Why are we waiting - the real story of the poor A&E numbers

Posted by Bruce Potter on
Another week, another set of waiting time targets missed (both 18 weeks and even more so the A&E figures). So what...hardly new news, or is it a sign of a deeper problem?

What Nigel Edwards of the Nuffield Trust pithily observed last week is that these increasingly common breaches are really a symptom of a wider system failure.  Despite a mild winter there are many, many trusts on black.  Only the 30 worst offenders have been summoned to explain themselves, but all are struggling.

Surely we need to see these system-wide waiting time breaches as failures of the whole system, not individual management failures?  Acute Trusts, in particular are acting as the safety valve for a new and different scale and pattern of patient demand.  Patients are increasingly not prepared to wait for GP appointments but they are prepared to wait at an A&E for hours - go figure! 

Yes, there may be more primary care could do to head off 'frequent flyers' etc, but as happens in other countries, patients are increasingly impatient to "get treatment" and they see that as dispensed at hospitals. 

Take a step back and you can see this may not give the patient what they really need and critically, not the coordinated range of care a GP can orchestrate for the chronic comorbidities of our ageing population.  Unfortunately, with all the changes to out-of-hours services, and a more consumerist approach to health, patients want the (not so) instant reassurance of an A&E attendance. 

And that is the real lesson of the A&E waiting times – patients are voting with their feet and we need to stop blaming our Acute Trusts for being on the wrong end of that new patient expectation, and to stop punishing them for what patients are demanding. Let us hope that the Vanguards looking at A&E are brave and radical enough to respond to these changes.     

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Bruce advises both private and public organisations on all aspects of commercial, corporate policy and governance advice.

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