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Coffee House

David Cameron prepares for winter of discontent in A&E

11 November 2013

8:31 AM

11 November 2013

8:31 AM

There are two important NHS stories in the papers today. First, the Times reports (£) that A&E departments are facing severe pressures because of historic staff shortages. The paper notes:

‘Half of all senior doctor posts go unfilled at accident and emergency departments, putting unsustainable pressure on life-or-death care. The College of Emergency Medicine (CEM) says that 383 of the 699 specialist registrar posts in A&E have been left vacant over the past three years, stretching emergency ward doctors beyond capacity and driving up waiting times. The shortfall in senior doctors deprives A&E departments of the ability to see 766,000 people each year, since the CEM points out that each registrar would have seen about 2,000 patients. This is broadly equivalent to the numbers that would be seen by 12 district general hospitals.’

Second, most news outlets report that the closure of 53 NHS walk-in centres is putting even more pressure on A&E departments. It must be said that there are arguments in favour of closures: walk-in centres are costly and divert funds from other local services, particularly palliative nursing. Lord Howe, the health minister, told the Guardian: ‘Patients should be able to access good-quality out-of-hours NHS services, without having to go to an A&E. Walk-in centres may be part of the answer, but this isn’t a one-size-fits-all solution. Family GPs, community services and pharmacists all have a part to play.’ On the other hand the health regulator, Monitor, says that walk-in centres are popular with patients, especially those who find their GP surgery’s booking system inflexible or inconvenient. Monitor advises against further closures, a position backed by Labour.

Both of these stories will concern government strategists as winter nears and demand on A&E will increase. It is distasteful to reduce crises in healthcare to base party politics; but the political dimension is undeniable because the Mid Staffs scandal and its on-going fallout have burnt the Labour Party. Andy Burnham, the shadow health secretary, has been making noise in the Times’s Thunderer column (£) and on the Today programme, trying to pin the blame for the A&E crisis on the government. David Cameron is overseeing the government’s preparations for what could be a difficult time. The government is understood to be searching for solutions to staff and resource shortages in A&E. Private hospital beds are likely to be used in the event of an overflow of patients. Cameron’s direct involvement, though not unprecedented, is unusual: a clear sign that the stakes are high.

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