Typically, this column looks at a recent medical story that’s made headlines and discusses whether you should trust it or not.
But this week I’m going to predict the news? With a prediction I’m so sure of, I’d even place a bet if I were a gambler.
It is this: in the next few days, once the data is collected, the Government will come out and say that, thanks to its policies, the situation in the ER is improving.
Despite estimates published yesterday by the Royal College of Emergency Medicine that increasing waits for emergency beds caused more than 250 unnecessary deaths a week in England alone last year, the Government will point to a decline in the number of patients who missed the four-hour goal in March. .
The four-hour target means that we must see and discharge or admit patients within four hours of their arrival at A&E.
But let me tell you now: it’s a farce. Because, over the last month, four-hour data has been manipulated, a result of two policies introduced at the beginning of the month by the Government.
The Royal College of Emergency Medicine revealed this week that increasing waits for emergency beds caused more than 250 unnecessary deaths a week in England last year.
There are NHS targets for patients to be seen within four hours of arriving at A&E, but the resulting data is being manipulated, according to Professor Galloway.
Instead of focusing on the patient, these two policies seem like the last ditch effort of a desperate administration. And worse, all of this has been aided and abetted by NHS England officials whose job should be to do the right thing for patients, not our political leaders.
The first policy went into effect on March 1, when the government forced hospital chief operating officers and CEOs to sign a form (later leaked to the Health Service Journal) saying they would commit to meeting the target. four hours to 76 people. percent of patients in the emergency room (for comparison, when it was first set 20 years ago, this goal was 98 percent).
Then, on 12 March, another letter was sent stating that hospital trusts “would be eligible to receive additional capital funding in 2024/25 of £2 million” if they were in the top ten trusts, or in the top ten that improve, in reaching the four-hour target by 31 March 2024. The next ten trusts to show the greatest improvement will get £1 million.
This is called an Equity Incentive Plan, but it’s just a fancy way of saying bribery. Basically, your hospital trust will get an extra £2 million to spend on a building if it is one of the best among England’s 124 acute trusts. There are 20 trusts that will receive £2 million each to improve their care. Sounds great, right?
The problem is that it shows that the Government’s priority is good headlines rather than good patient care.
And the reality is that ultimately you or your loved ones who need A&E may suffer because of these policies. Let me explain why.
There are two types of patients who come to A&E: the first are the relatively minor patients who come in, with injured wrists, sore throats and the like. A long wait will be annoying, but it won’t cause much harm.
Instead of focusing on the patient, these two policies seem like the last ditch effort of a desperate administration.
Then there are those who usually arrive by ambulance and need admission: for example, the elderly, frail patients, those who have suffered a stroke or trauma patients. These patients are currently suffering the most in our emergency departments. Not only suffer, but literally die due to the delay in getting to the ward beds.
This was demonstrated by a landmark study led by Chris Moulton, former vice-president of the Royal College of Emergency Medicine, published in the Emergency Medicine Journal in 2022. The study showed that for every 82 patients who waited more than six to eight hours in A&E for a bed hospital, one additional patient died.
That doesn’t seem significant, until you discover what it really means: between 200 and 400 more people die unnecessarily each week due to long waits for hospital beds.
The simple fact is that it is relatively easy to improve four-hour performance for the easiest type of patients, where additional staffing can help solve the problems. Much more difficult are complex patients who need to be admitted to a ward, but a lack of beds means they sometimes cannot leave A&E for days on end.
And is it clear that the trusts in England have been prioritizing the easier types, to “play” the numbers in exchange for bribery? Sorry, I’m referring to the Capital Incentive Plan.
A&Es colleagues across the country reported that staffing levels were temporarily increased in the second half of March. Some healthcare professionals have also been offered shifts at higher rates than they would normally get. These are usually doctors who can make the biggest difference for “easy” patients, such as GPs working in A&E, who see the least sick patients (who might then be discharged within four hours).
But now that we’re entering April, staffing levels in emergency departments across the country appear to have declined.
This is because requests from politicians across NHS England were that improvements would only be made in March and not beyond. Is it any coincidence that the end of March is when the numbers are crunched to see how well A&E departments are performing, so that the public can be informed about the state of the NHS?
I have worked in A&E since 2001 and have never known conditions like the current ones. In the 12 months since January 2023, more than 1.5 million patients waited more than 12 hours in the emergency room. that’s 4,200 per day.
Would a government that cared about patients make an effort to improve care for those most in need? like those who wait more than 12 hours in
Emergencies before going to a hospital room. Would a government that cared about headlines do exactly what it has been doing this month? Are you pushing to try to get treatment a little bit quicker for our less sick patients and improve four-hour performance numbers? with the incentive of new construction.
BUT the best way to improve emergency care is not a new building in an already well-functioning hospital, but rather to increase community care. This would improve the rate at which patients could be discharged from hospital, thus freeing up beds on wards. Then, the sickest ER patients will be able to get the hospital bed they so desperately need, much faster.
It’s not just me who is concerned about this policy. Adrian Boyle, president of the Royal College of Emergency Medicine, told me: ‘The Capital Incentive Scheme is a poor way of trying to address the problems faced by emergency patients. Money and effort should ensure that there are enough beds so that patients are not treated in corridors.’
What this whole sorry saga shows is that political decisions are absolutely key to how we manage our patients in the shop. to how you and your loved ones are cared for.
Unfortunately, political interference is affecting patient care. It is time to depoliticize the NHS and, rather than allowing it to simply serve its political masters, it must become a truly “patient first” organization with cross-party agreements and planning, so that a change of government does not affect the changes that the NHS so much needs. . Our patients deserve no less.
@drobgalloway