'NHS Needs to Be Cherished and Celebrated to Survive' Our Hospitals, in Particular Our A&E Units, Have Been Coming under Increasing Pressure in Recent Times, with Stark Warnings Issued by Staff about the Current State of Our Beleaguered Emergency Units. Lisa Turnbull, Senior Fellow of the Welsh Institute for Health and Social Care at the University of South Wales, Looks at What the Future Holds for Our Hospitals

Western Mail (Cardiff, Wales), June 10, 2013 | Go to article overview

'NHS Needs to Be Cherished and Celebrated to Survive' Our Hospitals, in Particular Our A&E Units, Have Been Coming under Increasing Pressure in Recent Times, with Stark Warnings Issued by Staff about the Current State of Our Beleaguered Emergency Units. Lisa Turnbull, Senior Fellow of the Welsh Institute for Health and Social Care at the University of South Wales, Looks at What the Future Holds for Our Hospitals


Byline: Lisa Turnbull

"HERE now is the opportunity to build a hospital service equal to any in the world and matched, I would think, by very few."

" These are the words of a Government Minister not last week in the Se1 edd but 51 years ago when the current pattern of hospitals in Wales was laid down.

Today, we are going through renewed anguish about the future of those very hospitals.

As always in debates about the health service, the picture is complicated, changing and passionately contested. The different sides of the argument seem to find common ground elusive, and citizens in Wales can be forgiven for being both anxious and confused.

So what is all the heat about? We can probably tease out two main strands in the debate.

The first is about the here and now - why is it that hospital emergency departments in 2013 seem unable to cope with the numbers of sick patients and why are so many patients apparently stuck in hospital beds when they are medically fit for discharge - more than 50 at any one time in some of our hospitals? The second is about the future - how can we ensure that hospital services are as safe and sustainable as they could be? Today's problems are caused by a complex mix of increased health need and poor management of healthcare systems.

We are an unhealthy population - drinking, smoking, eating poorly and not exercising. We are also an ageing population. More people live with three or more long-term conditions.

Such people will periodically need help and, if we are not as good as some countries in maintaining people's good health, that will mean lots of hospital admissions.

We make the situation worse by not always getting people through hospital as quickly as possible. Too many patients are left waiting for the next test or the next treatment, spending time in hospital beds and corridors waiting for the next thing to happen.

The provision of NHS residential care or care at home is poor. Families often struggle to access medications or equipment, meaning that even if released from hospital, patients have to be re-admitted quickly.

In Wales, we rely on hospital care too much. Other countries are better at providing support in the community, caring for people before they become vulnerable and then stepping in quickly to care for them at home when crises develop.

These factors contribute to the distressing scene of ambulances queuing up to get their patients to the hospital, crowded wards with low staffing levels and operations being cancelled at the last minute as emergency cases crowd out operations that had been planned.

The answer to these problems is not always more beds. While this may be needed in some areas as a short-term measure, additional beds will soon be filled. The more sustainable answer is to re-balance our services and make them more efficient. Other pressures are also focusing the minds of hospital planners on centralising acute services.

It is obviously important that we should provide the best and safest treatment. Where we are talking about complex specialised surgery or trauma care, the best services are likely to be provided in a central location.

This is partly because specialised equipment is needed, because several different services need to be placed together or because the specialists need to hone their skills and build their experience by treating a large number of patients.

In addition, there are now a few specialities where the service is close to collapse because we cannot staff them. Doctors now work fewer hours per week than they used to because old working practices were unsafe, meaning that we need more doctors to maintain the same level of service.

Medicine has become more specialised over the years. Hospitals used to have doctors called general surgeons. That speciality has now been divided into nine sub-specialities and this way of working inevitably requires more doctors to staff the rotas. …

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'NHS Needs to Be Cherished and Celebrated to Survive' Our Hospitals, in Particular Our A&E Units, Have Been Coming under Increasing Pressure in Recent Times, with Stark Warnings Issued by Staff about the Current State of Our Beleaguered Emergency Units. Lisa Turnbull, Senior Fellow of the Welsh Institute for Health and Social Care at the University of South Wales, Looks at What the Future Holds for Our Hospitals
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