THE BLOG

Struggling A&E is a Symptom of a Larger Problem

14/01/2015 13:34 GMT | Updated 16/03/2015 09:59 GMT

NHS staff working in A&E are doing an incredible job under enormous pressure.

As demand surges beyond capacity and the political storm grows, it is clear they need help and they need it fast.

But my fear is that the pressure on A&E beds will never relent while the proposed solutions themselves continue to be strapped to a gurney of conventional thinking.

Too many of these answers bear the hallmark of the long-established silo-mentality, one that divides the NHS into chunks and says, 'medics do this, non-medics do that'.

Since A&E is considered a chunk that the medics 'do', we get the usual calls for more doctors and more nurses.

I believe this represents a failure to see the pressures on that area as a symptom of a wider problem.

We need to step back at look at the whole system to ask why so many more people are now attending A&E and what services we should provide to meet their needs elsewhere.

Cuts to social care are having an impact, leaving people without the support they need to live independently at home and causing a deterioration in their condition.

But there are also structural problems in the NHS that must be solved if we are to create a fluid system, free of bottlenecks and based around the needs of patients.

Rather than continue with the silo approach, we need a collaborative system that makes full use of the wide range of professionals available to the NHS.

In practice, this means physios and other professionals working alongside GPs in their surgeries to act as the first point of contact for patients with a problem.

Creating this additional capacity in primary care would ease the burden on GPs and also stop many people who can't currently get an appointment from turning to A&E for help.

It means providing preventative community-based services that help people with long-term conditions or those at risk of ill-health keep well and out of hospital.

(As an example, our economic modelling shows the NHS could prevent 200,000 falls each year, saving £275m, if everyone judged as being at risk was given access to physiotherapy.)

And finally, it means better coordination between hospitals, social care and community services to help get people out of hospital as soon as they are well enough to leave.

This approach would create a health service that is effective for patients, efficient and cost-effective.

Of course, accidents will happen and people will need to visit A&E but there too the same principle should apply.

One in five people attending A&E does so with a musculoskeletal injury - a broken leg, a dislocated shoulder and so on.

Forward-thinking hospitals, such as Salford Royal and Aintree, now let physiotherapists diagnose, send for tests and, if needed, treat those patients.

Where required, they then arrange a referral to the patient's local outpatient physiotherapy service.

The benefits of this approach are three-fold.

Patients get an expert diagnosis and immediate treatment to begin their rehabilitation from injury.

A&E doctors are freed up to see patients presenting with more complex problems.

And it saves money - when this approach was introduced in Salford, it was found to cut costs for patients on that pathway by 60 per cent.

The same is true when frail older people attend some A&E departments after a fall and are assessed by physios as part of a combined therapy team that has the sole aim of identifying and putting into place whatever the person needs to get well again and return home.

It's a patient-focused, collaborative approach and it works.

So I firmly believe the answers are there if we can just get the questions right.

Because the simple truth is that we can't go on doing the same things in the same way - patients need us to put into place some new solutions.