Delivering an NHS fit for the future starts by addressing the emergency care crisis
Finding long-term solutions to fix our emergency care departments will have to be on the immediate agenda for whoever is in power after the next General Election.
Throughout 2023, health and the NHS have been among the most high-profile issues on the minds of the public.
It is no secret that emergency departments are becoming increasingly stretched. Between April 2022 and March 2023 nearly 400,000 people who needed medical care waited 24 hours or more in an emergency department in England.
As we start to once again enter a new Winter battle and, with the very realistic prospect that the problem could deteriorate further, there has never been a more important moment than now to face up to the challenge of giving our emergency care departments the help that they so desperately need.
But how can we do so? Potential solutions were discussed at a Total Politics event at this year’s Labour Party conference in Liverpool, sponsored by the Royal College of Emergency Medicine (RCEM), British Geriatrics Society and Parkinsons UK. Chaired by the editor of PoliticsHome, Laura Silver, the discussion primarily focused on the pressures causing the emergency crisis and what can be done to fix the problem.
Opening the discussion was President of the RCEM, Dr Adrian Boyle. Citing his experience as an A&E doctor in Cambridge, he set out the scale of the current challenge with emergency care: “Too many people are waiting too long in our emergency departments. We have seen over the last winter, these horrendous situations of ambulances queuing outside our departments. You see that visibly, but what you may not have seen unless you have actually had to be in the emergency department is the people being looked after in corridors.”
This is something that is being noticed by others working on the frontline. Speaking as a fellow clinician on the panel, Professor Adam Gordon, who is a consultant geriatrician and president of the British Geriatrics Society concurred: “Like Adrian, I regularly spend one or more day a week in the emergency department in our hospital and the situation as he describes it, of people receiving care in corridors, is very real and very current.”
Most concerning of all, Dr Boyle explained how the emergency care crisis is a problem that is “deteriorating” and making people sicker, particularly older people: “In 2019, one in 10 people over the age of 80 would have a really long stay over 12 hours. In 2022, this number has risen to one in three… our system is making people worse.”
However, it is not just an issue confined to that demographic. Dr Boyle noted that another group, which has also been disproportionately disadvantaged by long wait times for emergency care at the moment, are people with mental health presentations.
The same applies to those with neurological conditions, including Parkinson’s, which affects around 153,000 people in the UK. Director of External Relations at Parkinson’s UK, Juliet Tizzard, explained that, while “people can live very well with Parkinson’s at home, they need a lot of health professionals to help support them to live well and stay out of hospital”. However, when people with Parkinson’s are in hospital, 86 per cent of them are an emergency admission. “Elderly people particularly can often get sicker as a result of that admission to hospital and emergency admission. That's certainly the case of people with Parkinson’s,” added Tizzard.
Tizzard argued that there needs to be greater access to multidisciplinary care for those who are disproportionately disadvantaged, a move to make it easier for people to navigate the pathways to care within the NHS and the need for a cultural shift where patients are treated as “whole humans”, as opposed to being defined by their particular condition in isolation.
Meanwhile, speaking from her own experience having been diagnosed with neuroblastoma at only six weeks of age, Councillor Carla Thomas, Deputy Portfolio Holder for Policy, Reform and Resources in the Liverpool City Region, gave another insight into current challenges for patients with long-term conditions: “I've seen the NHS at its best, working with care, compassion and dedication - especially in an emergency setting. But I've also witnessed the disjointed long-term care services due to complex health challenges, especially in mental health. I've seen it all from a professional level as well as a personal standpoint.”
Turning to solutions on emergency care, Dr Boyle argued that the present crisis stems from the combination of a lack of beds and underfunding, with the UK performing among the worst in the developed world in both of these areas: “We don’t have enough beds within our hospitals. If you compare us internationally, we are at the bottom of all the tables… We also compare very poorly to other countries in terms of the spend that we put into our population both as a percentage of GDP or absolute numbers.” While a degree of progress is being made on this following a commitment from the government to increase the number of beds by 5,000, Dr Boyle argued that we need to go further to fix the issue for good.
Crucially, Dr Boyle said that “problems in emergency departments are best seen as a marker of whole system stress” and wider issues with our health system as a whole, including the country’s problems with social care. Professor Gordon echoed this, saying: “Accident and emergency departments are the canary in the coal mine. They are not fundamentally where the problem with our health system lies... they are experiencing pressures as a consequence of issues elsewhere in the system. And that is most obvious in the lack of capacity in domiciliary care, which is primarily a social care provision.”
In addition to fixing social care, the panel agreed that prevention and technology both had important roles to play in easing existing pressures within the health system, alongside reliable data and maximising staff retention through fair pay.
For more information on the work of organisations involved in the event visit:
RCEM - https://rcem.ac.uk/
British Geriatrics Society - https://www.bgs.org.uk/
Parkinson's UK - https://www.parkinsons.org.uk/get-involved/campaigning-change
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