THE BLOG

Patient Knows Best...

05/03/2014 13:57 | Updated 05 May 2014

Every winter emergency care services in the NHS see a surge in demand, and every winter we, the public, hear the same story of how we are responsible for pushing the system to breaking point because we are using it for the wrong things. I just wonder why this problem isn't responding to treatment. Could it be that the diagnosis is wrong? Is it because no-one is taking the time to listen properly and find out why we end up in A&E and what we want?

Whilst I am not absolving any of us of our part in clogging up waiting rooms unnecessarily or putting extra pressure on GPs by bothering them with our sniffles, changing our behaviour is clearly not just a matter of information and education.

Millions have been spent by NHS England and the Department of Health on poster campaigns, radio advertising, even apps, to 'educate' us about how to use services properly. Yet still we roll up at the doors of A&E for all manner of ailments. Perhaps it's time that the politicians and policy makers faced up to the facts and started to look at things a little differently - through patients' eyes.

Our latest research shows that nearly 1 in 5 of us who have had a non-emergency medical issue admit to going to A&E to get it seen to. What's worse is that 1 in 3 would be likely to do so if their GP was closed, and 1 in 4 said they would if they couldn't get an appointment with their GP within a reasonable timeframe.

So despite around two thirds of us worrying that the NHS might not be able to cope when winter strikes it is clear that when it comes to our own health, and that of our family and loved ones, many will continue to use A&E for non-emergencies even when we know it's not the right thing to do.

This behaviour is often considered 'irresponsible'. In all our research, consumers and users of healthcare have themselves been quick to say that we all have a responsibility to use precious health and care services appropriately.

Yet at the same time I can see why people are frustrated. According to the national GP Patient Survey for example, roughly 1 in 6 of us report regularly having to wait more than a week for an appointment and that surgeries aren't open at convenient times. Getting an appointment with a GP is often described as "a joke" and is usually the first problem identified by the people I speak to about their experiences of health and care.

Of course there is always the option of visiting a walk-in clinic. Yet around a third of the people we have spoken to said they didn't know where their nearest centre was, let alone the services it provides. This may be why, as Monitor pointed out back in December, almost a quarter of these have closed in the last three years and the future doesn't look any brighter.

Let's not forget the impact of a rapidly ageing population and deep budget cuts on social care services, in particular on urgent and emergency care. Recently released NHS data showed how visits to A&E by ambulance for the over 90s are up 81 per cent compared to three years ago.

So, for those trying to behave responsibly the options are limited. This suggests an obvious if more difficult solution: look at the alternatives to A&E to give the public more options and make them easier to use.

Changes don't have to add additional pressure to already stretched budgets. In fact, the current system is hugely wasteful. According to the College of Emergency Medicine, of the 21.7 million people who attended A&E last year almost half, 47 per cent to be exact, left without receiving treatment. Based on an average consultation cost that would mean a potential £700 million being wasted that could be redirected. The challenge then is to unpick why people continue to use services the way do.

Take access to GPs as an issue. When we ask people, the vast majority answer that they want their surgery to open on Saturdays or to stay open later on weekday nights. There is already some of this and doubtless a demand for more. But there could be a whole package of solutions beyond extended opening hours. People who work might be better served by being able to register at a second GP surgery near their office. Those with mobility issues might prefer telephone consultations - the recent floods found one doctor operating from his local pub and discovering he could carry out many consultations on the phone very satisfactorily. All the commissioners and clinicians need to do is ask us what we really want.

Solving the GP question would be a significant step forward but we would also need to apply the same consumer-focused thinking across all services. Sir Bruce Keogh is trying to address some of these issues in the urgent care review, an initiative that I welcome. But ultimately change will only be achieved by making the alternatives more attractive to consumers.

This is a challenge that is familiar to any successful business owner - to work, services have to be designed around consumers. We all pay for the NHS through our taxes and we have a right to able to use it when we need it. It is also true that we have responsibility for using services properly. But before the commissioners, hospital managers, GPs, care home providers and others tell us what we are doing is wrong, they need to listen hard to why people do what they do and start to meet that expressed customer demand by redesigning around us.