Letters to the editor: Causes of A&E crisis are complex

 
Top thesp: Eddie Redmayne celebrates winning the Best Actor award at the Oscars on Sunday night (Picture: Valerie Macon/AFP/Getty)
24 February 2015
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The root causes of the crisis in emergency medicine are rising demand from an ageing population with more complex medical needs and years of chronic underfunding of services. Parts of the NHS are now being run in a constant crisis state, with many hospitals at or over capacity well before winter begins and so unable to deal with seasonal spikes.

While patients who repeatedly present at A&E without due cause add to the pressure on the system, we must be careful not to demonise people who often have underlying physical and mental health issues. Instead we must ensure better access to social, community and mental services where this is appropriate, and identify what can be done outside of hospitals to prevent unnecessary trips to A&E.

But while reducing the number of unnecessary admissions is important, pressure at the front door of our A&Es is also linked to delays at the back door, when patients can’t be discharged because there is simply nowhere for them to go. This leads to delays in admitting patients from A&E, with some being forced to wait for hours on trolleys.

All this places a huge strain on staff and services, putting people off entering or remaining in emergency medicine. We need to address these systemic issues and ensure our NHS is properly staffed, funded and resourced if the health service is to keep up with inevitable and unstoppable rising patient demand.
Dr Mark Porter, council chair, British Medical Association

It is shocking to hear of the significant number of patients regularly attending the capital’s A&E departments. While it’s tempting to call them “repeat offenders”, in many cases they are likely to be victims themselves.

The majority of these cases are linked to mental ill health or social care issues with complex problems and needs. This is especially true of those who attend A&E departments more often. While there are undoubtedly regular attenders who enjoy the safety and warmth of A&Es, the majority are resorting to visits because the specialised support they require isn’t being provided.

The answer is not to blame the patients. Instead we should see this as yet another consequence of a government which, rather than recruiting extra GPs and investing in community healthcare, has spent £3  billion on a chaotic restructure while forcing local authorities to pare services down to the bone.
Dr Onkar Sahota AM, Labour’s London Assembly Health spokesperson

The NHS is being abused but many do not seem to understand how it works. The disconnect between GPs adds to this issue: some direct their patients to an out-of-hours service that GPs don’t have to incur cost for. However, I suspect that many of us do not really respect this free service and there is no comeback for incorrect use. Waste continues to be the problem, perhaps clearer guidance is required?
Philip Jarvis

Use Oscars night to help minorites

The lead-up to this year’s Oscars was filled with activism — online campaigns such as #AskHerMore and the backlash against the film Selma’s small number of nominations dominated conversations. But amid all this, and perhaps most prominently, Patricia Arquette called upon minorities in America to come together and help women achieve pay equality.

Arquette highlighted a key issue among minorities. Her focus on the needs of US women was a change from the usual acceptance speech, but by narrowing her focus to Americans she isolated and forgot the needs of all women and minorities across the world.

Americans have a better quality of life than much of the rest of the world, and her view of equality is a narrow, western one that only seeks to benefit those in her immediate sphere. The sea of caucasian faces at the awards last night highlights that it is not only whiteness that needs the leg up, but minority ethnic people in and outside the film industry. Last night’s ceremony may not have been racist, but it reflected wider issues often forgotten in the West.
Rachael Krishna

Good and bad in the six-point plan

The economic plan announced by George Osborne and Boris Johnson (Friday) rightly identifies the urgency in meeting London’s housing need.

Acceleration of Housing Zones will help but they will take time to plan, finance and build. The ability to deliver volume fast will come from the release of smaller plots of public land, placed in the hands of a wider variety of developers.

Pocket has been working with the Campaign to Protect Rural England to identify these smaller areas and developing a clearer process to facilitate their development. It is this facilitation that is so crucial. We can help identify land but it still takes more than twice as long to buy public land compared with private deals. Making sure government bodies release land they don’t need is fundamental.
Mark Vlessing, CEO and co-founder, Pocket

Having read the Osborne and Johnson six-point plan I see an impending disaster for London.

At a time of austerity cuts that have meant the closure of A&E units, police stations, fire stations we don’t need more people and housing without essential services in place.
Alisteir McLaurin

Improving on our sick-note culture

I agree with Lucy Tobin (Friday) that changes to ill-health certification must first address current problems inherent in the system before spending money on new remedies.

The change from “sick note” to “fit note” was a step in the right direction. It is a great pity that employers and businesses have not been converted. Many patients report that their managers will not accept a return-to-work fit note with amended or staged consideration.

The Secretary of State for Work and Pensions, Iain Duncan Smith, could make immediate savings to the taxpayer without outsourcing by making administrative changes which are responsible for the current medicalisation of the sick note.

This creates demand, rather than a need-led service.
Dr Jayshree Pillaye

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