The A&E crisis is not about hospital staff and money – we must focus on the causes

Top of the news today is the ‘A&E crisis’. Before you get really worried, this ‘crisis’ is based on hospitals that are not meeting the 4 hour target. The system is NOT close to collapse. However, the solutions being put forward to solve this crisis are short term and not sustainable.

It’s essential we focus on the causes of rising attendance, not simply think that a sticking plaster of money and staff is the solution. The causes include poor patient and practice management by GPs, an increase in complex elderly patients, unresponsive social services and people who get drunk.

Pro-active GPs have shown that if they evaluate their patient calls in the morning, then the majority of patients can have their needs met without even going to see the GP. Some have employed community based doctors who can make home visits quickly to sort out patients problems before they become an emergency. Other GPs have examined their patient records and worked out which patients need extra management to help reduce the chances of a crisis in the future. In all cases A&E attendance has dropped dramatically.

The other issue is personal responsibility. During the week about 30% of attendance is due to people being drunk; at the weekend this can rise to 70%. We have to start fining people who abuse the system in this way.

We need to take a long term view of how we manage the complex elderly patient differently with a more multidisciplinary model across social and primary care, and not through A&E. Trauma patients should be dealt with by specialist centres not in your average local A&E department.

In the past hospitals have spent a lot of time and money trying to sort out their A&E problems, but because hospitals are just at the receiving end, nothing sustainable has been put in to place. Over all these are short term measures to get us over the next 12 months. The answer is to solve the problem of rising attendances. We cannot go on increasing staff and money.

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About Julia Manning

Julia Manning is a social entrepreneur, writer, campaigner and commentator. She is based in London and is the founder and Chief Executive of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal. Through networking, technology, research, relationships and campaigning 2020health has influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer at City University, a visiting clinician at the Royal Free Hospital, working with south London Primary Care Trusts and as a Director of the UK Institute of Optometry. She specialised in diabetes (University of Warwick Certificate in Diabetic Care) and founded Julia Manning Eyecare in 2004, a home and prison visiting practice for people with mental and physical disabilities using the latest digital technology, which she sold to Healthcall (now part of Specsavers) in 2009. Experiences of working in the NHS, contributing to policy development, raising two children in the inner-city and standing in the General Election in Bristol in 2005 led to Julia forming 2020health at the end of 2006. Julia is a regular guest on TV and radio shows such as BBC News, ITV’s Daybreak/ GMB, Channel 5 News, BBC 1′s The Big Questions, BBC Radio, LBC and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week. She is mum to a rugby-mad son, a daughter passionate about Shakespeare, and wife of a comprehensive school assistant head-teacher. She loves gardening, ballet, Zimbabwe, her Westies Skye and Angus, is an honorary research associate at UCL and a Fellow of the RSA.
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