Health service needs all parts to function

Sir, – Many words have been spoken about the ambulance service and the recent regrettable delays, and no one is backing away from the problem.

Here is the thing though, health care is an integrated solution, which means each of the segments must be capable of operating at the level required, otherwise hold-ups occur and patients’ progress through the system is slowed.

So, to meet the four-hour metric 95% of the time, to see a patient at A&E, triage, determine the extent of the problem and move the patient on to the correct next stage, requires this next stage to be capable of receiving the patient.

Any of the next stages could

cause hold-ups at the front end A&E.

A senior acute care doctor on the radio yesterday explained some of the complexities, where a lack of primary care packages can be a cause of delay to discharging patients home. You can appreciate this will cause a back-up in the flow of the hospital.

Another surprising but unintended consequence was described, where prior to Covid a primary care doctor could receive a call to attend a patient, attend and determine if the patient needed hospital, then the patient could be in hospital late morning or early afternoon when the maximum support staff are available for X-rays, scans and blood work.

With the addition of a telephone call inserted at the first activity, the patient now arrives late afternoon or early evening when fewer support

staff are available to process, resulting in more delays, causing slower progress and, yes, ambulances stacked with patients in the entrance.

The ambulance service, acute care and others groups within the health service are working at high stress levels to stay afloat.

Resilience is being shown by all of these groups.

Being an integrated service, how would privatising any of the parts of the health system help smooth this flow and efficiency or the resilience? Alistair Ballantyne. Birkhill,

Angus.