Don’t believe the hype: Myths in critical condition

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The word on the street is one of A&E services at breaking point – are things really as bad as the papers say?

Sarah Rees examines the reality of the ‘emergency room emergency’.


Predictions regarding how dreadfully dreadful the winter will be for the NHS have developed into full-scale Armageddon – dampening any positive thinking and making your own (unrealistic) new year’s resolutions appear quite reliable.

The doom-predictors’ most prized object is the emergency services, with papers and news reports morbidly jubilant in their coverage of the general ‘crisis’ in A&E – nightmarish statistics and heart-tugging anecdotes of old ladies left on hospital trollies have been stalking the pages of the national press for some time.

Further ammunition is supplied daily via the NHS England’s ‘situation report’, allowing Joe Public to see exactly how bad things are in their local A&E every single day – a morbid advent calendar, if you will, that will last till March.

Read too many newspaper headlines and you may find yourself staying inside in a bid to avoid accidents (or emergencies) that could force you into the fiery hell that is (allegedly) A&E; but are things really as bad as they sound?

While even my sunny optimism falters when pitched against the evidence, I would suggest that there is a tendency to over-egg the pudding (the media? Over-exaggerating? Surely not). This past month I have, on more than one occasion, matched hellish headlines with good intention stories, and been pleasantly surprised when, upon peeling back the layers of scaremongering found, not stale crumbs, but complete and wholesome good news canapés.

What morsels of hope are these? I hear you ask eagerly. Before the good news, let’s digest the bad. What exactly are the problems that have stretched A&E thinner than a French crepé?

Firstly, the increasing pressure of an ageing population can certainly take some of the credit for the bleak position of the NHS. Modern medicines and an improvement in lifestyle is raising life expectancy, but these oldies eventually begin to decline, with their complicated health issues all too often resulting in more admissions into A&E departments.

There is also that charming, substantial problem of funding. Thanks to the financial crisis, there isn’t much money in the NHS coffers anymore, leaving all departments and personnel trying to handle an increase in pressure with a decrease in support. More people + less money = bad news.

A major thorn in the side of A&E departments is the lack of alternative options. Walk-in centres are closing with alarming speed, GPs shut up shop 5pm on Friday, and even as NHS Direct closes, the new boy NHS 111 has proved somewhat inefficient. Where else can a worried patient head to, when crisis strikes?

As if this wasn’t enough, A&E departments are understaffed and overworked, while trainee doctors choose not to study for what is seen as a very stressful job – and who can blame them?

Finally, and perhaps the most unappreciated cause of all, is the problem of attitude among service users.

In my mind, the emergency department is a pretty serious place to be, only to be ventured into in ‘A Real Emergency’, a place that looms in my mind as Mordor must in the brain of Frodo.

I am, according to statistics, something of an exception. Most people see A&E as the logical place to roll after a heavy night out, or the quickest way to see a doctor when the surgery’s phone line just keeps on ringing. You’d think it was fairly obvious that broken fingernails and ill kittens did not count as emergencies, and yet there are an alarming number of people who have strolled into A&E with just those issues. An estimated 30-40% of all A&E attendances are unnecessary, and people have been known to arrive with concerns about turning orange…only to remember they got a fake tan – I mean, please.

When all of these sprains of gloom are totalled up, it’s easy to see why A&E fracture is the logical prediction. What is all too often overlooked (and under reported) are the projects/initiatives/schemes that are in place to target all of these ills, and the people doing their merry best to improve the prognosis the of emergency departments countrywide.

Managing elderly people’s conditions have become a hot topic, with so many areas now offering care in the community to prevent older people – and other high-risk patients – having to head to A&E in the first place.

Alternative options are also on the rise, with widespread talk of GP surgeries extending their services to the weekend and improvements being made to NHS 111. The public are also being educated on the many services the local pharmacist can offer and encouraged to consider visiting a pharmacy when in need of advice or treatments for certain illnesses.

Not enough doctors in A&E? More training posts for juniors are being created, while those with the power are changing regulations to make choosing the emergency medicine option an easier route.

There is also, thank goodness, a big push to stop patients thinking A&E is an appropriate place to go with a broken nail in the form of adverts, posters and even funky videos on You Tube.

While the government (despite the best intentions) can’t magic more money in the coffers, they are doing what they can, with interventions, such as ‘reclassifying’ emergency services into serious and non-serious emergencies, to maximise the available resources.

Despite all this good news, the public perception of A&E departments continues to be gloomy and reports continue to pepper us with alarming statistics. Why?

Think of the NHS as a huge lumbering cruise liner that has spotted an ice berg in the water. Alarms are raised and the wheel is spun, but the weighty beast takes a maddeningly long time to turn. Changes take time, but they will come as best they can in this tricky climate.

In the meantime, we can all do our bit by changing attitudes and expectations, accepting the harsh truths, and allowing the golden ideal of a perfect health service to mellow into a more satisfactory and obtainable reality.

Sarah Rees writes for PF Discovery, an online resource that offers news and information on the reformed NHS. She is editor for digital title Access NHS, a free publication that covers news, analysis and features on the changing health service. Visit for more details.


Pf Discovery

The work is never done for us Pf Discovery caretakers, and this month has seen much moving and shaking on the PfD website as we beaver like house elves to keep everything up-to-date for our discerning subscribers.

There was big excitement upon the upload of Academic Health and Science Networks (AHSN), and these 15 innovation-fuelling groups now have their own tab and member information, including contact details and relevant documents, available at the click of a mouse.

We’ve also been hard at work on sourcing information on Clinical Senates (CS) and Strategic Clinical Networks (SCNs) – two groups with overlapping roles that both serve, broadly speaking, to offer a platform for sharing ideas and bouncing around new strategies for coping with local healthcare issues.

From our research, it seems that most CS and SCNs are gradually getting themselves sorted but are at varied stages of progression, which our data reflects. We hope to have more details on both CS and SCNs up on PfD in the coming weeks, so keep your eyes peeled.

We have been keeping a close watch on Commissioning Support Units (CSUs), increasing our database to include more key members of these groups, and listening to the talk of potential partnerships. While there are currently 27 CSUs, some may look to merge to ensure they get authorised as the lead provider of health care support. Two partnerships are in the discussion phase – Central Midlands and Staffordshire and Lancashire CSUs are one, while the other potential gang is Kent and Medway, North West London and South London CSUs.

So that’s the word on the street this month at PfD headquarters.


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