First it was GPs, then A&E departments that came under the microscope. Now it's the turn of our ambulance services. New statistics show that 12 of the 13 ambulance trusts in the UK are failing to meet their targets for rapid response to potentially life-threatening conditions - currently eight minutes for at least 75% of calls.
This is not good news - in recent years, treatment of conditions like heart attacks has been revolutionised by so-called 'clot-busting' drugs and ultra-urgent surgery to remove clots. There is only a very narrow window of opportunity from when the clot blocking an artery supplying blood to the heart can be removed before the heart muscle it supplies dies off. Doctors in A&E now live by the mantra that, where the heart is concerned, 'time is muscle', and hospitals now have 'door to needle time' measurements for how quickly the clot-dissolving drugs are administered.
Strokes are increasingly being treated as 'brain attacks', with specialist centres able to scan the patient within minutes and check if they are eligible for medication to break down the clot in their brain or even for surgery to retrieve the clot. Again, the window of opportunity is narrow.
We all know that delays happen. My father had a heart attack a decade ago while gardening, and carefully finished cutting the hedge, sweeping up the trimmings and putting his equipment away before he called an ambulance. People - especially stoical retired army officers - make their own choices. But what we can't control is delay in getting emergency help once we've summoned it.
The main problem seems to stem from delays in handing patients over once they get to hospital. The turnaround should be no more than 15 minutes before paramedics are back in their ambulances, ready to respond to the next call. In fact, this handover took longer for almost 400,000 patients in 2015/6, with over 10,000 waiting more than two hours.
This handover delay in turn is due to pressure on A&Es, with numbers of patients up 6% in 2015/6 on the previous year (the average year on year increase in recent years has been 2-3%). With winter looming, this is only going to get worse. Ironically, there are more A&E attendances in summer than in winter - but in winter, more have to be admitted to hospital, and this involves waiting for a bed. In summer, 16% of people attending A&E are admitted: in winter this figure is 20%. Over the winter months, admissions for chest problems (especially flare-ups of chronic obstructive pulmonary disease (COPD) double from about 1,000 to 2,000 a day. Every winter there are about 25,000 extra deaths, with one in 20 deaths linked to cold weather and infections common in winter.
People have played the blame game over A&E delays for years. Some claim it's down to difficulties getting a GP appointment. There is undoubtedly a problem, with GPs straining under ever-increasing workloads. In the last 10 years, the number of patients seen in GP surgeries has increased by 63%, their administrative load has increased by 115% and the number of tests they deal with by 217%, as more and more sicker patients are kept in the community rather than being admitted. Yet GPs carry out more than 340 million consultations a year in England alone, compared with about 20 million in A&E. The knock-on effect is likely to be small.
Delays in discharging patients because of lack of social care undoubtedly play a part. Hospital doctors I speak to talk of a constant battle to free up beds filled by patients who don't need - or want - to be in hospital, but who are too sick to go home alone. So too do admissions linked to social isolation and lack of care at home. Professor Keith Willett, NHS England's Director for Acute Care, made a powerful case at a meeting I attended last month. Among over-75s, a recent study shows a clear link between social isolation and the risk of admission. Among the patients admitted, 86% came from their own homes and almost half said they were socially isolated. Half of these lived alone, and one third of these had had either one or no social contact in the last month.
But we all need to take responsibility too. The areas with the highest increase in A&E attendances do not correlate with the areas of greatest health need. Seventeen per cent to 19% of people attending A&E leave with no investigations and no treatment. A community pharmacist could almost certainly have provided all the advice - and the self-help remedies - they need with no appointment and no three hour wait. The 6% increase in A&E attendances last year was driven mostly by the least sick among us.
Is there a solution? Not in the short term. NHS budgets will continue to be squeezed as our ageing population gets sicker. But maybe, just maybe, we could all think twice about attending A&E unless it really is an accident or an emergency. That might just turn a crisis into no more than a drama.
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