Listening to A&E staff they, almost without exception, say that the vast majority of the public turning up at A&E are in need of treatment and they would not be happy turning them away. Stories about people turning up with broken fingernails are scandalously amusing, and nurses like to tell such anecdotes for a laugh, but they represent only a tiny fraction of A&E attenders. Both GPs and A&E have witnessed a massive increase in patient numbers. This increase that has very little to do with immigrants although such claims will be made since immigration, together with the EU, are currently fashionable scapegoats. Indeed if it were not for the thousands of immigrant doctors and nurses in the NHS (e.g. the 40,000 doctors born overseas) things would be far worse, to the point total collapse.
I find one clear factor in the rise of patient numbers and few other possible factors. The clear one is the rise in numbers of elderly people in the UK (over 65s) who are also living longer (into their 70s. 80s and 90s). These are presenting a wide range of medical conditions that are often compounded into multiple problems (I sometimes feel that I am personally responsible for 5% of the increase of NHS usage). Other possible factors are increased susceptibility to illnesses due to modern lifestyle issues such as working stress, processed foodstuffs, sedentary pursuits; increased expectations and demands for the delivery “health” to the citizen; and increased diagnosis of illnesses that may have been dismissed as “growing pains” or “getting old” in the past.
Why is A&E unable to cope with this increase? The simple “vicious circle” explanation is that too few doctors and nurses in A&E create very poor working conditions that deter new doctors and nurses making a career in the service and so on, and so on. Actually there is no great shortage of young doctors entering the A&E service. But many (most?) of them have left after 2 to 3 years experience so there is a thin “middle tier” to go on to become A&E consultants. There are, however, structural issues that underlie the the A&E problem with increasing numbers. The GP service is also understaffed and overworked so they cannot take up many extra patients. The 111 service, as alternative to GP and A&E has been, largely, a failure; it does little more than forward patients to other services – especially GPs and A&E. In my experience the Walk-in Centres have been better but I don’t know how many of these there are and how much “traffic” they deal with. The largest problem, however, seems to be cutbacks in Social Care caused by financial cuts applied to local authorities. Even if there were more doctors and nurses in A&E they might not be able to treat to more patients because of the hospital bed logjam. Thousands of beds are filled with people – prominently the elderly – who don’t require hospital treatment, don’t want to be in hospital, have a home to go to, and could be there if only they had a little support from Social Care. That, of course, would be hell of a lot better and cheaper for all of us; but it isn’t there.
What about the responsibility of individual patients? Of course it is easy to point a finger at the drunks (which I do even though I once went to A&E for stitches in my scalp caused by a drunken fall when I was 20) and perhaps town centre medical tents could help some of the demand from this quarter. Or, they could stop getting drunk. But a broken arm from a drunken fall is just as much a broken arm from a rugby match – and, arguably, both are self-inflicted – and both need treatment. We could direct people away from A&E when they don’t need to access it. The 111 service appears to use non-medical staff to lead people through a simple flow chart based on YES/NO before directing on to another service. Perhaps every home in the UK should have one of these to help decide where to go when you are ill or injured – stick it on the onside of one of your kitchen cabinet doors. With a bit of imagination we could think of all sorts of ways to mould the individual into the sort of patient (GP, A&E, Walk-in, Pharmacy, etc) with which the system can deal. Maybe. What I am damned sure about is that politicians, or anyone else, jumping up and saying “People should be more responsible!” will make no bloody difference at all. If “irresponsible” individuals are the "problem" they need to be assisted in becoming a "solution" – not harangued.