Where’s the last place you want an emergency waiting to produce an accident – in Accident and Emergency.

But figures appearing over the last weeks suggest a growing crisis there.644632_10151361908992411_1823532701_n

Early in June figures from the King’s Fund showed that waiting times in A and E had reached a nine year high.

On 14 June, the Guardian reported that attendances to accident and emergency had hit a record high with 21.739m patients in the first 11 months of 2012-13, with ‘a notably large jump occurring between 2011-12 (21.481m) and 2012-13 (21.739m after 11 months)’.

The knee-jerk response of Health Secretary Jeremy Hunt was to blame Labour’s GP contract and its out-of-hours provision. But the recent escalation in the figures points to other causes.
As the Guardian’s Health correspondent Denis Campbell writes
‘The figures cast serious doubt on health secretary Jeremy Hunt’s recent claims that the rise in A&E attendances was due to Labour’s “historic mistake” in 2004 of letting GPs no longer be responsible for providing out-of-hours care.

There is a need to inject some sober analysis into these figures, as the King’s Fund has tried to do.
Denis Campbell again ‘The ageing population, and the fact that growing numbers of older people are suffering from one or more long-term illnesses, such as diabetes and breathing problems, are key factors in the ongoing surge.’

There are, however, other compounding factors, many of them firmly placed on this Tory/LibDem government’s watch.

The Mail Online, scarcely a Labour apologist, has pointed to the loss of hospital beds under this government – at an average rate of about 7 a day, a 6% fall since May 2010.

As Andy Burnham stated in Parliament ‘More than 4,000 nursing posts have been lost since May 2010 and the Care Quality Commission says that one in 10 hospitals in England is understaffed. It emerged last week that the problem is set to get worse. A survey of NHS HR directors by the Health Service Journal found that 27% of trusts were planning to cut nursing jobs in the coming year, that 20% were planning to cut doctors and that one in three was not confident that they had enough staff to meet demand.’

The government have managed to add chaos to this crisis by bringing in a new penalty clause for patients kept waiting for longer than 30 minutes outside A and E. This has had the ludicrous result of shifting £90 million worth of fines on to the ambulance service!
This is just the sort of divisive, counter-productive move which, as Shadow Health secretary Andy Burnham points out
‘Is a clear sign of the chaos that is now engulfing the NHS. People expect to see the NHS pulling together to protect patients. They do not expect to see one part of it fighting another.’ [Mail Online]

As a response to all this, Labour called an emergency debate on 5 June.
There Andy Burnham accused Jeremy Hunt of ‘sticking to the spin, continuing to blame the GP contract’, while experts queued up to tell him it was not the cause of the problem. The NHS Confederation, the Royal College of General Practitioners, the King’s Fund and the Foundation Trust Network all told him that the causes lay elsewhere.’
A major cause is the Coalition’s cuts to Social Care and Local Authority budgets. ‘Two-thirds of NHS finance directors have identified social care and its collapse as the single biggest driver of the pressure on A and E.’
It was left to Labour to show the leadership that the NHS desperately needs. The Labour party in Parliament convened an A and E summit, to give front-line staff from all over England the chance to report on the reality on the ground and to suggest practical ways in which the pressure might be relieved.

There were two overriding messages: first, the pressure in A and E is an issue for the whole health and care system; and secondly, there is no one simplistic, single cause but a range of complex underlying factors.

These include the £3 billion costs of the reorganization forced by the Coalition’s Health and Social Care Act, the huge personal costs of that reorganization, in terms of staff time and attention, and the ransacking of Councils’ social care budget which has left many, including the elderly, very vulnerable.

On 5 June Labour moved a motion in Parliament
‘ That this House 
is concerned about the growing pressure on Accident and Emergency departments across the country over recent months; 
notes this week’s report from the King’s Fund which concludes that waiting times in A&E recently hit a nine-year high; 
further notes that in the Labour Government’s last year in office 98 per cent of patients were seen within four hours; 
believes that a combination of factors lies behind the extra pressure on hospitals but that severe cuts to social care budgets are one of the most significant causes; 
is further concerned that one in three hospitals in England say they do not have sufficient staffing levels to deal safely with demand on services; 
further notes that over 4,000 nursing posts have been lost from the NHS since May 2010 and that a recent survey by the Health Service Journal revealed that a further round of front-line clinical job losses are planned for the coming year; 
further believes that the Government has failed to show sufficient urgency in dealing with these problems; 
and calls on the Government to bring forward an urgent plan to ease pressure on hospitals by, amongst other things, re-allocating £1.2 billion of the 2012-13 Department of Health underspend to support social care in 2013-14 and 2014-15, and ensuring adequate staffing levels at every hospital in England.’

Andy Burnham concluded
‘the Government must act to shore up social care in England, which is collapsing. Our solution is for the Secretary of State to use about half of last year’s underspend in the NHS, £1.2 billion, to provide emergency support to councils over the next two years to maintain integrated, home-based support. As he knows, the Budget revealed a £2.2 billion underspend in last year’s Department of Health budget. No use was made of the budget exchange scheme. In other words, he handed that money back to the Treasury. I call on him to reconsider his decision, reopen negotiations with the Treasury and act to prevent a social care emergency.’

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