NHS ‘unfit for 21st century’
New chief inspector of hospitals calls for urgent action over threat to patient safety in A&E wards
THE NHS is unfit for the 21st century, the new chief inspector of hospitals has said, warning all trusts to take urgent steps to make Accident & Emergency departments safe.
Prof Ted Baker said it was “not acceptable” to keep “piling patients into corridors” as he urged hospital leaders to act swiftly to guard the safety of those in their care.
In his first interview as chief inspector, he said that too many hospitals had “wholly unsatisfactory” arrangements that endangered patients, as well as denying privacy and dignity.
Prof Baker has written to all hospital chief executives, calling for immediate action to improve safety in A&E, as fears grow that the NHS will struggle to cope with overcrowding this winter.
Trusts are instructed that ambulances should not be allowed to queue outside A&ES, and warned of the dangers of leaving patients in corridors, where staff cannot even see them.
Prof Baker told The Daily Telegraph that he was concerned that a culture of “learned helplessness” had sprung up in some A&ES, where staff “just pile the corridor full of patients” leaving them unmonitored and without access to vital supplies such as oxygen.
But the Care Quality Commission (CQC) inspector said far more radical
‘The one thing that I regret is that 15 or 20 years ago, the NHS did not change its model of care’
action was needed to stop hospitals becoming entirely overwhelmed.
“The model of care we have got is still the model we had in the Sixties and Seventies,” he said. “That is the fundamental thing that needs to change; we need a model of care that is fit for the 21st century and the population as it is now.” About half of hospital beds are now taken up by people who should not be there, Prof Baker said, either because their health would not have deteriorated with the right care or because they could have been discharged if help was at hand.
Prof Baker, a former hospital medical director, said the NHS had made a critical error in failing to take decisive action under the last Labour government, when it became clear that reform to build community services was required.
“I think the one thing I regret is that 15 or 20 years ago, when we could see the change in the population, the NHS did not change its model of care,” he said. “It should have done it then – there was a lot more money coming in – but we didn’t spend it all on the right things. We didn’t spend it on transformation of the model of care,” he said.
In the past three decades, the population has risen 16 per cent, but the number of pensioners has increased by more than one third.
Next month the CQC will issue a report on the state of health and care services, which is expected to highlight mounting pressures on hospitals, a year since the watchdog warned that social care was approaching a “tipping point”. Prof Baker suggests that hospitals – increasingly running at occupancy rates exceeding 95 per cent in winter – are in danger of running out of beds and staff.
Winter is coming. And health officials are living in fear. Last year, NHS hospitals had the worst performance in recent history, with almost half declaring major alerts as they became overwhelmed, despite mild weather and low levels of flu.
This year, every hospital has been ordered to station GPS at the front doors of every Accident and Emergency (A&E) department to ease the strain by diverting unnecessary cases.
But the new chief inspector of hospitals is wary. “I’ve seen lots of attempts to reduce the number of people attending A&E and the majority of them don’t work,” says Prof Ted Baker bluntly.
Many previous front-door triage schemes “haven’t made a difference” to the workload inside casualty units, he says, while others have created their own demand.
Some can work, he says, if patients are diverted correctly. Initiatives to take medical care into care homes, instead of taking frail elderly people into A&E, have shown merit, he says.
“The trouble is that you can set up a service and if people come to the service but there is no analysis to ask – ‘does this stop them ending up in A&E?’ – you can end up creating a service which creates its own demand.”
“What I would guard against is quick fixes and simple solutions to A&E,” says Prof Baker, who took up his post last month.
Every NHS trust is under strict orders from NHS England to introduce “front door streaming” at every major casualty unit by December. This means finding GPS to stand at the doors – at a time when there is a national shortage of doctors.
Prof Baker suggests the NHS might be wiser to test some options before embarking on mass experiments.
“What there has to be is really thoughtful implementation of initiatives – building on them if they
‘You can end up creating a service which creates its own demand. What I would guard against is quick fixes and simple solutions to A&E’
are successful but not sticking with them if they don’t make a difference,” he says. “There has been a lot in terms of front door triage where Gp-led services or nurse triage are put on the front door of A&E but they don’t make a difference to the workload,” the former hospital medical director warns.
One of the pilot schemes was quickly suspended after the death of a man who was turned away by the A&E department of Bristol Royal Infimary last November, just six days after its launch.
A national review of such schemes will not report until next summer, with researchers warning that the evidence base to support the initiatives is “weak” while it remains “unclear” whether the measures are safe.
And safety is the key concern of Prof Baker. With this in mind, on Friday he wrote to the chief executives of every NHS acute hospital trust, urging them to take steps to safeguard all A&E patients.
The eight point plan reminds them not to leave patients outside in ambulance queues, nor to routinely use corridors as overflow areas for patients when pressures mount. Patients needing urgent care should be identified, with systems in place to spot patients who are deteriorating.
It seems surprising that the heads of NHS hospitals would need reminding of such basic elements of healthcare. “It’s important that we give people the confidence to focus on what’s important … in terms of quality and safety. You can get buried in an awful lot of guidance,” he says.
But he added far more radical action was needed, to reform NHS services so they could meet the needs of the population, before hospitals became entirely overwhelmed.
Around half of all hospital beds are taken up by people who should not be there, he said – either because they could have avoided admission with the right care, or because they could have been discharged if help had been at hand.
“One of the saddest things is you go into A&ES and you find patients who are dying; admitted to A&E in the last hours of their life because wherever they were couldn’t provide support for them.
“That is tragic; the system is not built around these patients.”