GROWING demand on A&E departments will make them unsustainable if effective action is not taken quickly, according to MPs on the Health Committee.
Launching a report following the Health Committee’s inquiry into emergency services and emergency care, the Tory Committee Chair Stephen Dorrell MP – a former health secretary from 1995-97 in the Major government during the height of the ‘Mad Cow’ crisis – said, ‘The A&E department is the safety valve.
‘When demand for care is not met elsewhere, people go to A&E because they know the door is always open. It is vital to ensure that the needs of patients who don’t need to be at A&E are properly met elsewhere so that those who do need to be there receive prompt and high quality care.’
He is plainly for keeping people out of A&Es.
He stated: ‘We were concerned that witnesses disagreed about the nature of demand for urgent and emergency care. The system is “flying blind” without adequate information about the nature of the demand being placed upon it. NHS England needs to establish a proper information base to allow informed decisions to be made.’
Dorrell is searching for a gatekeeper to turn people away from A&E care and lock the doors on them.
He adds: ‘Even if the information was adequate it is unclear who is responsible for using it. We were told it is the responsibility of Urgent Care Boards, but witnesses were unclear about how many UCBs are planned, what powers they will have, and how they will relate to other commissioning bodies – particularly the recently created Health and Wellbeing Boards whose remit also covers urgent and emergency care.’
Dorrell is complaining that Urgent Care Boards are not sufficiently laying down the law as to who will be admitted to A&E care and who will be excluded. He says: ‘The Committee is mindful of pressures which will build during next winter and is concerned that current plans lack sufficient urgency. It recommends that NHS England should ensure that Urgent Care Plans are agreed for each area before 30th September 2013.’
The Committee goes on to argue that there is a requirement to restructure provision of urgent and emergency care if patient need is to be met in the longer term. Stephen Dorrell says, ‘It is clear that the structures established 60 years ago are not appropriate for the 21st century. We need to reorganise the way in which emergency and urgent care is delivered.
‘Enabling primary care to assume a more active role in dealing with urgent cases is an important part of this. We recommend that NHS England, as the commissioner of GP services, should actively seek innovative proposals for community-based urgent care services, including improved access to step-up/step-down residential facilities.’
Again: ‘It is also clear that emergency care in acute hospitals needs to change. There is strong evidence that centralised specialist units save lives, but proposals for change must be genuinely evidence-based and reflect local needs and conditions.’
The Dorrell solution is to shut down A&E’s in favour of a few centralised units, letting those who are turned away take their chances in the Community.
He is singing the same tune on ‘low staffing levels’. He says: ‘We think it is extraordinary that consultant coverage for a minimum of 16 hours a day during the working week is guaranteed in only 17% of designated A&E Departments. The figure is even lower at weekends and there are high vacancy rates for senior staff and consultants leading, inevitably, to high locum costs.’
MPs also question the role NHS 111 will play in the emergency and urgent care system. ‘It is disappointing that the decision was made to launch NHS 111 when so little evidence had been gathered to support it, says Stephen Dorrell. ‘We are concerned that having to speak to a call-handler and going through a laborious triage process will only encourage patients to see A&E as their first port of call.’
NHS 111 has failed in doing its job. According to Dorrell, its job is stopping people going to A&Es. Dorrell also has a vision of ambulance treatment replacing A&Es. ‘Ambulance services should be regarded as care providers in their own right and not a service that simply readies patients for their journey to hospital. Ambulance Trusts must invest in recruiting qualified Paramedics who are able to treat patients and avoid unnecessary trips to A&E.’ Patients are to be left at home and denied access to A&E treatment after treatment by an ambulance crew!
What is proposed here is not a result of Mad Cow Disease, but the Tory determination to smash up the NHS. This attack must be defeated. The £50bn of cuts that are being carried out must be halted and A&E closures stopped.
There is only one way to do this. This is by the trade unions calling a general strike to bring down the coalition and bring in a workers government that will see defending and developing the NHS as one of its main tasks.
