A&E Perspective: Don't Panic!

Dr Dan O'Carroll


December 19, 2019

'Don't Panic' is the phrase on the back cover of The Hitchhiker's Guide to the Galaxy . This is explained in Douglas Adams' novel as the Guide 'looked insanely complicated' to operate. It is also credited for being one of the reasons that it outsold Encyclopaedia Galactica , as well as it being slightly cheaper.


Marvin The Paranoid Android

I was minded of this whilst considering where we are in emergency medicine in the UK, with the ongoing challenges for the whole of the NHS and social care against the background of apparent political upheaval and the crystallising form of Brexit.

Once again, it's increasingly difficult to read a news article or watch any news programmes without hearing horror stories regarding the NHS, and we wonder if anything is going to be different through this coming winter, or if there is any light at the end of the tunnel.

NHS 'Crisis'

It seems that there is greater acceptance (or perhaps less denial) that the NHS is in crisis and it featured heavily in the recent general election campaign, both in what the politicians were proposing and what the public deemed to be a high priority for the future direction of the country. Some commentators consider the claim of an extra £350 million per week for the NHS was one of the crucial statements of the 2016 Brexit campaign. One of the many pre-election polls suggested that the NHS was the number one consideration for the voting public.

It is perhaps unsurprising that the NHS featured prominently in both major parties' campaigns. The incumbent government promising a 3.4% rise in funding in its 5-year spending plan, and Labour 3.9% increased funding, bringing the budgets to £149 and £155 million per annum respectively by 2023-24. Claims and counter claims were made regarding the planned expansion of nursing numbers by 50,000, with some mathematics that even my 9-year-old daughter has called into question.  

The Conservatives said GP numbers will be boosted by 6000 within 5 years, which possibly should be treated with some scepticism as a similar claim was made for 5000 extra GPs in 2015, but UK numbers have actually fallen.  Forty new hospitals are to be built by 2030, even though only six of these have currently been identified. Labour focused very heavily on the claims that government plans for post-Brexit trade deals, particularly with the USA, would result in the sale of the NHS to American healthcare organisations. These were rebutted vigorously by the government but many believe that one of the conditions that would be attached to any future trading relationships would be to open up access to the NHS market and possibly increase the costs of many medications to be much closer to their US prices.

The NHS took centre stage and dominated many of the headlines with the news surrounding the publication of pictures of a young boy at a Leeds hospital sleeping on the floor due to the non-availability of beds. This resulted in false claims of 'fake news', 'dead cats' being thrown rather than punches, and the shocking sight, for many, of the Prime Minister, initially, refusing to even look at the picture of the boy, and even grabbing the reporter’s phone rather than acknowledge any responsibility.

Election Landslide

The Conservatives have won the election and we can only hope that given time they can fulfil their promises regarding increased funding and the expansion in NHS staffing numbers. It is not for me to question why they haven't taken the opportunity whilst being in government for the last 9 years to bring about any of these improvements. All of us in emergency departments look forward to the day when the crowding is due to the extra 50,000 new nurses, rather than due to unfortunate patients waiting many hours beyond the 4-hour target to be seen, and waiting even more hours for an available bed.

One of the many pledges of Boris Johnson when he first became Prime Minister was that he would fix social care, but the proposed extra £1 billion per year, would in my view, be nowhere near enough to make up for the previous cuts and chronic underfunding.

Until the social care crisis is addressed there is little hope of dealing with the ever-worsening situation for acute hospitals and services. As it often appears with the Prime Minster, his plans seem somewhat lacking in detail, and worryingly, since achieving his landslide victory, there are already suggestions that social care will need some sort of paid insurance policies to make it work.

Another urgent action that needs to be addressed is the pensions crisis, which the Conservatives pledged would be dealt with within 30 days of taking office. The clock is ticking regarding this, as many are not reassured by the recent sticking plaster approach offer that was made in the run up to the election, which would only deal with tax bills earned in this financial year 2019/20.

Broken System

There is no time to waste before starting to fix these problems. Many clinicians are now openly stating that the system appears to have broken beyond the point of repair.

Data published by NHS England on the day after the election showed the 4-hour target was achieved for just 71.3% of attendances. The worst figures on record. Equally concerning is that 94.9% of acute and general beds were occupied.

The Royal College of Emergency Medicine (RCEM) winter flow project shows that since October 2019 more than 38,000 patients waited over 12 hours for a bed at the sampled sites (approximately a third of the acute bed base in England), yet the data published by NHS England reports only 13,025 patients experienced waits over 12 hours since early December 2011. Many of us have previously questioned the variability in the way this metric is reported and that it may be open to 'gaming'.

An unpublished paper makes claims that almost 5500 patients have died over the past 3 years because they have spent so long on a trolley in an A&E unit waiting for a bed in overcrowded hospitals. If these results, when published, stand up to scrutiny, they should be a source of national shame.

Legendary science fiction author, Arthur C Clarke said Douglas Adams' use of "don't panic" was perhaps the best advice that could be given to humanity. So if we are to choose to be reassured by Adams' novels, as long as the second most intelligent beings on the planet, (the dolphins) haven't abandoned us, perhaps there is still hope for us.


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