NHS is under strain from record numbers of A&E admissions and not enough consultants, warns doctors’ group RCP.
A combination of increasing hospital admissions, fewer consultants and a European law restricting the maximum hours medical staff can work will stretch the NHS so much it “may reach breaking point within the next few years”.
The Federation of the Royal Colleges of Physicians (RCP), which represents hospital doctors across the UK, says its latest census of members shows that the NHS is under stress, especially in specialities caring for very sick patients.
The biggest pressure comes from record numbers of people coming to A&E departments. In the past year, attendances have risen by 5% in England to 20.5 million – the equivalent of 40% of the population making one trip in the year. Hospital doctors say patients are not visiting GPs when they should, especially because family doctors offer limited out-of-hours cover.
The increase in hospital patients has not been met by a rise in hospital doctor numbers. Since 2004, the workforce has increased by 12% but the workload has gone up by 19%. This has been exacerbated by the introduction of European working time regulations, which limit doctors to a maximum 48-hour week.
Many hospital trusts are having to cut back on services and in some cases are shedding staff to balance their budgets.
There are now fears that there will not be enough posts in future for doctors who are currently in the last couple of years of their training. Andrew Goddard, the RCP’s director of medical workforce, said: “We have already seen a drop in the number of new posts being advertised in 2010, and although we have enough doctors in training, they need to have jobs.”
The college warns that this trend will continue, with the NHS being asked to make savings of £20bn by 2014, and claims that unless radical steps are taken, frontline care will be affected.
“The bottom line is that patient care will suffer. I can see wards becoming overcrowded and eventually [hospitals] will have to stop taking patients. That will mean waiting times will inevitably rise… … obviously a bad thing.”
The shadow health secretary, John Healey, has argued that, despite coalition promises to protect health service funding, there would be a real-terms decrease in NHS spending during the course of the parliament because medical costs were rising faster than health secretary, Andrew Lansley, had accounted for. House of Commons figures show that in 2009-10 prices, NHS funding would drop by 0.25% to £100.4bn in 2014-15.
Healey said the RCP’s warning was “further evidence of the strains that are starting to show in the NHS” at a time when the government is embarking on the biggest shake-up of the health service in 60 years. “Money is tight and efficiency savings do need to be made, but the overall situation is not helped by the government breaking two big promises it made on the NHS – wasting £3bn on a high-risk reorganisation and cutting, not increasing, real-terms funding.”
Lansley insisted that spending on “health resources” was going up. In response to the RCP’s warning, he said he had worked with the professions to ask “how best to secure better patient outcomes and the right level of supervision for trainees through greater consultant involvement in direct clinical care at night and at weekends”.
He added: “We are very much aware of concerns about support for junior doctors. We are clear that provision of service should not be the primary purpose of postgraduate medical training. Rather, the objective is to produce fully qualified specialists who are able to provide high quality and safe patient care; and for the service component of training to be properly supervised.”
Randeep Ramesh
The Guardian