Crisis? What Crisis?

As the NHS goes into meltdown once again both locally and nationally we asked NHS lobbyist and regular thorn in the side of Health Ministers and officials past and present HUGH McCLOY to give us his personal view on the latest crisis in A&E.

You can follow Hugh on Twitter here and keep up to date with his campaign for the return of Acute services to the Mid Ulster Hospital here.

Crisis What Crisis

This Winter Crisis of 2015 is not the same as the Winter Crisis of 2014 which was caused by different issues from the Winter Crisis of 2013. Considering that the winter crisis of 2012 was bad it is in no way linked to the Winter Crisis of 2013, 2014 or 2015 – it was a good performance compared to the Winter Crisis of 2011. The Winter Crisis of 2010 however is where all this begins.

What happened in 2010?

Prior to this from 2007 we had seen the closure of 3 A&Es – Mid Ulster, Omagh & Whiteabbey – and a loss of beds and wards for financial reasons across the country. This led to the 2010 crisis and this has been repeated year on year to one level or another.

Stop Blaming Patients

While there are many people blaming patients, politicians would like to blame people who “should not be there”; I ask you “who should not be in A&E”? Everyone in a decision-making position in health knows it is the patient who is acutely ill and needs admission who is causing A&Es to fail, not because they are ill, simply because there is no bed for them in the wards; as there is no bed then they stay in the A&E treatment cubicle or are wheeled into a corridor. This stops the turnover in the A&E and thus patients start to build up. The problem is a simple one; the answer to it is also simple – reopen the hospitals the Government closed that caused this crisis in the first place.

Take Antrim A&E for example; a brand new A&E with a capacity of 90,000 patients a year. The question is could the rest of the hospital wards behind the A&E cope with 90,000 admissions a year? It cannot. It is struggling to deal with in the region of 30,000 direct admissions from A&E a year on top of other pathways to the hospital wards such as GP admissions.

The first review carried out specifically for a failing A&E system in Northern Ireland was in Antrim – the Ruter & Hinds review I was in the boardroom meeting after this review. Valerie Jackson who was the Acute Director of the Northern Health & Social Care Trust specifically stated in her breakdown of the review that 90% of people waiting in A&E were waiting on a bed. Having a minor injury did not even factor in the analysis.

When you step back and look at the issue, how many people are travelling to A&E knowing that even on a good day they could face hours sitting in the waiting room if they do not think they have to be there or have somewhere else to go for treatment? Remember the alternatives being suggested are already as stretched as the A&Es with the lowest ratio of GPs per person in 24 years: . Minor Injury Units have very limited opening hours and most cannot treat children under the age of 5 even though all they have is a minor Injury. The Doctor on call service is again stretched and like many people who will have used it instead of being seen you are referred to A&E

The problem is simple, we have X amount of in-patient beds in our acute health system. Since the Assembly was established in 1998 the number of hospital beds available has dropped year on year. While advances in medicine have given us a faster turnaround in beds, the advancement of medicine has been outstripped by the removal of beds and the increasing readmission rates due to patient’s not being treated correctly in the first place.

Table 1

391 beds have been cut since April 2009 in our hospitals – almost 100 of them in the Mid Ulster Hospital alone, a 9% loss. In total 1,114 beds have been cut from our health system across different areas since April 2014.

  • Non-Elective inpatients, treatment regarding the critical care and life of a patient has risen by 12%, roughly an extra 20,000 cases a year since April 2009.
  • The amount of day cases has risen by 10% in the region of 18,000 a year.
  • Total admissions increased by 30,000 between 2009 and 2013.
  • Elective inpatients, the type that has now been called off by the Health Trusts on first glance looks like it has dropped significantly by 17% – roughly 10,000 episodes. This is not telling the full story. Since April 2009 as the health service was falling apart due to lack of capacity and ward closures more patients were being sent to the private sector. In 2009/10 there were a combined total of 86,249 non elective cases, in 2013/14 there was a combined total of 80,502 a drop of roughly 6,000 episodes.

To put this into context we have seen a 9% loss of inpatient capacity against a 12% rise in the amount of life saving episodes needed to be carried out. With non-elective care already being stopped in the private sector without the public sector being increased waiting lists rise. The maths simply do not back up the claim that changes in health provision were made to save people’s lives.

Table 2

Take into account A&E departments are only a door to the hospital; other doors include for example direct GP admissions to the wards. When the wards fill up A&Es and other areas such as theatres cannot function as there is nowhere for the patients who need admitted to go.

The problems I am speaking off are one part of the puzzle. Look at these performance stats and see with your own eyes. Forget empty MLA press statements they are meaningless!

Table 3

Table 4

Table 5

The Blame Game

Maybe blame the doctors and staff? The ever-changing landscape of health services in Northern Ireland has left this area a no-go zone for health professionals. How many doctors and consultants will choose Northern Ireland for a long-term career when there are no guarantees that there will be a long-term career? The loss of hospitals also came with the loss of doctor training posts for both home-grown doctors and international students. We had a system that worked and it is not too late to revert back to that model.

If you are looking someone to blame look at Sinn Fein’s health strategy from 2001 to 2011 with multiple closures of services including Mid Ulster, Omagh and Whiteabbey. The entire Northern Ireland Executive in 2007 for the Review Of Public Administration which again led to service cuts and the Comprehensive Spending Review of 2008 from the Executive which saw the UUP fast track Sinn Fein’s health strategy with a few extra cuts of their own

All of the above led to a major cuts in acute care in Northern Ireland. If you don’t want to blame any of the above then let’s blame the DUP. Their health strategy is to social care what Sinn Fein’s was to acute care – cuts. The Alliance Party & SDLP are part of the executive and could have done more but sat silently when push came to shove.

Or blame finance, that’s an easy one to hide behind. It will always be an issue however; between each health trust is spending £500,000,000 a year buying private care; it is time to filter that money back into public services to provide the system that worked instead of firing more money at a system that has failed. MLAs know this but they first must admit they got it wrong and accept that no amount of finger-pointing at Health Trusts will make it better. With the assembly set to take millions in loans along with austerity cuts to the health service required to be able to pay the loans back the outlook is not good.

Or will we look at the private sector and see if we can put some blame on there. It is true that if you are on a year-long waiting list in the public sector for an operation if you go private you will be treated in a matter of days. Maybe there is a hidden agenda here to deliberately make public services fail so that the Assembly and “political donors” and big business lobbyists get their payback by privatising acute care as is happening in England & Wales.

Let’s stop laying blame and demand accountability. This starts and stops in Stormont and if we keep electing politicians who no more care if you live or die then ultimately people will die.

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