Health: Extra money is not the answer to crisis on A&E
Another winter has come to a close - a season in which we saw another winter crisis for the NHS. Each year we hear the same stories - more patients attending A&E than ever before, four-hour targets being missed, patients waiting on trollies in corridors for hours before being admitted to a ward and ambulances queuing outside hospitals waiting to transfer patients.
Then there’s the issue of being unable to discharge patients who are medically fit to go home because care packages are not in place.
It seems the health care system in the UK is buckling under the pressure.
The NHS was set up according to premises which have turned out to be false. The first was the expectation that as people became healthier, demand for services would fall. This hasn’t happened, instead demand continues to increase. Secondly, population demographics would remain about the same - instead people are living longer and the population is getting older.
Finally, it was planned that a large proportion of the cost of the NHS would be paid for out of what was the National Insurance stamp. It is now mainly supported through general taxes - but the NHS always seems to be short of money.
The annual budget for the NHS is around £120bn, which rises significantly if social care is included. Most governments, including the present one, over many years have increased NHS spending in real terms, but it still isn’t enough. A&E departments need to be able to admit patients to wards, but often can’t due to medically fit patients still occupying those beds, a practice known as bed-blocking. We need better integration of health and social care, so that people do not stay in hospital once they are medically fit, freeing up beds for those who need to be admitted from A&E.
Pooling health and social care resources within one integrated care system can result in reduced hospital stays. A pilot in Torbay where the NHS and social care have worked closely together resulted in fewer patients staying in hospital when they are medically fit to be discharged. This joined-up approach would need shared local budget deals, which could be supported by the devolution deals happening regionally.
Local authority budgets have been squeezed in recent years and the amounts of money going into social care has had real terms reductions. Indeed since 2009 social care funding has been reducing at around 1% per year. This is at a time when the population is getting older and needs more social care provision not less. But social care budgets need to be considered alongside the NHS budgets because cuts to the former invariably have a negative impact on the latter.
Whatever the solution the blame game is not helpful - the government, health tourism, immigration have all been used as scapegoats for the crisis.
If we want a health care system that is there when we need it, we need an adult debate about what sort of health care system we want and how we are going to fund it in the future.
Pumping in additional money isn’t the answer. We need to consider what the options are, look at what other countries are doing and then decide which direction to take. We can have as much health and social care as we’re prepared to pay for. Doing nothing will mean more of the same, and an annual winter crisis for years to come.
David Wood is Principal Lecturer in Adult Nursing and Public Health at Sheffield Hallam University