Public Sector Thought Leadership


We can solve the A&E crisis…by halving waiting times

We can solve the A&E crisis…by halving waiting times - written by Mr. Jonathan Stanley MBChB, MRCS(Eng), PG Cert. Health Economics and Management, Member of UKIP health forum

A&E waiting times have reached an all-time high and the worst of the bad old days of the 1990s are back.  We should take no lessons from Labour on how to manage this.  Its shambolic management of the NHS saw shake ups, break ups and the pointless disruption of training that led directly to staff shortages.   An obsession with waiting times over quality has poisoned debate over how we can best deliver health care in Britain.  UKIP’s common sense approach will give us back emergency care our country can be proud of.        

This government correctly identified what doctors and nurses all know:  universal waiting times are a political whim dressed up as an outcome.   It is lunacy to compare a broken toe to a broken leg and insist that at three hours fifty nine minutes the toe must be treated before the leg, else the first patient will “breach.”  

There are many tricks used to cheat the system.   It is common for patients to be rushed onto acute medical or surgical units  (set up in response to the four hour wait) with minimalist care provided while staff drop everything to see those who mistake superglue for ear drops before the clock times out.   It is reasonable for some patients to wait longer than others and much work went into the Manchester Triage System that could ensure the NHS delivers its charter:  health care based on need, not the vote winning slogans of career politicians.

When all A&E cases are treated within 4 hours but urgent cases are treated at a GP’s discretion it begs the question, what is an emergency?   Where there is doubt the dice are loaded towards patients with easy access to A&E or won’t wait; the young and mobile with 24/7 lifestyles whose expectations are highest.  In short, those least isolated in society receive the best prompt care available.   

GPs have been innovative in trying to reduce A&E admissions and Acute Visiting Services being pioneered are an excellent example of how a more clinical and less political approach to emergency care can help patients and taxpayers alike.

Politicians proudly ignore demands and markets only to create a system that is definitely not needs based.   How can the under 30s make up almost 40% of A&E admissions?   At weekends this rises alarmingly due to irresponsible drinking.   As our population ages universal waiting times will be viewed not as halcyon but dogmatic and wasteful.   Large numbers of unskilled immigrants with poor language skills only add to this burden and in some areas this can be a major problem.

It is time for a British societal perspective.   We should accept that if a triaging clinician feels we don’t need treating within two hours required for standard cases then we be either  willing to pay or willing to wait longer so cases most deserving are treated best.   People should pay a higher charge if they haven’t registered with a GP as being directed back to primary care avoids unnecessary A&E visits.   Recent arrivals are overrepresented in this group and it is also only fair they pay for health insurance until they are paying both National Insurance and Income Tax.

Regardless of treatment cost, the prescription charge exempts those most in need and unable to pay for medicines.   It raises money to pay for treatments that Scotland and Wales now struggle to afford and prevents overuse of an otherwise free system.   A similar flat fee would allow an honest choice between waiting more than four hours, and paying.  The same exceptions as for the prescription charge could apply unless the patient was drunk and disorderly or incapable.   It is UKIP policy that the decision to charge for prescriptions is taken at a community level, not a national one.

In Britain we can expect better and faster service for Fido from our vet than we can for our parents and children from our local A&E.   If minor injury units were part funded by the flat fee a much better quality of service and care could be provided, while keeping our health service away from huge multinationals so favoured by big government.  They would relieve NHSDirect and walk in centres that often act as feeders to A&Es rather than replacing them.   If cooperatives run pharmacies and GP collaboratives provide cover out of hours then professional owned mutuals can run minor injuries units.  

The introduction of NHS111 further complicates matters and should be scrapped as a non starter.   I have never seen anything introduced so shambolically into the NHS and that’s saying something!  

In summary UKIP would:

    •    Scrap NHS 111 – it is a complete shambles

    •    Support profession led approaches in primary care that reduce admissions   

    •    Keep A&E free of charge for those triaged as needing treatment within two hours

    •    Focus on two hour targets for standard cases: cases that wait four hours rather than two suffer worse  than those that should wait four and wait more. 

    •    Non urgent cases to be seen only when no standard and urgent cases are waiting

    •    Allow mutual providers, including GPs, to charge a flat fee to see non-emergency cases 

    •    Ensure people can pay upfront fees off over a period of time when registered with a GP

    •    Apply the same clinical exemptions to the flat fee as for prescription charges in England

    •    The flat fee will only be discounted for those registered with a local GP

    •    The flat fee will not be discounted for those who are drunk and either disorderly or incapable

    •    Insist immigrants to the UK are not cleared for entry without evidence of valid health insurance.