Comment

Mike Paynter: Don’t blame winter pressures or patient demand for A&E crisis

The government’s reluctance to adequately fund health and social care is forcing patients and clinicians to endure ‘winter pressures’ all year round, says urgent care nurse Mike Paynter.
A&E

The governments reluctance to adequately fund health and social care is forcing patients and clinicians to endure winter pressures all year round, says urgent care nurse Mike Paynter

The NHS is now consistently failing to meet the standard that 95% of A&E patients should be seen within four hours. This is not just an issue for emergency departments it is a marker of unprecedented stress across the whole system of health and social care.

It is worth remembering that the waiting time target was originally set at 98%. Health secretary Jeremy Hunt is considering relaxing the 95% target further, so that it applies only to those patients with time critical clinical conditions.

This begs the question, what happens to those patients who have legitimate clinical need

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The government’s reluctance to adequately fund health and social care is forcing patients and clinicians to endure ‘winter pressures’ all year round, says urgent care nurse Mike Paynter

The NHS is now consistently failing to meet the standard that 95% of A&E patients should be seen within four hours. This is not just an issue for emergency departments – it is a marker of unprecedented stress across the whole system of health and social care.


In most emergency departments and acute units, ‘winter pressures’ last all year long.
Picture: Neil O’Connor

It is worth remembering that the waiting time target was originally set at 98%. Health secretary Jeremy Hunt is considering relaxing the 95% target further, so that it applies only to those patients with ‘time critical’ clinical conditions.

This begs the question, what happens to those patients who have legitimate clinical need but are considered not ‘time critical’? The four-hour target matters, principally because long waits affect patient safety, but there is also the issue of the patient experience.

Rationed care

Negative patient experiences are well documented in the media. Usually there is at least one upsetting, distressing or tragic patient story in the headlines each week. Such stories rarely capture the emotional effect on nurses tasked with trying to deliver basic and essential care.

Nurses are being forced to ration care due to the relentless and overwhelming demand. In most emergency departments and acute units, ‘winter pressures’ last all year long.  

It is wrong to criticise or blame patients for attending the 'wrong' service; their need for assessment and treatment, whether actual or perceived, is genuine to them. The offer of a primary care appointment in two weeks is little comfort at the point of need. And more patients are turning to emergency departments or community-based minor injury units because they can't access timely primary care.

‘Health and social care funding cannot be seen as two separate issues – they are intricately linked’

At the start of this year the chief executive of the British Red Cross described the NHS as being gripped by a ‘humanitarian crisis’. Our emergency and acute services are not akin to those of war-torn Aleppo or Sudan, and the prime minister has criticised the Red Cross for using such an emotive term. However, many nurses and doctors would agree with the statement. The same terminology could easily be applied to social care, where our colleagues are struggling to maintain a service as well as achieving unrealistic austerity savings.       

The awful stories about people dying after long waits on trolleys do nothing to attract the next generation of graduate nurses to consider a career in emergency or acute care. Emergency department vacancy rates of between 15-20% are not uncommon.

Social care funding

The pressures on recruitment and retention in primary care, and in particular general practice, are resulting in job offers being made to emergency nurses and other acute care nurses with readily transferable skills. The incentives for emergency nurses to move to primary care are attractive: financially it’s usually at least one band up on Agenda for Change, there is usually no weekend work, very little evening work, and there is a structured day with a lunch break and public holidays off. What’s not to like?  

This month, NHS England chief executive Simon Stevens questioned the government’s claim to have given the NHS the money it asked for, and called for increased funding for social care. Health and social care funding cannot be seen as two separate issues – they are intricately linked. So far the prime minister’s response to the NHS boss has been the same as that given to the British Red Cross. She has to start listening.  

NHS nurses and others working in emergency and acute care are doing a remarkable job but they cannot fix this crisis. It is underfunding in the health and social care system that is responsible for the negative headlines, not clinicians.    


About the author

 

 

 

Mike Paynter is a consultant nurse for community urgent care in Somerset and a member of Emergency Nurse editorial advisory board

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