Response to comments on ‘An Accident Waiting To happen’

 

 

 

 

 

 

 

This is a response to some of the points raised in the comments about the last post on A&E …a good debate …thanks to everyone who had a go.

The real point is to ask whether the BBC should have taken the King’s Fund’s press release at face value or should it have questioned the figures more deeply.

Looking at the King’s Fund’s report it seems to be more an opinion piece than about conclusions based on the facts…and the crucial piece of information is missing…how many people were treated at minor injury units pre 2004 and how many after the new GP contracts were introduced….these figures were just lumped together….making the report useless…at least for gauging the effects of the GP contracts…..

Though possibly looking at the graph you could calculate that perhaps one half of the walk-in centre data, shown in red, (but only that in 2004 as it’s a one off increase),  could be attributed to patients diverted from GP surgeries…the other half being the previously unrecorded data.  The King’s Fund makes no such calculation.

 

Dez in the comments raises some points stating:

‘The actual number of people attending A&E units has hardly changed since 2004.

In fact the number of people turning up at A&E has remained fairly constant since 1987.

Or in other words, the longer waiting times for people in A&E have nothing to do with GP contracts or increased demand.

Got it yet?

There – has – not – been – an – increase – in – demand – at – A&E – units.’

 

Well firstly the walk-in centres and minor injury units were A&E’s by another name…they were created to take patients with less serious ailments out of the major A&E units to allow more serious cases to be treated quicker…but they are still ‘A&E’.

Major A&E unit patient numbers remained apparently ‘stable’ …but that hides the truth…it may be the same number of patients but they are more seriously injured or ill people….the less serious have been ‘diverted’ to the walk-in centres…so overall numbers have risen.

　

Next…well common sense should immediately say that Dez’s claim that there has been no rise in numbers going to A&E can’t be right.

Between 2001 and 2011 the population increased by 3.7 million in England and Wales….7.1%.

And between 2004 and 2011 the population increased by 3 million.

Dez….you are saying not one of those 3 million extra people went to A&E….John Bercow yesterday said that immigrants were harder working than Brits…he didn’t tell us that they were also so remarkably healthier!

　

So you say there has been no rise in numbers at A&E units….. the NHS’s College of Emergency Medicine says something different in 2013:

‘A&E departments have seen a rise in the number of patients they are seeing in recent years, with an extra 4 million people a year using emergency services compared with 2004.’

 

　

The very King’s Fund report you quote even tells you that numbers have risen enormously:

‘The NHS has experienced a phenomenal increase in accident and emergency workload over the past decade.’

　

So does the BBC….a trustworthy advocate for you Dez surely ? Not only does it state that numbers have grown substantially but that the GP’s refusal to do out of hours work led to part of that increased workload at A&E:

‘It has been clear for some time that pressures have been growing in A&E.

For the past decade the numbers attending the units have been rising year by year. There are now more than 21 million visits annually – up 50% in a decade.

There is a combination of reasons why they have grown, including a rise in number of people with chronic conditions, such as heart disease, that end up having emergencies; the ageing population; and problems accessing out-of-hours GP care.’

 

　

And look, the BBC says it again:

‘GP consultations are up by a third since the mid 1990s.

Some of this workload has been passed on to hospitals with referrals for non-emergency care at one point during the 2000s rising by 15% a year.

There are signs the GP workload has had an effect on A&E too.

Amid complaints that doctors could no longer cope, they were allowed to relinquish responsibility for providing out-of-hours care in 2004.

This has been taken on by agencies, but with confidence in the system low there are large numbers of patients now attending A&E who do not need emergency care.

The College of Emergency Medicine estimates up to a third could be treated elsewhere.’

　

And here even one of the radical BMA’s representatives admits numbers have risen whilst rigorously denying his members had anything to do with that:

Dr Buckman told the BBC Radio 4 Today programme:

“People who go to A&E are not going because of GPs. There is no doubt some of it is because people are confused about how to get access to out of hours services and some of it is because NHS 111 is sending people there.

