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Dr Bob's Blog - What’s going on in urgent care?

User AvatarPosted by at 19/09/2013 10:36:30
Dr Bob Bowes

There has been an awful lot in the news recently about attendances and increased waiting times at A&E and not all of it has been right. I am going to try to set the record straight.

The Health Secretary, Jeremy Hunt, blamed longer waits at A&E on GPs no longer working 24 hours a day. As I and most of my colleagues routinely work 50-hour weeks, I cannot agree that adding night shifts would increase our efficiency or the quality of patient care we provide.

Some hospitals blame the new helpline, NHS 111.Others blame cuts to social services budgets, for leaving patients stranded in hospital wards.

And, of course, we’ve all heard about members of the public who turn up in A&E because they’ve cut themselves shaving or broken a fingernail.

What’s really going on and why? It is complex and, while some of the factors above play a part, none of them gives the whole picture.

First of all, it’s not the case that attendances at our A&Es are climbing steeply. They’re holding fairly steady: around 105,000 patients from west Kent (and a further 15,000 from East Sussex) have come to one of the two A&Es in Maidstone or Tunbridge Wells in recent years.

It is true that some of them are in the wrong place. Our local consultants say between 10 and 15 per cent of patients come to A&E with problems that could be treated elsewhere.

On the whole, however, the increased pressure on our local A&Es and hospitals is because they are treating more patients who are severely injured or very ill. This means that, on occasion, people who attend with relatively minor problems are waiting longer to be seen.

What can be done about this? While it is absolutely right that everyone who needs A&E should be treated there, we would like to see more options for frail, vulnerable people, especially those reaching the end of their lives.

We at NHS West Kent Clinical Commissioning Group are investing in training for care homes so staff are able to detect problems before patients deteriorate and become an emergency. And we want patients to decide what care they want in their last weeks and months.

When this was piloted locally, the number of care home residents dying in hospital rather than the home where they lived fell from 57 per cent to six per cent.

We’d also like to see people making better use of services in the community such as the minor injuries units at Edenbridge and Sevenoaks hospitals, their GP surgery or their local pharmacist.

We all need to make sure that hospitals and their A+E departments remain effective for those who need them by using other services when we can.

If you have a story about local health services you would like to share, you can email westkent.ccg@nhs.net or write to me, Dr Bob Bowes, at West Kent CCG, Wharf House, Medway Wharf Road, Tonbridge, TN9 1RE.