Health Secretary Jeremy Hunt is correct to say that there was a 'dramatic fall in confidence' in alternatives to Accident & Emergency units. He says that this has built up steadily since GP contract changes in 2004. He is right of course, and who can blame him for making the obvious political point that Labour government negotiations have helped fuel this present mess?
They may have caused it, but he is in power to help solve it.
As a group of NHS Trusts has warned that casualty departments could collapse within six months as a result if 'huge pressure', any long term strategy will frankly not alleviate today's problems. Patients cannot wait for Sir Bruce Keogh's much-anticipated review of A&E care to be published, scrutinised, responded to, discussed and eventually implemented. The acute need is here now.
Broadly speaking the medical profession is urging the government to press ahead with the re-configuration of acute services, with increased investment in and use of primary care outside of hospitals. The public remain to be convinced and the obvious pressures on A&E units only serve to baffle patients as to why the government wants to downgrade their local units.
The College of Emergency Medicine warned that A&E units were grappling with 'unsustainable' workloads and a lack of staff. We are then told that A&E units must be downgraded because they are unsafe: well of course they would be without the staff to meet the massive increase in patients – over half a million in five years.
Surely, however unappetising it is to the Health Secretary, he should now accept until the causes of increased attendance at A&Es are dealt with he should instruct all downgrades to be suspended.
The are many causes, including the NHS 111 telephone service driving excessive numbers of patients to A&E, poor access to some GP services, and an increase in clinical need - the list goes on. Overall, far too many patients who should not be treated at A&E are nonetheless being sent there anyway. If people who didn't actually need to go to A&E were treated more appropriately, they would not only get better care, but our A&Es would not be under such immense pressure and it would save millions of pounds a year.
Indeed, only today Dr Dan Poulter, the Health Minister, said 'we’ve got to start thinking about how we stop people who didn’t need to be in hospital arriving there'. But until that thinking is done, and changes are made so that we stop funnelling patients to A&E - when we are downgrading so many A&E units - the Health Secretary should call a halt to all plans to downgrade Accident & Emergency units.
The long term strategy of specialist, centralised hospitals supported by excellence in primary care is well documented and well supported in the medical professions. Yet we are in danger of putting the cart before the horse - reducing A&E provision before the alternatives are in place - and exacerbating the lack of trust rather than building it.
Nick de Bois is Conservative MP for Enfield North.