Straight Talk

Martin Green explores the accident and emergency crisis and its repeating patterns.

Professor Martin Green, Chief Executive, Care England

Once again this year we have been beset by headlines about the accident and emergency (A&E) crisis in our acute hospitals. Every year we have the same repeating story of A&E departments unable to cope with demand and waiting time targets not being hit.

This year was particularly interesting because the pressures were supposed to be worse than they had ever been before, and yet we are not in the grip of a severely cold winter, we have not seen an unusually high level of flu, but we are still mired in the problem.

It is my view that some of this derives from the way in which the system separates out the funding of health and social care and has not recognised the realities of the 21st century; where much of the population are older and living with multiple conditions. The health service is built on a 20th century model of diagnose, intervene, and cure, this model is no longer fit-for-purpose, and we have to think differently about how we ensure people live well with their long-term conditions.

Long-term care is largely the preserve of the social care system, and yet the Government has protected NHS funding at a time when we have seen dramatic cuts in social care budgets. It is also interesting to see the way in which the bad behaviour of the NHS is constantly rewarded by more money being put into the system. Rather than looking for the cause, the Government rewards the NHS for having a crisis.

The Secretary of State announced that he was putting an extra £750 million into the NHS, but there was no clarity about how this money should be used to solve the problem, and in many cases, acute hospitals just opened more beds, and expanded, rather than solved the problem.

Social care is the answer to our problems in health. Every year we have been going to the Department of Health (DH) and the NHS, telling them that we have the solutions to their problems, asking them to engage with us and hoping that they will see the logic of using services that can offer better outcomes to patients, and more value to the taxpayers. Every year we hear the same platitudes, but we do not have any different approach to forward planning. This year the DH has finally engaged with us, now we are in the midst of the crisis, but if they had talked to us when we wanted to talk to them, 10 months ago, there probably would not have been a crisis.

I am a firm believer that there is a need for culture change in the NHS. Every reorganisation costs the taxpayer millions and results in new structures, reconfigured offices, endless amounts of money being spent on infrastructure, but here is the problem, they just recycle the same people and move them from one desk to another, and having done that, they fail to understand why they still have a problem.

The question I want to ask is, why, if these people are so good, were they incapable of finding a solution to the problems of the interface between health and social care years ago. It is ludicrous to think that just by giving a new job title, a new job description and a new office, people will suddenly be capable of coming up with a new solution. The NHS is in serious need of fresh thinking and people who are prepared to challenge its power elites and put citizens at the centre of the service.

A good example of the way in which power elites are not being challenged, is the fact that one of the reasons why there is pressure on the acute sector is because GP services are so difficult to access. At any point when the Government wants to get a GP to do anything, the default response is to pay them more. This certainly does not happen with the rest of the private sector that works in health and social care, and governments are very eager to try to force more and more out of their contracts with social care providers, but they fall shy of addressing the problems in GP services. GPs are private contractors to the NHS and it is time that the Government started to require them to deliver a 24/7 service.

I am always mildly amused when people talk about ‘out of hours’ health services because illness does not fall into a 9 to 5 pattern, health emergencies happen around-the-clock and we should have a system that is geared up to that. If you can have 24-hour services in other sectors, I think we have a right to expect it from health and social care, particularly because as taxpayers we are putting over £120bn a year into the system.

I am sure many will see this as a heresy, criticising the NHS, the sacred cow of our system. I am absolutely committed to a high quality health service, but it must be fit-for-purpose and fit-for-the-future and that requires us all to understand that we must work differently. The NHS must change its culture and share its resources with social care, it is only by changing culture, and the way we work together that the NHS will serve us in the future, as well as it has served us in the past.

Do you agree with Martin? What are your thoughts? Add to the debate in the comments below. Subscription required.

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