A&E is the barometer for a health and care system under pressure | Phil McCarvill

Phil McCarvill

What happens in one part of our health and care system reverberates across all other parts – that's why whole-system solutions are needed to avoid a winter crisis.

It used to be a given that if I, or any one of my colleagues at the NHS Confederation, were interviewed about NHS performance figures or a serious incident, journalists would ask what more NHS organisations and staff could do to improve the delivery and experiences of care.

It is noticeable that in response to ongoing concerns about pressures across the NHS and wider care system – and in particular in A&E departments – this line of questioning has all but dried up. Even the most gnarled of journalists now start from the position that this situation is different and that NHS organisations and their staff are working at full capacity to deal with unprecedented pressures. 

Put simply, there is a general acceptance that NHS staff could not be doing more.

Much of the current focus has been on what is happening in A&E departments. But it is clear that A&E departments are a barometer for a wider system under pressure. Cuts to social care and pressures in mental health, primary care and community services all mean that many people feel the only option is to go to A&E.

We should not allow ourselves to pretend that this is somehow a situation that has crept up on us over recent weeks. The NHS Confederation and our members – which commission and deliver services across the NHS – have been highlighting the pressures associated with increased demand, the failure to adequately invest in community services and the impact of cuts to public health and social care. 

Back in 2012, we warned that funding issues with social care would have profound effects on the NHS. These are messages we have communicated to successive governments to influence spending priorities. 

Over recent days, the situation in the NHS has been commandeered by all sides of the political debate to reinforce their own position: insert your preferred cliché about ‘political footballs’ and ‘weaponising the NHS’. 

We need to cut through the hyperbole. Some of the language used recently has been inappropriate at best; alarmist at worst. And this does nothing other than secure a few headlines. It doesn’t help the staff across the health and care system who have been dealing with these growing pressures for months. It certainly doesn’t help the people who are waiting longer to access the care they need, and neither does it facilitate a rational debate involving politicians and the public about current and future funding of the NHS. It is more appropriate to say that the NHS is just about managing. 

Our shared concern should be what happens over the next few years. Given the increasing complexity that comes with the ‘bonus’ of living longer, we must accept that demand for care is only likely to increase. We can therefore either sit and wait until the next time pressures boil over, or we can proactively do something about it.

To avoid a quick return to the headlines of recent weeks, there is a need for whole-system solutions that adequately reflect the reality that we have a health and care system, and that what happens in one part of that system reverberates across all other parts. 

As such, the NHS Confederation will continue to call for political agreement on social care funding, to press the case for care closer to home to be prioritised, and to ensure that our hospitals have the capacity to support those people who really need their specialist care. 

Phil McCarvill is the deputy director of policy at the NHS Confederation. Follow him and the organisation on Twitter @Phil_McCarvill @nhsconfed

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