All I Want For Christmas Is No Health Emergencies


Every winter is the worst winter for the UK’s National Health Service. But that doesn’t mean we’ve seen it all before. New data show NHS backlogs have hit a record 7.2 million, emergency departments are leaving patients waiting longer for care, ambulances are taking longer and then are kept waiting outside hospitals for lack of space in emergency wards. All of this is on top of looming nursing and ambulance-worker strikes, record levels of staff burnout and massive workforce shortages exacerbated by Brexit.

Increasingly, those who can pay for private treatment are opting to do so — including, reportedly and unsurprisingly, Prime Minister Rishi Sunak. But the private care fast-track doesn’t apply to those times in life when you need an emergency doctor.

While a prime minister who needs emergency treatment can expect a quick response (as we saw during the pandemic with Boris Johnson), ordinary Britons are at the mercy of the country’s increasingly overcrowded, understaffed and crisis-ridden Accident & Emergency departments. They have become the most visible and alarming sign of a system that, despite the enormous goodwill of its staff, is failing too many people in their time of greatest need.

It’s no longer unusual to read about cases such as the 85-year-old woman with a broken hip who waited in agony for 14 hours for an ambulance and then was forced to wait outside the hospital for 26 hours before being admitted for surgery.  Most people I know have their own A&E (or ER, as Americans say) stories to tell. A colleague who took a feverish child to A&E waited six hours to be seen (bear in mind that 15 children have died recently from Strep A infections). A friend had to call an ambulance for her husband, an NHS doctor himself, and was parked outside an A&E unit for hours as staff in various ambulances negotiated with the department over who would be seen next.

A&E departments were already overstretched because people have struggled to get GP appointments and because of understaffing. But they couldn’t move patients onto the wards for further treatment because there were no beds available. Patients now get stuck for hours on trolleys, lining corridors and using up all available A&E space. When ambulances arrive hoping to decant new emergency patients, the hospitals tell them to cool their heels, making a mockery of the whole idea of the emergency department.

In London, there are a half-dozen private urgent care services that are handy if a child is ill or has had an accident. The Urgent Care Clinic at the private St. John and St. Elizabeth Hospital, for example, charges a £120 flat fee to see a doctor, who will then order x-rays, blood tests or prescribe medication. But such clinics are designed for the quick treatment of infections, minor injuries and wounds — they can’t treat heart attacks or strokes or other trauma.

The data have shown a few modest improvements in some areas. But overall, the picture is of a crisis that has been building for years. It exposes the woeful lack of capacity — whether it’s hospitals beds, diagnostic equipment or nursing staff — to serve an aging population with more complex health needs. Pumping in more public resources won’t be able to solve capacity problems quickly. Contracting more hospital services to the private sector, as was done during the pandemic, is one route worthy of more consideration.

Another policy change that could help unblock emergency room care is fixing Britain’s underfunded and fragmented social-care system. Better access to social care would speed discharges and help move patients more quickly from A&E to wards, freeing ambulances to meet urgent calls.

Boris Johnson promised in 2019 “that we will fix the crisis in social care once and for all.” In November, Sunak postponed Johnson’s plans to impose a cap on care costs borne by individuals and scrapped the dedicated tax that was created to fund it. Some other reforms are to be implemented in stages from October 2023, but they are too little, too slow.

I’ve become used to periodic NHS-failure stories and winter crises in the 25+ years I’ve lived in the UK, but I’ve never seen such a systematic breakdown of normal services, such despair among doctors and nurses or such loss of faith from the public. Britain is clearly moving toward a two-tier health care system in which more people who can opt for private care do so. That will always be a minority in a country with an abiding belief in its universal care model. But if the government wants to save the NHS, it at least needs a system that’s there when emergency strikes.

More From Bloomberg Opinion:

• Big Bank Job Cuts May Just Be Getting Started: Paul J. Davies

• Shareholder Democracy Doesn’t Work. Here’s How It Can: Luigi Zingales and Oliver Hart

• Sunak’s Post-Brexit Britain Is Becoming a Worst-Case Scenario: Clive Crook

–With assistance from Elaine He.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Therese Raphael is a columnist for Bloomberg Opinion covering health care and British politics. Previously, she was editorial page editor of the Wall Street Journal Europe.

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