Elephants and scapegoats in the pressures on emergency departments

Curiously, elephants in small rooms often escape detection even by experts. Ham’s editorial reviewed pressures on English emergency departments.1 2 Yet he avoided explaining that while the NHS runs at white heat, hospital bed numbers are still being cut. This is despite the UK having the second lowest per capita ratio in the European Union,3 the population having risen by 10%, and 8% of major emergency departments having been closed over the past decade (although an increase of 25 major departments was needed to maintain equivalent levels of occupancy).4 Moreover, Ham is surely aware that high emergency department occupancy, like high bed occupancy, is associated with poorer patient outcomes, and that patients in England have poor outcomes for many major conditions, with absurdly delayed investigation and treatment standards.

Financial and clinical failure of the NHS is a political choice that creates useful leverage to introduce politically unacceptable policies. Analysis of falling performance in the four hour emergency department target shows that only 11% of the decline is caused by a rise in the number of elderly people seen.4 Yet, the continued political and Department of Health misattribution of emergency department pressures to elderly people, and of bed pressures to elderly “bedblockers,” suggests an ageist agenda.

Blaming older people for the NHS crisis creates a specious excuse to introduce policies that exclude an increasing proportion of them from acute secondary care in favour of default “palliative care” (perhaps the true reason for the marked rise in elderly deaths noted in 2012 and expected again this year).5 6 Recklessly slashing emergency admissions by 15% over the next two years, claiming a (non-existent) capacity to offer appropriate diagnostic and clinical care in the community, and the proposed 168 hour working week for doctors are further examples. Sadly, Ham fails to challenge the party line.