“But some of it is about a rapid rise in demand.”

　

Surely he’s not in the pay of the government is he…nor the BBC or The College of Emergency Medicine?

　

And yet more evidence:

‘Nationally, 20 per cent of patients attending A&Es during normal GP opening hours require an admission. But at some primary care trusts the average is as low as 6 per cent, suggesting significant numbers of patients are visiting A&Es in place of GP surgeries – even when practices should be open.

NHS Alliance chief executive Mike Sobanja said: “At its simplest these figures may show that patients are ringing up for an urgent appointment and cannot get one, and so go to A&E.”’

　

　　

GPs are under pressure even when they are ‘open’…because of immigration and the vast numbers of new patients…resulting in people not being able to get appointments during the day…so they go to A&E….and in out of hours times patients go to A&E as well… immigrants often going straight to A&E treating it as a GP practise.

 

So Dez, your point:

There – has – not – been – an – increase – in – demand – at – A&E – units’

…has been comprehensively debunked.

　

　

What about your other point…that a change in the way data has been recorded explains why it looks like there has been a rise in admissions due to GP contracts changing?…you say…

‘It shows that from 2003-04 the way the data was recorded was changed – so that it included visits to “walk in centres” & “minor injuries units”.

 

You haven’t read the King’s Fund report properly….it does say data gathering changed but not in the narrow way you suggest.

Previous to 2003/04 there were these walk-in centres in existence……the government then introduced the GP contracts….and set up a whole new set of walk-in centres….to cope with an expected increase in workload at A&E….an increase you must presume they believed would arise from the fact that they knew that a majority of GPs were going to opt out of working ‘out of hours.’

The change in methodology in recording data  included adding in these already existing walk-in centres….but it also included the newly set up centres as well…and as stated earlier the King’s Fund makes no distinction between the two…which is the crucial figure that you need if you want to know how GP contracts effected the data.

Here the King’s fund evades giving the actual figures just claiming ‘much of the increase was due to previously unrecorded data‘:

‘So, much of the increase [how much?] in 2003/4 was due to previously unrecorded attendances now being collected, but also additional – but less serious – work being carried out in the new units. From 2003/4 to 2012/13, attendances in type 1 units have remained more or less unchanged. It is attendances in type 2 and 3 units that account for all the increase.’

Here it tells us that there were new walk-in centres created in 2003/04 to divert less serious cases away from expensive major A&E units:

‘Until 2003/4, statistics on A&E attendances included ‘major’ A&E units only. But around this time more, smaller units – including walk-in centres (WiCs) and minor injuries units (MIUs) – were introduced with the intention of diverting less serious emergency cases away from the larger, more expensive A&E departments, and the statistical collection was changed to record attendances separately for ‘type 1, 2 and 3’ units. Type 1 essentially reflecting major A&E units and types 2 and 3 defined as the smaller, walk-in and minor injuries units, together with specialist emergency departments.’

　

　

So 2003/04 Labour created more walk-in centres to cope with an expected rise in attendances at A&E.

Immigration contributed massively to the rise in attendances at A&E.

GP contracts and opting out contributed to a rise in attendances at A&E.

　

And finally….

Yes in 2004 some of the initial rise in the data showing higher rates of attendance at A&E could be attributed to previously unrecorded data….but much of that was down to new patients in new walk-in centres….but that was a one off change in the data that couldn’t be replicated for any following year.

So what of the following years? How to explain patient numbers that continued to rise year on year…from around 16 million  in 2004 to just over 20 million in 2011 before levelling off?

Are you saying Dez that that rise was because, year on year, the NHS kept finding ‘forgotten’ walk-in centres whose data they hadn’t recorded and so each year these undiscovered centres had their data added to the charts?

Plausible….or maybe not.

The truth is a complex combination of things…mostly increased population due to immigration combined with the difficulty of getting access to GP services whether in opening hours or not.

　

And the point of all this? Perhaps the BBC should have been delving a bit deeper into the King’s Fund’s claims and not taken them at face value.