Winter Crisis: A Reflection on 2016/17

The NHS was brought to its knees after a larger than normal/expected increase/admittance of patients this winter of 2016/2017, which caused almost a third England hospital trusts to state they needed urgent action to cope.
 
The number of patients waiting for over 12 hours in Accident & Emergency units has doubled in two years and cases amongst the elderly are almost tripling, according to new figures from NHS Digital.
 
Here are some key points summarising the crisis:
 
·         The figures show the number of patients aged 60 and over who spent more than 12 hours waiting in A&E tripled from 43,209 to 111,498 cases.
·         British Medical Council chairman Dr Mark Porter said: “We already know that we have an overstretched and underfunded NHS that is failing to keep up with rising demand and these figures confirm it is getting worse year on year”.
·         The depths of winter saw a surge of attendances in A&E, with the overall figures showing a 12% rise in the period from January to March last year.
·         This comes after Health Secretary Jeremy Hunt claimed that one in three of patients attending A&E don’t need to be there.
·         Vice President of the Royal College of Emergency Medicine Chris Moulton, said: “These figures demonstrate that we don't have enough acute hospital beds or enough social care for a growing and ageing population”.
·         While the amount of elderly people forced to wait on trolleys is rising fast, most of those going into casualty units are younger patients, according to the figures.
·         In fact, the total number of attendances under the age of 65 is 78%, this suggest that the younger patients are pushing out those who potentially are most in need. The total figures for attendances are stated as over 23 million, an increase of more than 700,000 cases in a year.
·         But it’s not all negatives; an NHS spokesperson said: “These figures show that last year the median time to assessment was 11 minutes and, on average, patients left A&E just two hours and 40 minutes after arriving”.
 
In short, the winter crisis highlighted the NHS’s lack of three areas: staff, hospital beds and support. For most of you reading this, this is nothing new.
 
What caused the winter crisis?
 
A lot of the commentary on the recent winter crisis in the NHS has mentioned the issue of ‘bed blocking’as a key factor. This combined with severe cuts have resulted in more people remaining in hospital for longer because there is nowhere for them to go after.
 
Another contributor to the crisis is the number of people making unnecessary trips to A&E.
 
To an extent, the rise makes sense as the UK’s population is growing disproportionately fast when compared with other wealthy nations – in particular the aging population is growing every year. In 2015 there were over three times the amount of people over the age of 85 than there were 25 years earlier.
 
This increases demand for two expensive types of healthcare. The first is care for the terminally ill: about 25% of all hospital inpatient spending is on a patient’s last three months, according to data referred to by The Economist.
 
The second is looking after people with more than one chronic condition – about 70% of all NHS spending goes on long-term illnesses. Over half of 70s and over have at least two long-term conditions.  
 
You’d expect that funding would increase with these growing demands and population but the NHS’s funding is significantly lower than in comparable European countries, for example, 30% lower per person, than Germany. In the current decade (2010/2011-2020/2021) the projected annual growth in spending is set to be just 0.9%.
 
Older population most at risk
 
In the recent press the NHS has come under fire for ‘patronising’ advice on attempts to prevent the winter crisis.
 
Professor Paul Cosford, of Public Health England was drafted in to prepare plans to prevent a winter crisis in November 2016. His advice to the elderly specifically was no more than to “wrap up” and “turn up the heating”, which was met with anger from both the public and healthcare workers for ignoring the struggle older members of public have in paying heating bills.
 
Paul Green, of Saga, said of Professor Cosford’s comment: “This advice doesn't take a lot of imagination to give. Whilst it might remind people of something that is completely obvious, it doesn't help with their energy bills. 'There will be some older people who think it is patronising, while others will listen to the advice and say, 'Yes, but I cannot afford to put the heating on'. These people don't need the nanny state – they need enough money to heat and eat.
 
There will be some older people who think it is patronising, while others will listen to the advice and say, 'Yes, but I cannot afford to put the heating on'. These people don't need the nanny state – they need enough money to heat and eat”.
 
Approximately 25,000 deaths every year are attributed to cold weather, with pensioners most vulnerable to problems such as high blood pressure, resulting in heart attacks, strokes and pneumonia.
 
NHS England responded: “Whilst the actions being promoted are simple and easy to implement, if put into place, they will help prepare against winter and go a long way to protecting some from a hospital visit”.
 
How can it be prevented?
 
Currently there has been little to no clear plan on how to avoid another winter crisis, which in recent years has become an annual event. However, the reflection and the severity of the impact over the last few months suggests that a plan needs creating now. We all know how quickly that time will come again!
 
I would be interested in getting your thoughts on the major issues that hit your hospitals and medical professionals during the winter. Feel free to comment.