- Posted:Wednesday 07 January 2015
A&E is often seen as a service in crisis and is the focus of much media and political interest. But A&E is just the tip of the iceberg – the whole urgent and emergency care system is complex, and surrounded by myth and confusion.
Our animation gives a whistle-stop tour of how the system fits together and busts some myths about what’s really going on – explaining that the underlying causes go much deeper than just A&E and demand a joined-up response across all services.
Human beings, our clients are diverse and as the animation showed, display complex and sometimes multifactorial reasons for A&E attendance.
This diversity and complexity requires more diverse workforce inclusion not just "Drs and Nurses" , echoing some of the comments above it is interesting to note the lack of acknowledgement of the role the Allied Health Professions can play, in the UK there are over 64000 AHPs who straddle the continuum of care for all ages groups,and a number are independent/ supplementary prescribers.
Working with social care and voluntary sector colleagues AHPs can collaboratively start to change the system response, especially around people who have higher disease burdens and lower levels of activation
which in turn can help "unplug" some of the bottlenecks being currently experienced.
And it must follow, as the night the day,Thou canst not then be false to any man.”
I applaud the work done in showing where the bottle necks are in the system and also possible solutions. But are we really honestly drilling down to the clear and present harsh reality: we just haven’t got enough resources/beds/staff in the system, etc, as the previous poster has written.
A study done and published in the BMJ in the recent past said of 11 or so high income countries we most cost effective in terms of heath care provision and also patient satisfaction. Imagine, therefore, how much more better we will be if we did put more money into the system?
So yes, we should have more joined up thinking and more inter-department communication and coordination, and yes that will help reduce admissions but i am reasonably and honestly sceptical it will make a significant difference till we bite the bullet and are honest with our self that we simply need more money and resource to cope with the inexorable tide. Yes i admit it may not solve our problem completely but it will go a very long way in that direction. It is from there we can progress to say we are being honest with our patients.
COI: best interests of our patients is my professional Raison d'être
1. How many patients are sent to A&E
2. The speed of the discharge
3. Readmission rates
4. The number of patients prematurely or needlessly going into residential or nursing care
5. The number of patients who would prefer to die at home, but are unable to
In addition, politicians should be open and honest to the public about what they can expect from the current health service rather than promising "the pie in the sky". Now that the elections are over, NHS will face its real biggest challenge and the public are going to face the reality of modern NHS.
Much of the information in this film is similar to my current thoughts with regard to the problems and potential solutions facing unscheduled care in the NHS, but there needs to be more factual evidence and cross referencing with other data sets to clearly substantiate the hypothetical points highlighted. This video aims to create discussion around the current concerns that the NHS is facing crisis, the main symptom of which is the increasing pressure being felt in frontline services, with a particular focus on A&E. It is a subjective text with no clear statistical data and states that it aims to highlight the complexity and myths surrounding urgent care and make suggestions around solutions to improve this. I felt this was more narrative and opinion that definite fact, although I could relate to some of the points detailed, in particular that the current system for urgent care is confusing for both patients and staff and also very disjointed with poor information sharing. I agree with the suggestion that the problem is not due to over admission to hospital but indeed the lack of social care support in the community to aid discharge when patients are medically fit. Additionally, there is a well-documented issue with recruitment and retention into front line medical services, particularly A&E but more recently into General Practice, a fact that is overlooked in this film. There is no clear backing for some of the claims in this, many of which are perhaps more anecdotal although perhaps correct. Patients do often self-present to A&E in crisis, and without a doubt it is entirely unsuitable for mental health patients, however at the present time, there is no real alternative due to underfunded and scanty community mental health services.
"Since then, the overall number of attendances has increased significantly to 22.3 million in 2014/15, a rise of more than 35 per cent over the period. Until 2012/13, attendances in type 2 and 3 units accounted for the vast majority of this increase, with attendances in type 1 units increasing at a much lower rate.
"From 2005-2010 the proportion of patients spending more than four hours in A&E hovered around 2 per cent – an outcome of the 98 per cent target introduced in 2000 and first met in 2005. However, since 2010, when the coalition government relaxed the target to 95 per cent, the proportion of patients waiting longer than four hours has increased."
These inaccuracies make me hesitant to use this otherwise excellent animation as a learning tool for others.
The number of A&E attendances jump from 2003/04 onwards, when type 2 & 3 units were introduced into the data. Most of the increase in A&E attendances occurred in the first few years after this, when more units were opened and more recording of data to these units happened. Whereas between 2010/11 to 2013/14 (just as example) attendances were 21 million (plus or minus some decimal numbers).
For the second question your quote refers only to performance against the 98 and 95 per cent targets. But in actual numbers, the number of patients seen within 4 hours has been increasing. From 340k patients treated after 4 hours in 2005/06 to over 1.8m in 2015/16.
Hope this helps,
One doesn’t need to watch the video to see what is being suggested.
Very obvious data agenda. Just look at the video still.