The A&E debate: we should be treating the cause, not the symptom

Guest blog by Gail Beer, Director of Operations 2020health, in response to the announcement that struggling A&Es in England will receive a £500 million bail out from the government.

 The whole A&E debate seems to be upside down to me.  We have an increase in A&E attendances of significant numbers, we struggle to meet the four hour target, into which millions of pounds have already been pumped, and the ambulance service cannot cope. 

Theories on the cause of this rise in use are bandied about – we hear stories of NHS 111 sending patients needlessly to A&E, the changes to GPs out of hour’s contracts are blamed for some of the problem and then there is the tariff, which is universally acknowledged to be wrong!  Our A&E departments and ambulance services are experiencing inappropriate use, and to judge from what I read about 111 there are some inappropriate calls to their service too.   

So the solution is … to give A&E departments that are failing to meet their targets loads of money   and a new idea … let’s implement consultant triage, which I thought was implemented way back when the four hour target was at 98%.  Politically expedient and yes it will get us through this winter. But it is upside down thinking; no focus on the cause, just a quick jab of painkiller to get us through this crisis.

We are treating the symptoms but not the underlying cause of the problem. Why are so many people attending A&E?  The GP contract might have something to do with it, but I would suggest this is not a major contributor. NHS 111 might be sending the wrong type of patients to A&E, and no doubt the rise in alcohol fueled revelry is having an impact as well. Add to this the fact that of course it is easier and quicker to wait four hours in A&E to see a doctor rather than two weeks to see your GP.  Join these dots together and there’s no surprise that there is an increase in pressure on the system.

Yet these pressures cannot be the whole explanation for the rise in A&E attendances; surely the nation is not so poorly that so many of us have to go to A&E.  I think what we really need to do is understand why people go to A&E and have greater clarity on those attendances that could be treated or should have been treated  elsewhere or indeed self treated.

We must take a long hard look at what we need to provide in terms of emergency and urgent care, and be clear about what the public can expect.  We  do need to review out of hours access, and we should be exploring  new models of care and new ways of giving access to care, with new providers , for example pharmacists. We know we must do these things,  but they are not quick wins and the NHS moves at glacial pace.

 A&E has to be for accidents and emergency: they are not ‘anything and everything’ departments as I have heard them called.  We have to encourage the public to use these services wisely otherwise we may end up not being able to afford to provide the high quality services they expect.   We must also give people the confidence to care for themselves and manage their own illnesses without going to A&E.

The public requires greater clarity about when and how to use services as it is all a rather confusing mishmash.  While those planning and directing health care maybe clear the public don’t seem to be, It is essential that we   guide and support people in making the right decisions and then provide them with the appropriate knowledge when they have made the wrong choice. You don’t know unless someone tells you.  

 Throwing more money at A&E is not a long term game plan; it is just not sustainable and doesn’t help the NHS or its patients.  Time for change but let’s engage the public in the debate and help them to help the NHS. 


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