It’s the best known brand in the world for urgent healthcare….…

Don’t go to A&E unless you are dying, says official NHS advice Don’t go to A&E unless you are dying, says official NHS advice! Patients told to avoid hospital A&E departments. Published 3 January 2017

Don’t walk across the grass! Chris Moulton Vice-President, Royal College of Emergency Medicine Consultant, Royal Bolton Hospital And here are some more things that people say………

“THERE ISN’T REALLY A WIDESPREAD PROBLEM IN NHS A&E DEPARTMENTS” 1

Thousands of 12-hour trolley waits and longer!

“THE INCREASING DEMAND FOR A&E TREATMENT IS COMPLETELY INEXPLICABLE” 2

All types of A&E department

A&E (type 1) attendance and population growth in England over the last decade: In 2004-5 there was one Type 1 ED attendance for every 3.78 members of the population. In 2015-16 that number was one for every 3.66 members of the population. (9.2% versus 12.8%)

The number of people over 85 years of age will grow by almost 90k per year for the next 20 years. Moreover, compared to 2010 there are already an additional 130,000 people aged over 85 alive today.

Dementia

“MINOR INJURIES AND INAPPROPRIATE ATTENDERS ARE THE PROBLEM” 3

Repeated in the Keogh Report in November 2013 and New Year 2017: Over 40% of patients leave A&E with no investigation or treatment…….. Actually it’s less than a third - but most still need A&E advice and reassurance

Between 15 and 20% of A&E attenders are suitable for primary care But even if they all stopped coming…. it would make no difference at all to old ladies waiting for beds for hours on trolleys!

“BRITISH PEOPLE GO TO A&E TOO MUCH” 4

Attendance rates at EDS in the UK and North America in 2011 and 2012:

“THE NHS HAS ENOUGH BEDS TO DEAL WITH THE UK’S MEDICAL NEEDS” 5

May 2015:

International bed numbers: England seems to be less than averagely endowed with hospitals compared with other countries. And its public hospitals tend to be smaller on average than other countries’ too.

The Kaiser Family Foundation 2015: international bed numbers Country Number of hospital beds per 10,000 population   Japan 137 Russian Federation 97 Germany 82 Austria 76 France 66 Belgium 65 Switzerland 50 Netherlands 47 Australia 39 Italy 35 Denmark Norway 33 Spain 32 Canada Ireland 31 USA 30 World United Kingdom 30 AND NOW IT IS 23! Sweden 27 The NHS has lost 15,000 beds in the last six years!

“the ever-increasing number of (A&E) attendees and admissions means that hospitals need to generate extra bed capacity – our analysis suggests that, on projected population trends, 17,000 extra hospital beds could be needed by 2022 unless more can be done to treat people outside of hospital” The Nuffield Trust (2015). What’s behind the A&E crisis? Policy Briefing No. 3, March 2015 http://www.nuffieldtrust.org.uk/publications/whats-behind-ae-crisis

“THERE IS ENOUGH CAPACITY IN SOCIAL CARE TO DEAL WITH OUR AGEING POPULATION” 6

The Royal Bolton Hospital Emergency Department by night

At the present time, one in 15 acute hospital beds are “blocked” throughout the NHS; the figure is one in five in some hospitals!

“THE NHS PROVIDES A SEVEN-DAY SERVICE TO SUPPORT A&E” 7

Guess the day and the time…….. Friday afternoon at 2-30 pm

“PREVENTIVE MEDICINE IS THE ANSWER” 8

Health promotion doesn’t save money. Why should it Health promotion doesn’t save money! Why should it? People just live longer and get different diseases.

“DIVERSION OF PATIENTS AWAY FROM A&E IS THE ANSWER” 9

Monitor and NHS England 2015: Urgent and emergency care – a new payment model Table 5 – An illustrative estimation of volume based payment Providers 111 GP OOH Ambulance A&E EA Price adjustment 15% 35% 25% Marginal price (£) £2 £25 £26 £31 £403 Outturn activity shift (%) 20% 8% 4% -15% -2% Outturn activity level 197,760 27,810 42,848 87,550 30,282 Volume based payment on outturn activity (£’000) £ 449 £ 688 £ 1,103 £ 2,762 £ 12,303 Baseline TRR (£’000) £ 2,870 £ 1,965 £ 7,282 £ 11,696 £ 35,869 Outturn commissioner expenditure (£’000) £ 2,888 £ 7,293 £ 11,534 £ 35,618

So do diversion and deflection schemes work? There is considerable UK and American experience and……….

Him………or Her? And anyway…….who is most likely to be deterred from attending their local A&E department by a public information campaign?

We need more round-the-clock urgent care capacity, and more social care to free up hospital space. You can’t get a quart into a pint pot!

Staffing, Systems and support for emergency care RCEM 3S Campaign Co-location of urgent care services Better access to social care More acute hospital beds Equitable and adequate staffing for urgent care

If people keep walking across the grass….…

You can stand there and chase them away with a baseball bat…

Or you can build a path! Twitter: @RCEM_VP