I worked in A&E for many years only 'retiring' a few months ago. I don't think people realise how bad it really is in A&E. As a locum I travelled around the South-East working; and it was never a case of a quiet or busy hospital; but busy or dangerous.
Emergency (as A&E should be known) is the canary in the coal-mine of healthcare. By definition Emergency should only be used in-extremis; so if every Emergency is groaning under the weight of ill-health what does that tell us?
We are facing a health system that is just about to collapse.
The problem is that as a society we are no longer fulfilling both sides of the sick-contract. When people get sick it is society that must help them get better, but equally they must want to get better.
The word want in todays society means more than a glib statement of intent. If a doctor advises a patient that their heart condition is going to get worse if they carry on smoking, want implies they stop smoking.
Yet every doctor knows that lifestyle advice to many patients is at best hopeful, at worst a waste of breadth.
Re-balancing the sick-contract in our society is going to take a little time, but it is going to happen in one way or another. The Tories want to re-balance it by privatising it and allowing their mates to make enormous profits. The rich will have a sick-contract they can afford, and the poor will be denied treatment.
The reality is the system needs to change; patients have to take responsibility for their own health. The first step to this is to charge for access to service. The idea of free-at-point-of-care is an anachronism. Food, water, air, shelter are all more important for staying healthy and people readily accept they have to pay for these*.
Many people do not realise how expensive healthcare is. A patient came to see me in ED for follow up for a chest infection he got on his cruise. The bill from his ship-doctor to his insurers was £2 500!
I looked at the breakdown and realised the whole thing was a scam. He'd been put on oxygen despite his oxygen levels being fine: charge, £40 per hour for 3 hours. He'd had iv drugs when oral was fine. They'd bought him back to review him everyday for three days (and give him oxygen at the same time): charge £800 etc etc
If he'd come to Emergency I would have given him a £10 box of augmentin and sent him on his way. Cost to NHS approximately £150.
If we allow the NHS to get privatised this is the system we're going to fall into. A system where doctors are encouraged or even incentivised to over-treat so their hospital can charge. And who will pay? We will!
The NHS is an amazing system, but to save it we need to re-establish balance. People need to understand that it's not free, that accessing it requires a responsibility on their part. The easiest way to do this in my opinion? Charge an access fee across the board.
Yeah, they'll be some people for whom this unwillingness to pay is catastrophic. How is this different to economic decisions about housing, or heating, or good food? The deeper issue of economic inequality is responsible for this (not some malign health policy) and in essence the very structure of money itself.
A token £10 charge for the GP; £20 for Emergency and £40 after 11pm in Emergency would cut presentations by 25% (my guess) and give the NHS 5 years breathing space to sort out the deeper problems in society.
Doing nothing means welcoming in the world of privatised healthcare and £2 500 chest infections.
*you pay for air in terms of quality and whether you can afford to live away from a busy road.