My six-point prescription to end A&E crisis

AS an A&E doctor for 22 years, I have never known anything like this: the NHS is in crisis. In every hospital up and down the country, patients can be waiting hours in A&E to get treatment, and then many more hours, or days, to get a bed on a ward.

Many of them are stuck in corridors in all states of distress – not only is this undignified but the care is inadequate as a result.

They are not as closely observed as they should be and, in many cases, this means the subtle signs of deterioration are missed. Their care is delayed and this results in patients who shouldn’t die, dying.

The Royal College of Emergency Medicine estimates that there are currently 300-500 avoidable deaths a week in the UK because of the failings in emergency care.

That statistic isn’t just a number. It’s a mum, dad, gran or loved one. It’s someone who has paid taxes all their life, in the belief that the NHS would be there for them in their time of need – but now it’s not. And for dedicated NHS professionals like me it’s deeply distressing that we’re not be able to deliver the level of care our patients need.

The current spike in flu and Covid cases is not the cause of this crisis; it’s just the straw which has broken the NHS’s back. The main problem is lack of ‘flow’ of patients through hospitals because of a lack of beds. In the UK, we have 2.4 NHS beds per 1000 people – but the European average is 5 per 1000, and in Germany, 7.

But worse still, up to 20 per cent of our beds are occupied by patients who are medically fit for discharge. They need social care but it just can’t be provided, and so for their safety, these patients stay in hospital.

The Government’s new Health and Care Act is designed to tackle this – the aim is to prevent hospital admissions through better community care, and to speed up discharging patients. But this is a longterm solution and we need action now.

Here is my six-point plan to tackle the crisis in A&E – to help save the NHS, and help save lives.

1. UNBLOCK BEDS

The first thing we need to do is open up capacity, and free up all NHS beds for those who need medical care. The easiest way to do this is to discharge the medically fit patients to care facilities. We currently lack these facilities, but we could use private hospitals’ capacity, or even hotels.

We could also use the Covid Nightingale hospitals (some were repurposed as vaccination or testing centres) – not as hospitals but as Nightingale social care settings (which could be staffed by the Army and use volunteers as carers).

2. CANCEL NONURGENT SURGERY

As a temporary measure, nonurgent outpatient clinics and elective operations should be suspended and the staff and space used to run additional wards so that A&E departments no longer have patients in corridors.

3. SUSPEND OFFICIAL INSPECTIONS

A lot of hospitals’ and GPs’ resources are taken up in preparing for the inspections by the regulator, The Care Quality Commission.

During the current crisis, these should be suspended as the time and resources involved would be much better spent treating patients. The same goes for annual doctor appraisals and training that is not patient-relevant, such as how to use a fire extinguisher.

4. ENCOURAGE PEOPLE TO GET VACCINATED

Flu and Covid numbers are escalating – we need to be doubling down on our efforts to get people vaccinated.

5. LET PHARMACISTS PRESCRIBE

Many patients who come to A&E could actually be looked after elsewhere. While we’re not talking about lots of cases, they still take resources away from more sick patients.

Greater use of pharmacists would help. In Scotland pharmacists can prescribe antibiotics for common complaints such as urinary tract infections – but not in England.

Another problem is that 111 is sending too many people to A&E needlessly – in this immediate crisis we need to review the risk threshold for when 111 tells callers to go to casualty or call for an ambulance.

6. DECLARE A NATIONAL CRITICAL INCIDENT

Individual NHS organisations and hospital trusts can declare critical incidents (defined as where they cannot ‘deliver critical services, patients may have been harmed or the environment is not safe’).

But we also need a national critical incident response, which would allow us to mobilise all available resources such as the Army as we did in Covid.

In the medium term we need to concentrate investment on admission-avoidance teams in the community: patients are coming in because of a lack of district nursing, home care and community palliative care.

All of this results in patients being looked after in A&E corridors rather than their own homes. There are a few trial schemes nationally where paramedics have access to senior A&E doctors 24/7 to discuss individual patients who could avoid hospital admission.

If needed, dedicated A&E doctors with diagnostic equipment are sent to the patient’s home to try and prevent this. This needs to be scaled up at speed to more patients.

If in the next few days, we take this different approach, then those 300-500 avoidable deaths a week will start to slowly drop off. But if we do not, then they will start to rise and rise. And they are not a number. They are our loved ones. But if you do need us, make sure you come to A&E – we are still there for you.