Crisis. What crisis?

As I write, the Sunday newspapers are holding forth on this year’s ‘Winter Crisis’ in the NHS. Apparently, we are in danger of returning to the ‘dark days of the 1990s’. ¹

Now, don’t get me wrong. I remember those days. They were indeed dark. I just don’t remember when they got much brighter during the noughties, before the current problems suddenly came upon us, out of the blue. To me, there has always seemed too much to do, too little time (or staff) to do it – particularly when it comes to acute medicine (and, I suppose, surgery and A&E. Perhaps, now is the time to throw off my old bigotries).

And it just got worse and worse. Even if you threw more staff at the problem, the load simply increased to saturate the newbies’ time, like some particularly devious Parkinson’s Law. Partly through numbers, but also through expectation. ‘When I were a lad’, you did your best to look after patients. Now you have to do the Daily Daily’s idea of the best, or some politics and/or economics graduate in Edinburgh or London’s idea of best. It takes extra time, looking over your shoulder to check what you are doing is someone else’s idea of a good idea.

And I was never convinced that inserting artificial targets and time-scales helped. Long ago, as a patient, hanging around in A&E for 4 h didn’t particularly upset me, since that’s where all the doctors and nurses were. OK, it’s not ideal, but better than being sent up to the first random bed in Ward n + 1 because it’s 3 h 57 min and the clock is ticking.

Crime of the century.

So what’s to be done?

One long-held theory among more pro-active medics is that time may be freed up by reducing unnecessary attendances at A&E. Oddly enough, a next-day newspaper article reflects the Government’s viewpoint. ² A quick calculation by the Scottish Conservatives at £118 per visit (Information Services Division figures) suggested needless attendances are costing £32 m per year. Ahead of its time, one method of having such patients seen appropriately in Primary Care was pioneered in a Scottish hospital back in 1998. In this issue of the SMJ, the policy is revisited, and the current format assessed for efficiency and safety. Elsewhere in the issue, the soap-box ‘In My Opinion’ is launched with a view, all the way from Portugal, that the benefit from statins may have a ceiling that we may be wise not to ignore. A case report on a neurological condition treatable by steroids is also included – with my personal seal of approval as no suggestion is made that it should be looked after by rheumatologists.

And Pratticus returns, this time venting his/her spleen at everyone’s favourite form of communication.

And that Winter crisis?

As it happens, I searched the same paper in vain for Scottish Premiership football results. My son pointed out it’s the Winter break. A weekend off for severe weather conditions. Of course, outside it is a balmy 10°. Next month, blizzards will no doubt wipe out a fixture-list, with the current Saturday lost for no reason. What we need, I decided, is a clear Saturday near the end of the season. ^a Worst-affected teams could play one of their backlogged matches …

… and it struck me. The Governments have been right all along. We don’t need more staff, we need to be more organised. Clear the A&E decks on the 21^st June, then all the Winter crisis backlog patients can come along …