 million this year and a £30 billion funding gap between now and 2020/21. London’s St Bartholomew’s hospital is an immediate example. Said to be losing £2 million a month, it is making 1000 staff redundant. In a review of the quality of care and treatment in 14 failing hospitals, Sir Bruce Keogh, the NHS Medical Director, has noted a shortage of nurses and specialist medics, and an excessive use of temporary staff.  He advocates the NHS moving to seven-day working to maintain standards of care and treatment at weekends, which is obviously right, but will call for a greater flexibility by staff that cannot be taken for granted at a time of pay constraint, tight budgets and poor morale. 

Sir Bruce Keogh’s recommendation is the creation of a two tier A&E service with selected units handling life-threatening cases – strokes, heart attacks, and suspected brain haemorrhages – whilst others deal with less serious cases. He also wants GP practices to open in evenings and weekends. The latter would help because growth in A&E traffic is the result of GPs working nine to five and not at weekends, forcing people into emergency hospital units. The two tier proposal would only work if people feeling unwell could accurately diagnose the seriousness of their condition, though presumably the ambulance service would help with this. However, travel to the ‘super’ E&A units would be longer for some who need urgent treatment. 

Polls consistently show that the quality of care provided by the NHS is a top priority amongst voters. David Cameron fought the 2010 election with the slogan that the NHS is safe in Conservative hands and cited his family’s experiences with Ivan, his son who had cerebral palsy and epilepsy.  The Opposition will remind voters of this in 2015 when the NHS will be a key issue again. It will not be surprising if the Chancellor’s Autumn Statement on 5 December includes provision for increased spending to enable the NHS to tackle these problems and head off talk of a crisis.