Winter A&E pressures - Community services must be part of the solution

by Phil McCarvil Head of Policy & Public Affairs, England Phil McCarvil, Head of Policy & Public Affairs, England

Much has been written over recent weeks about the ability of A&E units to deal with the increased demands associated with seasonal pressures and wider demographic change. While there has been a strong focus on the number of people using A&E services there has been much less emphasis on the profile of those using them and the need for longer-term solutions. Little appears to have been done to break down data to determine the profile of those using A&E services. What proportion are frail and elderly, how many are terminally ill and what percentage are living with conditions like dementia?  If we had a clearer idea about who is using these services we could more precisely explore why they have ended up there.  The bottom line is that, for many of these people, busy A&E units and hospitals can be extremely distressing places, and speaking frankly, it can be extremely time consuming and expensive for the NHS. Using billboard and other media campaigns, people are rightly being encouraged to use pharmacies and other community-based services instead of going straight to A&E. However, at present, most of the major solutions being suggested seem to focus on putting more money into hospitals to deal with the immediate pressures. The real, long-term solution surely lies in shifting resources from acute services out into the community in order to prevent people, who often have no immediate clinical need to be there, ending up in an A&E department simply because of the absence of appropriate community based services.

The benefits of community-based services

We know from the Nuffield Trust’s Exploring the cost of care at the end of life that community nursing services, like the Marie Curie Nursing Service, can not only provide high-quality care but also help reduce the cost of caring for someone in the last months of life by around £487 per person.  Community-based services currently help keep thousands of people out of hospital and in their own homes and care homes; however, the role of charities is so often overlooked when it comes to solving the big challenges facing the wider health and social care system. If we are going to meaningfully tackle the recurring, annual pressures on A&E and other hospital services, we need to know who is using these services and then use this knowledge to enhance the community-based services which can intervene earlier and thus prevent visits to A&E units. This will require investment in community-based services. This means resources for social care, carer support, community-based nursing and hospices, as well as quicker decision making regarding care funding packages. While it's clear that the NHS must address the immediate issues associated with the ongoing increased demand for A&E services, in the longer term we need to rebalance services so our health and social care system is ready for the further stresses associated with our already ageing society.  We must break out of this annual cycle of awaiting and then addressing winter pressures and seek longer-term solutions which harness the strengths of charities and other community-based services.