PROFESSOR ROB GALLOWAY: The best way to solve long, risky emergency room wait times? Improve people’s nutrition

We Brits are famous for our ability to queue for hours, but there is one type of queue that is both inappropriate and potentially dangerous.

The latest NHS performance data was published last week. Those of us who worked in the NHS knew all too well what this would lead to: bigger waiting lists, people with cancer waiting far too long to start treatment and patients waiting too long in A&E.

As someone who has worked in emergency departments for 22 years, I am shocked to see what is happening in emergency departments across the country. But that pales in comparison to the way patients suffer.

Twenty years ago, the Labor government introduced a target for 95 percent of people in emergency departments to be seen and treated within four hours. In Northern Ireland and Wales that goal has never been achieved. In Scotland, this was last met in July 2020, at the height of Covid, when patients were afraid to come to hospital. In England this was last achieved in July 2015.

The A&E targets were not just missed, but catastrophically missed. Only 54.7 percent of patients attending emergency departments in England in December were treated within four hours. In that month alone, one in nine people waited more than twelve hours to be discharged or admitted to a ward; that is more than 150,000 patients.

The A&E targets were not just missed, but catastrophically missed. Only 54.7 percent of patients attending emergency departments in England in December were treated within four hours (File Image)

The main reason for this is the increasing number of vulnerable and elderly patients requiring admission – with an increase of 5.7 percent compared to December the year before – but without an equivalent increase in resources.

And the dangers of this were demonstrated in a groundbreaking study published in January 2022 in the Emergency Medicine Journal. It showed that for every 82 patients who waited more than six to eight hours in the emergency department for a hospital bed, one additional patient died. This means that every week 300 to 500 people die unnecessarily due to the long wait for hospital beds. That is equivalent to two plane crashes per week.

But the solution does not lie in a new attempt to strictly enforce the four-hour rule. Let me explain why.

When I was a resident physician, I became frustrated with the four-hour rule, and especially its unintended consequences, which were not always in the best interests of my patients.

For example, if I were caring for a patient whose emergency department care would have been achievable within five hours, I would often find that he had been wheeled to an empty bed in a ward at three hours and 59 minutes to get a four-and-a-half -fifty minutes to avoid. hour ‘break’. But the care they needed would then be delayed because there was a different set of doctors in those wards.

It was a blunt but otherwise effective tool: the key was that it was backed by sufficient funding to employ sufficient emergency department staff, with bed capacity for patients requiring admission. Only when I look back do I realize its success: I rarely saw patients in the corridors.

But what is being done now to meet the four-hour targets is a band-aid and not the ultimate answer. In five to ten years the problem will simply return because we are not addressing the real problem.

Failure to meet targets has nothing to do with a lack of GP appointments, or with patients ‘abusing’ the system, or with poor management: the reason why emergency departments across the country are failing to meet targets – causing our patients to suffer – is a simple case of The demand is greater than we can handle.

So what can be done? My thoughts on this have changed dramatically after so many years in the NHS coal department.

Yes, we need to solve the problem here and now – and that means investing in more beds and staff. But long-term investment is most needed in social care and GP services.

This will help ensure continuity of care by experienced doctors who know their patients and have the expertise to make decisions to treat people at home rather than sending them to hospital. This should at least prevent the situation from getting worse. But it won’t solve the problems because demand will continue to rise.

After years of working in emergency medicine, I know that I spend most of my time undoing the damage caused by an unhealthy lifestyle. I have come to realize that we need to focus our efforts primarily on reducing demand; we need to create a national welfare service, not a sickness service.

Western medicine is about treating conditions such as strokes, heart attacks and cancer rather than preventing them. Even when we talk about prevention, such as high blood pressure tablets, we do not discuss the reasons for high blood pressure.

This reactive medical care has led to increasing life expectancy. But this often comes at the expense of a deteriorating ‘health span’: the number of years in which we enjoy good health.

For example, the NHS is so brilliantly set up that most people after a heart attack receive immediate care from the ambulance service, emergency departments and specialist cardiologists.

Your life is saved, but the remaining years may be of poor quality. If your heart is weakened, you will be short of breath, unable to walk and require regular medical care, unfortunately all too often in the emergency room and later possibly in an inpatient hospital. We are creating a population of sick patients, who will be sick for years, and creating ever-increasing demand on the NHS.

No matter what the various political movements tell you, increasing hospital resources will help, but will never solve this long-term health crisis.

If we really want to improve the NHS and meet the targets not just next year but every year, and prevent them from slipping, we need to tackle lifestyle issues; poor diets full of processed foods loaded with sugar and fat, lack of exercise, loneliness, excessive alcohol consumption, smoking and obesity.

We should tax junk food and use it to subsidize healthy eating and exercise. This is not ‘nanny statism’; it is simply sensible policy to give everyone the opportunity to make healthier choices.

We need to make healthy living the easy choice. In many workplaces, vending machines only offer junk food. That needs to change, just like the ‘buy one, get one free’ offers on rubbish food.

Children need to learn how to cook healthy food. We also need to tackle the pandemic of inactivity – not just encouraging people to exercise, but ensuring that schools encourage all children to walk or run a mile every day.

It’s not just the government, we all need to take action. Unless we do that, we will never meet the targets – and the NHS as we know it will be gone in ten to twenty years.

@drrobgalloway