In the first week in January, over a quarter of patients in Accident and Emergency waited longer than four hours and only one hospital met the target of treating 95% of patients within 4 hours, a leaked report to the BBC showed (1). More than ten hospitals issued mayor alerts that they were under “unprecedented pressures”, while 66 out of 152 trusts raised the alarm over bed shortages in the same period (2)
January has always been one of the busiest months for the NHS, cold weather always aggravates chronic health conditions, such as respiratory and heart conditions, and icy conditions can cause falls and broken bones, and it is flu season. This year has seen one of the busiest Januarys that people can remember, but this wasn’t without warning. The A&E targets were missed throughout all of last winter (3).
Our government has been slow to act though. Theresa May only admitted that the NHS under pressure yesterday afternoon (Friday 13th) (4), previously she’d avoided saying anything. Jeremy Hunt did make a statement to parliament on Monday, January 9th, but it was a very typical Jeremy Hunt statement (5), slow on any actual help. In it he claimed that the 4 hour waiting time target could be reviewed and only apply to “urgent” patients, and that 30% of people attending A&E “do not need to be there”.
Now we have a new policy change from Theresa May to deal with this whole NHS crisis, but this new policy has left me feeling, what?
Theresa May says she’ll force GP Practices to open 8am to 8pm, seven days a week (6). If they do not do so they could lose extra funding that they deeply need. But will this relieve any of the pressures on hospital A&Es?
The reality is this will not provide any extra GP appointments because this isn’t employing anymore GPs, (Already there are over 4,600 empty GP posts, 12% of the workforce (7)), it is just stretching the current number of GP appointments over seven days instead of five. The reality will see less GP appointments during the week, and will there even be a demand for all these weekend appointments? A BMJ survey from November 2015 found only 2.2% of patients would choice to see their GP at the weekend (8). Also, with all these extra bookable appointments to cover GP Practices will not be able to offer as many emergency appointments. If people cannot get an emergency GP appointment where will they go? A&E?
Also, will these weekend GP appointments prevent all these people who need admitting to hospital? How can GPs manage at home people who need hospital admission? How will these GP appointments prevent the chest infections, the pneumonias, the chest pains, the broken bones that all need admitting to hospital? How will these GP appointments provide the extra social care that is needed to allow patients to be safely discharged home?
This crisis is due to a shortage of hospital beds, there are less than half the number of hospital9), we have the second lowest number of beds per head of population of European countries (10), and these beds are filling up with patients who cannot be safely discharged. Social services budgets have been cut by 40% since 2010 (11), which has left social care in a dangerously underfunded state. It can just about fund the people it already cares for, there is little to no spare funding for new people, for home care or residential/nursing home care. This lack of funding has created a bottleneck in hospitals. There is a large number of elderly patients who cannot be safely discharged home because they need social care and there is no funding for them. It is also creating another problem, there are elderly people at home who need social care and are not receiving it. Because they are not receiving it their health is deteriorating and soon they will need admitting to hospital, but there are not the beds available.
Helen Stokes-Lampard, chair of the Royal College of GPs Council, has said general practice is "skating on thin ice" (12). The cut in resources in General Practice and the low numbers of GPs means that people with non urgent problems are waiting four weeks or longer for a GP appointment. In this time a non urgent problem can soon become an urgent problem, a problem that could easily no longer be treatable in a GP surgery. The government’s plan will only add to this problem.
This crisis is down to funding, or the lack of funding of the NHS. Simon Stevens, chief executive of NHS England, described it as, “In the here and now, there are very real pressures. Over the next three years funding is going to be highly constrained and in real-terms NHS spending per person in England is going to go down, 10 years after Lehman Brothers and austerity began.” (13)
88% of acute trusts are forecasting a deficit at the end of this financial year (14). Demand on NHS services has increased by 3-4% on last year (14a), much higher than the current inflation rate, which is 1.2% (15), yet the NHS’s funding is only increasing 0.9% a year (16), and this doesn’t take into account the £22 billion of “efficiency” savings the Department of Health is demanding from the NHS by 2021 (17).
This crisis is due to funding and resources cuts and yet the government reacts by almost bullying GP Practices into working seven days a week, without any extra funding. Our NHS is on its knees and this government is still demanding more for less from it. They are not taking responsibility for the mess they have created and they are doing nothing to sort it out. They are offering no leadership in this crisis.
In November last year I was admitted to hospital with pneumonia, this was not because I couldn’t get a GP appointment. My GP had been treating my pneumonia but, because I had caught an antibiotic resident strain, my GP soon reached the end of the treatment options open to him. He had me admitted to hospital because I was too ill to be safely treated at home. How would a Sunday afternoon GP appointment have prevented this?
So where the hell did the government come up with such a useless policy in the fist place? A crowing article in today’s Daily Mail may give the clue, its titled “Open all hours, PM orders GPs: After the Mail exposes half-day surgeries, doctors are told to open from 8am-8pm - or lose cash” (18). Again we see the emergence of that dangerous Government move, policy creation by Daily Main headline. Our politicians are being dictated to by the worst newspaper in the country.
Theresa May has shown that the NHS is a very low priority to her, otherwise why did she leave Hunt in post as Health Minister, and her reaction to this very avoidable crisis only is further proof of this. How will bullying GPs solve the shortage of available NHS beds? Who the hell voted for her?… Oh yes, no one.