Tuesday, 21 May 2013

A&E crisis - a true crisis or a case of it wasn’t me?

A few years ago there was a song called "It wasn't me" which if you wish to listen to is here. In the wake of Francis loads of people are saying “It wasn’t me” and now the same is happening with a so called A&E “crisis”.

One evening last week several of us caught the UK’s Channel 4 news programme with headlines about the “crisis” in A&E and how it was close to “collapse”. There was also a piece on NHS whistleblowers which in one programmes seemed more on healthcare than on the now implemented NHS reforms every had in a single programme.

We thought we would chip in with some of our thoughts for unlike politicians who have never worked in healthcare we have over the preceding decades noted a few things about A&E.

The first is that the “failures” and “collapse” of A&E appears to allude to one and one thing only and that is the failure of Trusts, formerly hospitals now pseudo private entities, to meet the four hour wait in A&E target. Not familiar with this target which bares no relation to healthcare? The failure is not a lack of treatment but the result of a mission critical tick box NOT ticked. Ticked boxes are important medical care is not.

Our limited sorties into the Dark Lord’s seriously retarded world of commissioning has involved many meetings where NHS managers perform numerous self colonoscopies looking into places most people wouldn’t normal venture into to try and work out why this 4 hour NHS “Constitutional Right” is not being met by their incompetence.

It is now being discussed at CCG boreds by GPs across the cuntry oops misspecallin journ otyo who are getting incredibly enal about looking up the same dark holes as NHS managers have looked up for years and more worrying the tubes are now being shared. The same rocess occurs in your local hospital for if they don’t meet the target someone will send the boys (Monitor) round.

Accident and Emergency departments were once meant for 2 things only. Accidents e.g being hit by a Jumbo jet while crossing the runway at Heathrow or an Emergency e.g a heart attack. They were never meant for what they are actually be used for now which is if I can’t get what I want NOW because I think it is URGENT I will go to A&E.

Several of us as GP trainees (now Registrars) recall patients pitching up to practices being offered appointments which weren’t convienient to patients and we saw them later as patients when working in A&E as locums when they swore blind at A&E reception that they couldn’t get an appointment at their GP (to suit them) and so had “had” to come to A&E as an “emergency”.

Healthcare dear reader if you work in general practice is always forced on the patient – my wife/boss/headteacher/superviser/nursery etc always, says that the patient, told me I “had” to come for a “check” so any patient attending anyway rarely attends of their own volition.

The 4 hour target for being seen in A&E and the 48 hour target for access to a healthcare professional in general practice we would suggest has created this problem for it has created the illusion of rights but denied any patient in the UK any responsiblity whatsoever. It is not a case of a target being applied to true medical need it is a case of politicians pandering to the pathetic.

Both of the above are political necessaties that have no relevance to medical practice and have been and continue to be counter productive for years before Khunta opened his ill informed, unknowing mouth which is the only qualifications you need to be a Secretary of State for Health other than being an MP.

The 48 hour GP target is not about the seriously ill being seen urgently it is you can be seen with any crap whatsoever urgently in contrast to the old GP defined systems of urgent only. So you get I will see if I can my results a bit earlier and block a really ill patient oh I got lucky I will try it again. I had the tests 6 months ago and I want the results -NOW.

 I can’t see my GP in 48 hours my viral sore throat is an emergency so I go to A&E and I am seen in 4 hours that is much quicker than waiting up to a whole 48 hours. I will do the same again next time I have another miner illness and can’t get an instant GP appointment.

People do not realize that most who work in healthcare will try and see patients based on healthcare NEED not on patient WANT which is infinite and always now.

The current NHS Tripartite meerkat model is based on WANT and profit not on true NEED hence the politically defined targets.

Politicians WANT and NEED votes and the NHS is an easy football to kick so healthcare workers pander to the pathetic (politicians) and not the true ill.

True medical NEED is therefore overwhelmed by politically generated patient WANT (QOF et al) which is not the same as true patient NEED for anything other than a true accident or a true emergency. The 4 hour target reinforces this and the see GP within in 48 hours merely reinforces this too. It generates WANT but does not statisfy true healthcare NEED.

Any politician heard of Pavlov’s dogs? Politicians rang the bells and the dogs just keep running back salivating for more instant satisfaction via political targets. The politicians keep ringing the bells and wonder why patients keep drooling saliva over the NHS but they never provide the tissues – just the saliva we are meant to mop up and that sticks up the system which the politicians created.

The medical colleges may share some of the blame but all are above reproach but in the good old days surgeons and physicians were expected to do a 6 month stint in A&E but this was withdrawn leading to a withdrawl of junior staff from A&E which caused a problem called reduced staffing levels. Increase demand decrease staffing levels this truth should be self evident except to those demanding efficiency gains. 

The NHS flawed meerkat has a part as all three partys in the current TriPartite sponsored market system believe market good NHS bad. So using free market economics if demand increases then so should prices to restrict demand if supply is limited which in healthcare it is.

So busy A&E departments and GP surgeries should be able to charge more and so those less able to pay would go to less used, less costly resoures and so demand would be equalized? Unfortunately the NHS Soviet market fixes costs to the patient at zero, free, gratis and for nothing which means people just keep consuming an incredibly finite resource that has no hope of resupply.

Joe/Joanna Public knows that if they want more texts on their mobile they pay more for the privilege but when it comes to their healthcare there is no texting restriction. You just turn and go whatever and whenever.

NHS 111/NHS redirect has been blogged about many times. Want to go to A&E or your GP with nothing wrong with you? Just ring a moron with no healthcare experience to get your NHS 111 “that will do nicely trip to A&E/urgent appointment to see your GP” for sod all wrong with you. You may even get an executive taxi sent to convey you there at no extra cost whatsoever to you.

So there is no A&E “crisis” that cannot be reversed very simply by the politicians that created it in the first place you simply need to turn the clock back. But that will never happen because just like Staffordshire the A&E crisis is a case of “it wasn’t me”.

Praise be to the Party for ensuring that whenever there is a healthcare problem caused by political interference the only people who get blamed are those who strive to deliver the health service the politicians and managers have collectively cocked up.