Over the past year the news has been consistently featuring stories about the crisis in Accident and Emergency departments across the country.
Despite Clinical Commissioning Groups and Acute Hospital NHS Trusts beginning their contingency planning for the ‘winter pressures’ as early as August last year there was still a crisis with A&E departments and staff stretched to breaking point under the weight of demand. Some even had to close, for periods, to new admissions so they could deal with the patients lining corridors on trolleys and in ambulances, waiting to be triaged.
So what’s going on? Last Christmas the weather was unseasonably mild and the number of people with seasonal flu was not exceptional and yet the NHS hit crisis point.
I think the factors that are contributing to the excessive demand on NHS services are inter-related and ones that we continue to ignore at our peril.
Employing over 1.5 million people the NHS is the fourth largest employer in the world and the largest employer in Europe. As a result it is a very complex organisation that is not however, the mistress or master of its own destiny. Instead it is subjected to the ever changing whims of politicians whose main aim appears to be more about their popularity than about the NHS achieving organisational consistency and sustainability.
Currently with a coalition government and no dominant political party the thirst for popularity and power has been gathering pace as we head towards the next General Election in May. The appetite for political point scoring escalates daily as each Political Party vies for pole position as the NHS champion when in reality their behaviour suggests they are more concerned with using the NHS as a pawn in the popularity game.
Some of the issues our healthcare system is experiencing are the direct result of conflicting policies and complicated funding mechanisms making collaboration difficult as different agencies ‘protect’ their resources and compete against one another.
GPs, who are contracted by the NHS to provide primary care, are been squeezed and criticised at every turn as they are increasingly expected to do more for less. Acute hospitals are tasked to reduce the number of people in hospital and so discharge people into the community often while they still have relatively high healthcare needs. The resultant demand exceeds the available resources and funding available to support this so the situation quickly deteriorates. As a result social care and community based healthcare often find themselves caught up in the middle of it all as they too struggle with increased demand and significantly reduced budgets.
The other significant factor is our aging population. As more people are living longer they are often doing so with longer good health but with multiple long term health conditions that are complex and require complex solutions. This scenario was not the vision that prompted the formulation of the NHS. The NHS was first designed to treat people with a single health condition and that along with the advances in technology that were unimaginable in 1946 we now have a system that is out-of-date. However, with politicians pulling the strings the NHS is without the means to change the rules of engagement with the people it serves as they continue to expect a service that is unsustainable in the current climate. It needs to change and the public need to shift their perceptions too.
If the NHS is to function effectively, efficiently and remain economically viable it needs to be independent of the vagaries of politicians, short sighted short-termism and be like any other multi-faceted organisation. It needs to have the autonomy to make long-term strategic plans that are founded on realistic funding that really can deliver the principles upon which it is built and which we, in the UK, are so proud.
However, all the while politician meddle in the NHS policy and practice this is unlikely to happen.
I am not saying however that the ills of the NHS are all down to politicians. Oh no, the general public need to take some responsibility for the difficulties they currently face too.
It is not until people experience other healthcare systems that they truly come to value the NHS and all it provides for citizens. Something that we take for granted.
The public expectation is that the NHS will provide whatever we want/need always and without question. The fact that the NHS is now seriously cracking under the weight of all that expectation only highlights how unrealistic that belief really is, and has been for some time. However, no political party has been prepared to treat tax payers and voters like the adults they are and have an adult grown-up conversation about what is realistic in terms of healthcare. They have all failed to manage our expectations to the point where if we don’t get what we want, when we want it we behave, metaphorically speaking, like spoilt children and have a tantrum shouting loudly about ‘our rights’. At that point it seems that the moral obligation to others that ‘rights’ come with responsibility is conveniently forgotten. Individual needs override this so it seems and the ‘tantrum’ gains momentum when the person involves their local MP or the media, both of whom operate on the basis of self interest not necessarily public responsibility.
The result? Well those in the NHS responsible for making difficult moral and ethical decisions in an effort to maintain equity are pressured into ignoring fair and equitable decision making processes, guidelines, protocols to appease the media storm that occurs. What the media and MPs fail to reveal is how many people don’t get what they need as a result of that furore. So one person may benefit or not as the treatment demanded very often doesn’t get the wished for result which confirms the reasons for the initial decision, at the expense of many more who don’t receive treatment that does work. All this does is further raise public expectation and so the spiral continues. Is one person’s life and wellbeing more important than another’s just because they can shout louder?
Over the last couple of months we have seen people going to hospital Accident and Emergency departments for healthcare concerns that could be dealt with by a pharmacist or should be seen in primary care. Sometimes that is because they cannot get an appointment with a GP as they too are stretched to the limit with more GPs leaving practice every week than ever before. Clearly the whole healthcare system needs to work more effectively together and not in isolation as pressure on one part creates a domino effect on all the others.
So what can you do about this you ask? Well we all need to understand and take responsibility for using the precious resource that is the NHS properly. We need to take responsibility for our own health and learn how to care for ourselves care when we have minor illnesses; to understand when to seek help and when we can help ourselves. We need to be better educated about health and illness and not contribute to the pressure on the NHS by being the ‘worried well’. There are lots of ways in which you can help yourself and the NHS Choices website provides good sound information on a wide range of topics.
Use the NHS with respect or we are indeed in danger of losing or diminishing something which we are rightly proud of. You only have to look to those many countries without collective healthcare systems to make you realise just how fortunate we are.
If we want the NHS to continue caring for us and those we love then we must be prepared to pay more for it and to use it properly and not abuse it.
The other thing you can do is to use your democratic right to vote, if you are eligible, ask your local candidates questions and get involved. If you want more of the same then do nothing, if you want things to change then you need to take the first step.

Until next time …