|Volume 50 Number 35, September 12, 2020||ARCHIVE||HOME||JBCENTRE||SUBSCRIBE|
In September, the Health Service Journal (HSJ)  revealed a covert plan by NHS England (NHSE), already initiated by government, to roll out a "major A&E shake-up" in the coming weeks, a roll-out which they have been planning for a number of years to implement. Pilots for a new urgent care model requiring walk-in patients to book slots in emergency departments are expected to be rolled out in at least one site in every health system in the coming weeks in England nationwide. This followed an article on July 2 in Pulse  that former health secretary Jeremy Hunt finally admitted that he had wanted a "talk before you walk" system for patients attending A&E departments. An admission that came nearly three years after Pulsehad revealed that Jeremy Hunt had been in talks with NHS England urgent care leaders about potentially piloting such a system, even though at the time such a scheme was denied by him and NHS England .
In fact, as far back as 2014, Clinical Commissioning Groups (CCGs) had been encouraging patients to "talk before you walk". On July 23 this year, the Chief Executive of the Northern CCGs, Neil O'Brien, announced a "talk before you walk" pilot in Newcastle, North Tyneside, Gateshead and Northumberland for August, before the trial will then be extended throughout the rest of the North East, as well as North Cumbria and parts of North Yorkshire. He claimed that it "should work" because "what we've learned through Covid-19 is if you put more clinical resource into triage then a lot of patients don't need to go to A&E".
However, in spite the denials that emergency walk-in patients will "not be turned away" from A&E and walk-in centres, there was no clarity on what happens to patients who presently attend A&E and would normally be triaged at A&E itself and given the immediate treatment that they need, even if they had to wait. Dial "111 First" is the bench mark that NHSE and the government has been trying to implement over a number of years to stop patients with relatively "minor illnesses and injuries" from attending A&E. But at the same time, government cuts have led to cuts in GP numbers and walk-in services which have meant that, more often than not, attending A&E is the only way patients can get rely on getting the treatment they need. Adrian Boyle, vice president (policy) at the Royal College of Emergency Medicine, told HSJ  that NHS 111's performance depends on factors such as input from clinicians, availability of alternative services and patient flows through hospitals. He said: "There is a problem that there is a lack of public and professional confidence in NHS 111, but NHS 111 is only as good as the services that are behind it. What [the local NHS 111 concerns] represent[s] is a lack of alternatives to the emergency department. This is illustrating that there really is not adequate community alternatives to emergency department care."
Neither is there any attempt to recognise the lessons of Covid-19 in terms of treating patients who need it. Those lessons reveal the dark truth that so many patients have gone untreated and even died through lack of appropriate and timely treatment. Graham Jackson, senior clinical advisor to the NHS Confed, told HSJ : "We have heard from clinical directors of primary care networks that during Covid-19 some patients were wrongly referred to primary care" when they should have been referred to other hospital and A&E services and others faced "long delays before being directed elsewhere".
During the Covid-19 crisis this has caused huge concern with patients unable to access the healthcare that they need and suffering pain and discomfort and even serious long-term ill-health effects.
Already in April, the Guardian  had reported that "the chair of the Royal College of GPs said that doctors were noticing a spike in the number of people dying at home, paramedics across the country said in interviews that they were attending more calls where patients were dead when they arrived. The A&E chiefs' minutes said that on the weekend of April 4-5 the number of 999 calls in which someone had had a cardiac arrest rose from 55 a day in normal times to 140. Most of the people concerned died, doctors said. The minutes also reveal acute concern among senior medics that seriously ill patients are not going to A&E or dialling 999 because they are afraid or do not wish to be a burden."
Further, by May the Guardian reported  that "about 8,000 more people have died in their own homes since the start of the coronavirus pandemic, than in normal times as concerns grow over the number avoiding going to hospital. Of that total, 80% died of conditions unrelated to Covid-19, according to their death certificates. Doctors' leaders have warned that fears and de-prioritisation of non-coronavirus patients are taking a deadly toll." The Telegraph of July 28 ran an article which said, "Twice as many people are now dying at home from unexplained causes, rather than Covid-19, with experts calling for an urgent investigation into what is causing the excess deaths..."
That the government is keen for the NHS authorities to lock-in the changes to A&E from Covid in such a rushed and covert way without any proper investigation and assessment of the real lessons of the Covid crisis speaks volumes about the intention to further deny health care to those that need it. The government is using the cover of Covid not to decrease but to increase the dangers to health care. The nub of their plan is papering over lack of services wherever they be placed, and just making it harder for people to access them. This is the "new normal" that the government wants to "lock in" to the NHS, giving priority to the takeover by private corporations, and a business-led NHS that rations and denies a range of health services and even vital health services that people need.
However, health workers and people everywhere have other plans about what should be the new normal for health care in society. They are every day speaking out that health care is a right and are demanding better access to the full range of publicly provided health services in their hospitals and communities that people need.
 Exclusive: Major A&E shake-up plans to be rolled out
in coming weeks, September 2 2020
 Jeremy Hunt finally admits he wants 'talk before you
walk' A&Es, July 2 2020
 Listen in full: 'We may well pilot talk before you walk
in A&E, October 2017
 Warning as UK coronavirus outbreak leads to sharp rise
in deaths at home April 16 2020
 More people dying at home during Covid-19 pandemic - UK
analysis, May 8 2020
The data shows 8,196 more deaths at home in England, Wales and Scotland compared with the five-year average for this time of year, including 6,546 non-Covid deaths. It also indicates a drop in non-Covid deaths in hospital, however, leading experts to conclude that many who would ordinarily have been admitted to a ward and died there are instead dying at home.