Avoid A&E, says NHS as winter crisis bites early

·4 min read
NHS accident and emergency - Dominic Lipinski/PA Wire
NHS accident and emergency - Dominic Lipinski/PA Wire

The NHS is to launch a campaign urging the public to avoid A&E in an echo of appeals to protect the health service during the Covid pandemic.

The head of the NHS has instructed hospitals to prepare a public awareness campaign calling for people to “minimise” pressures on urgent and emergency services.

Such an instruction has never been issued so early in the year, and comes amid concerns that hospitals and ambulance services are already facing strains usually seen in the depths of winter.

People suffering a genuine emergency will still be encouraged to go to A&E, but on Friday night there were warnings that the campaign risks exacerbating the problems caused by patients staying away from the health service during Covid.

The government message to “Stay Home, Protect the NHS” during the pandemic fuelled record backlogs of patients who should have received help earlier, with 6.7 million people now on waiting lists.

There are fears that the effects of lockdown and delays to receiving healthcare may be killing 1,000 more people a week than would usually be expected to die.

Prof Carl Heneghan, an urgent care doctor and professor of evidence-based medicine at the University of Oxford, said the NHS needed to be very careful about trying to dissuade the public from using services.

“The NHS seems to be the only business I know that doesn’t know how to deal with demand, and work with the needs of its customers,” he said.

“As an urgent care doctor, I need to be in front of the patient to do my job. It’s often too difficult for the new mum to know when it’s appropriate to turn to emergency services. These decisions are difficult – it’s the job of a doctor.

“Too often I see elderly patients who apologise for taking my time and I say ‘don’t apologise – you could have been 24 hours away from death’.”

The instructions tell hospital trusts to “implement your winter communications strategy to support the public to minimise pressures on urgent and emergency services”.

The letter, entitled “next steps in increasing capacity and operational resilience in urgent and emergency care ahead of winter”, is from Amanda Pritchard, the chief executive of NHS England, and fellow officials.

It says: “We have begun planning for the coming winter earlier than usual, recognising pressure on the NHS is likely to be substantial, particularly in urgent and emergency care.”

Campaigns last winter used TV adverts, social media posts and billboards to urge patients to use the online service in cases that were urgent but not life-threatening.

A renewed “Help Us, Help You” drive later this year is expected to call on the public to be sparing in their use of 999 and A&E services and only use them for emergencies. People will be urged to use NHS 111 online in other situations.

The NHS letter also sets out new targets to improve the performance of emergency services, including a pledge to answer 999 calls within 10 seconds, compared to a current average of more than one minute.

The plans promise improved ambulance response times for patients suffering suspected heart attacks and strokes, as well as reductions in handover delays.

They come as senior medics warned that the NHS has “broken its fundamental promise” to be able to swiftly send an ambulance to those in need.

Dr Katherine Henderson, the president of the Royal College of Emergency Medicine, spoke out after a series of disturbing cases, including that of a 90-year old woman who waited 40 hours for an ambulance after a fall and then spent the night in the vehicle.

In another case, an 87-year-old man with cancer, seven broken ribs and two pelvic fractures was forced to spend 15 hours in a makeshift shelter as his family tried to protect him from the elements while he waited for an ambulance.

Ambulance chiefs on Friday said delays of more than an hour had left 40,000 patients at risk of harm in the last month, with three-hour waits for heart attack victims in some parts of the country.

It comes as healthcare leaders were accused of focusing on the wrong priorities after the NHS Confederation urged the Chancellor to cap energy prices, saying fuel poverty could heap pressures on the health service.

The intervention by Matthew Taylor, a former aide to Tony Blair, sparked criticism, with some NHS chief executives refusing to endorse the “overly political” letter.

Jacob Rees-Mogg, the Cabinet minister, described it as “cynical politics” and said the public “expects better” from an NHS body.

An NHS spokesman said: “As is the case every winter, the NHS will encourage people to use 111 for urgent medical help and as ever, people who need A&E or 999 should use those services - we will deliver the usual Help Us Help You campaign later in the year to support people to access this care.

“The NHS has already announced plans to significantly increase hospital capacity and resilience ahead of winter, in addition to a new contract with St John Ambulance to provide extra support.”