The recent statistics relating to waiting times at hospitals in North Wales make for sobering reading. Having just worked over Christmas and the New Year at one of them, I can assure you that the existing strain on our emergency departments is unsustainable. Being human, we all have our limit.
Pointing to a lack of doctors seeking a career in emergency medicine rather avoids the real issue. If you turned up for your first day of work in a factory and were offered your choice of roles within that factory, the majority would seek the least stressful because the instinct for self preservation is in all of us to a greater or lesser degree. This is one reason why the current system is spending more than ever on the more expensive option of locum doctors.
The issues are therefore numerous. Why is A and E deemed such an unattractive place to work? Why does it continue to get busier and busier? Why are we having to throw money at the problem in this way? Why are A and E experiences so variable depending on where you live?
Casualty departments have always been busy places but this has escalated somewhat in recent years for a variety of reasons. It is as much the lack of investment in Primary Care as anything else which has precipitated the current problems. Although it would be nice to imagine that all doctors have qualified out of pure altruism, that is simply not the case. They are health professionals. Professionals. They get paid for what they do and, I would argue, they get paid well. I don't deny the pressures upon them or the gravity of the decisions they have to make. The fact remains though that they are well paid for a job they chose to do. In life, we can't have things both ways. Where they choose to work within medicine is largely their choice and based on current figures, very few choose a career in emergency medicine. To suggest this is due to a lack of financial reward lacks logic. It is far more to do with anti-social hours, sheer work load and a cohort of demanding patients who regard the A and E department as their right.
If the UK invested properly in Primary Care as other countries do, this problem would be far less newsworthy. Talk of increasing man power in casualty departments rather avoids the real issue. A high proportion of people presenting to casualty departments do so as a last resort. If their local Primary Care offering was more robust, many of these patients would have no need to go to casualty. Our A and E departments are being used as a political football with the left bemoaning a lack of investment and the right adamant that their health care reforms are working. It is also important to highlight the negative portrayal of a career in Primary Care by our medical schools. The message is frequently, "Oh, you just want to be a GP?". It is not helpful. Here in North Wales, GP recruitment is a well documented problem but it would not take long to find out why that is.
I repeat, it is not bigger casualty departments that we need and nor do we necessarily need more doctors to work in them. In a recent piece, I highlighted the alarming number of people presenting to casualty departments needlessly. This is more down to a lack of education than anything else. Think about that for a moment though. Where were you educated regarding the reasons for presenting to an A and E department. Was it at school? I doubt it. Like me, you probably relied on the advice of your doctor (if indeed you had even been to see him/her) or the advice of your friends or family. People are thus just as inclined to present to their local casualty department based on peer advice as they are from the advice of their doctor. There is nothing wrong with peer advice provided our peers are well informed. But where were they informed?
This is why the time is overdue for a series of public information programmes on radio and television. I have seen posters in my local GP surgery but they should also be displayed on bus stops, in leisure centres (if your local council still deems your community worthy of one), in pubs and everywhere else where people congregate. I reiterate that the NHS by definition is a finite resource. It is free at the point of access for every man, woman and child. If we really want it to stay that way, we need to address public information and Primary Care investment with immediate effect.
That public information needs to be remind the public of their obligations in respect of this free service. Aside from reminding them of when it is appropriate to present to their GP or to their A and E department, it also needs to remind them about the value of a healthier life style. Not a Dickensian food regime per se. It needs to extol and promote the value of certain foods over others and to indicate what a healthy amount of food should be. It also needs to promote exercise now more than ever as a variety of devices continue to make us more sedentary in our daily living. If we're serious about the rising levels of obesity which will only impact more and more on the NHS, we need to say so. We need to be blunt if we have to be. To stand back and watch people reach their graves earlier than they need to is hardly the stuff of compassion - putting aside the financial arguments.
While investment in Primary Care is critical to address the root problems of many patients, the continued closure of community hospitals must be stopped immediately and the process reversed as quickly as possible. For rural communities in particular, community hospitals are a life line. It's important to recognise that a large district general hospital is not always the best venue for patients. We need to ask ourselves why it was that our community hospitals served us so well for so long? Put simply, they filled the need for those patients whose condition did not necessitate the attentions of a large hospital.
So the next time you see another headline about the A and E department in crisis, ask yourselves something. What could I do to help myself? When is it appropriate to go to A and E? Could my GP deal with this? Is my problem serious? Did I enjoy my last meal? Am I placing enough value on my health? This isn't a problem to be capitalised upon by the politicians. This is a problem in which we can all play a small part.
That said, the decisions being taken by local councils in North Wales are truly mind boggling. Ill thought out decisions to close care homes for the elderly will only ever end in tears. This is simple mathematics. By doing so, they reduce the bed space capacity in the community for this ever growing cohort of patients. It is a scandal that such a decision is being taken and an even bigger scandal that the general public are not being consulted for their opinions and ideas - they after all pay their council tax and value some services rather more than others. One of the reasons offered for such closures is that age old canard of cost. My local council alleges that a care home run by the Council costs £800 per resident. By contrast, the cost for the same patient in a private independent facility costs about £500 per week. There are only a finite number of inferences which can be derived from such a claim. Either the shareholder-driven independent homes are being run more efficiently or the council run homes are being run less efficiently. Of course, that over-simplifies matters somewhat but the inference is clear enough - and it is intended to be. The trend of local Councils farming out elderly care services to the private sector has been going on since the days of Thatcher. But neither does that it make it right. I'm afraid the figures of £800 and £500 are not based on fair comparisons - but I am not surprised. The power being assumed and abused by local Councils the length and breadth of the country badly needs reining in before irreversible damage is inflicted on a public who have become too afraid to voice their opposition.
Finally, when patients end up in our hospitals, it is time we addressed their nutrition more respectfully. To offer them pre-packaged food is frankly baffling. To have confectionary trolleys (however well meaning) sends out the wrong messages. This isn't hard. The recent edition of the food programme hosted by Sheila Dillon highlighted the great work being achieved by the Bristol Cancer Help Centre. Here, the head cook challenges cancer patients about the food they eat and the way they cook it. Having suggested we look at the link between what we eat and diseases such as cancer, she has been attacked by the mainstream medical establishment. She only sought to use patient nutrition to augment their medical treatment regimes. Since 2008, the medical mainstream has slowly been coming round to the idea of what is becoming something of a long playing record. The subject of hospital A and E departments yet again dominates media discussion today. While few can deny the strain currently being felt in our A and E departments, too few seem willing to explore the reasons behind this.
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