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.


About Julia Manning

Julia Manning is a social pioneer, writer, campaigner and commentator. Formerly a clinical optometrist specialising in diabetes and visual impairment, she is the founder and Director of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal and Social. 2020health has through research, events and campaigning influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. In 2014, 2020health were founding partners of the Health Tech and You Awards with Axa PPP and the Design Museum. Since 2016, 2020health has increasingly focused on digital health and public health in the community. Julia is a Fellow of the RSA and now also a part-time PhD student at the UCL Interaction Centre, studying the use of digital technology for stress management in the workplace. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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