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Poor performance must be tackled at root level

Poor performance must be tackled at root level

Dr Kailash Chand says the NHS crisis was avoidable and must be tackled by understanding the reasons
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Dr Kailash Chandsays the NHS crisis was avoidable and must be tackled by understanding the reasons

Waiting times and access to treatments are at the worst levels since the inception of the NHS. In August, the number of patients waiting for treatment hit four million. More than five million people will soon be on NHS waiting lists unless the health service receives urgent funding, says Simon Stevens, the head of NHS England.

The Royal College of Surgeons says the NHS has passed a tipping point. Patients are waiting longer on lists, on trolleys, in emergency departments and in their homes for the care they need. Pressures in social care are pushing more people into hospitals and trapping them there for longer. An increasing number of people, although clinically ready to go home, cannot safely leave hospital as the care system is unable to cope.

In 2017, the A&E crisis descended to its worst on record with nearly one in four patients waiting longer than four hours at England’s major A&Es.

The A&E crisis was avoidable. Since 2010, more than 66 A&E wards, of all types, have closed. Two in five NHS walk-in centres have either closed or had services cut. Moreover, 15,000 NHS beds have been axed. Collectively, this has reduced the NHS’s capacity of bed spaces by over 5 million a year.

The Government has manufactured this crisis by reducing capacity so savagely, failing to train and retain staff, and cutting GP and social care.

A reliance on agency staff in hospitals is exacerbating problems. Often these staff are unfamiliar with their surroundings, and working in pressured and dangerous conditions. Unfilled nursing vacancies have soared, which is one reason why the Red Cross declared an emergency in England’s hospitals last year. Sadly, this was also avoidable. The salary for a trainee doctor has fallen more than £2,000 in real terms since 2010, so an increasing number of doctors are going overseas.

The pressures put upon GP services mean that more patients are likely to present at A&E. More than 1,000 GP practices have closed. Medical school intake has stagnated, and the recent promises to increase the numbers will not bear fruit for years. It is no surprise that the number of unfilled GP vacancies has climbed steeply since 2010.

Nowhere is the taxpayers’ money spent more efficiently than in a GP’s surgery. Seeing a GP costs one-third the amount of an A&E visit. So cuts to GP funding and rural practices are ultimately increasing pressure on the taxpayer and patient.

Spending on social care has been cut 8% in real terms. The extra cash earmarked for social care by the Chancellor in the spring budget will not make up that shortfall. Cuts to social care mean far more over-75s are presenting at A&E.

The Government points to nominal rises in NHS spending but ignores population growth.

Our NHS is underfunded, under doctored and overstretched. There are no quick fixes and we need to be prepared to see further breaches of targets. In any case, I don’t agree with targets for targets’ sake — I believe people should be treated on the basis of clinical need. Declining performance must be addressed by a deep understanding of its causes, and their system-wide nature.

Dr Kailash Chand is an honorary vice-president of the BMA and the chair of Healthwatch Tameside

You can follow him @kailashchandobe

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