Healthcare experts have warned that Merseyside’s NHS is headed towards yet another A&E crisis this winter.
Last year across Liverpool and the country people queued for up to twelve hours just to see a doctor and other patients were left on trolleys, waiting to get into a proper bed.
Just last week the national lobby group for NHS chief executives warned that without a cash injection of £350m that hospitals would struggle to make it through the winter.
So far the government has handed out £13m in cash for A&Es to prepare, with ministers agreeing an extra £150,000 for the Royal Liverpool and Broadgreen University Hospitals on Friday.
But Liverpool’s Cllr Paul Brant has said that cash is just a drop in an ocean in a system that has been starved of resources.
He said: “It is peanuts compared to the amount we’ve lost.
“Just since the government introduced Clinical Commissioning Groups in 2013 Liverpool has lost out on £32m of cash for the healthcare system.
“Money is being taken away from Liverpool and given to more affluent places – if we’d been given the average that’s how much more we’ve have had in the last three years.”
Chris Hopson, chief executive of NHS Providers, said: “Last winter we came under pressure as never before, this winter could be worse.”
So what is causing the crisis?
People are stuck in hospital who shouldn’t be there
Often elderly people or those with care needs find themselves in hospital much longer than they need to be. They could be better served at home if a care plan could be agreed.
But after seven years of huge local government cuts social care services, which are run by local councils, are stripped to the bone.
So patients can’t leave and are forced to remain in hospital until a plan for looking after them can be but in place – this is called bed blocking.
But the number of people who need the help is increasing every year.
Liverpool Council design care packages for up to 100 people leaving hospital every week, up 51% compared to last year.
Last winter every Merseyside hospital saw it beds filled to high levels, creating a dangerous backlog.
Research suggests using more than 85% of beds can be dangerous as it can leave inadequate space for emergencies, delay operations and increase the risk of infections and mistakes.
Every hospital breached the 90% level between last October and this February.
Aidan Kehoe, chair of North Mersey A&E Delivery Board told the ECHO that between the Royal, Aintree and Southport hospitals they have over 200 patients who are well enough to leave the hospital, but are waiting for a care package to be made available.
But he explained that they had been working closely with Liverpool, Sefton and Knowsley councils to develop Home First – a service which hopes to get rapid response community teams to see elderly patients in their care or nursing home so they don’t end up having to go to A&E.
He added: “From October, staff from GP services will be available in or close to emergency departments and patients who do not require urgent or emergency care will be directed to the most appropriate service.”
Cllr Brant, who is cabinet member for adult social care, said the scheme was “innovative”.
“We’re genuinely at the cutting edge of trying to make this work – despite the lack of money – hospitals and the council are really pulling together, ” he said.
More of us are turning up and we’re sicker and older than we used to be
As the cold weather bites more people head to A&E, but the system can’t handle the increased pressure – this is what causes waiting times to spike.
The number of people turning up in A&E every winter has gone up 8.9% in the last five years.
But Mr Kehoe told the ECHO the problems start well before people reach the hospital doors.
He said: “The situation becomes increasingly challenging over the winter months.”
“It is important to recognise that this is a symptom of wider challenges being faced by the entire health and social care system.”
The fact is we’re now living longer and often have more complex conditions to manage.
The number of people over the age of 65 using the NHS in Liverpool has doubled in the last 25 years and is set to double again.
Estephanie Dunn, the Royal College of Nurses (RCN) Director for the North West said: “Not only are we living longer but we might have multiple conditions – making treatment more complicated.”
Fewer staff members are expected to do more with less
Adding to the fact that there are fewer beds available and the patients in them often require more complicated care is a growing staffing crisis.
Across the North West there are over 4000 nursing posts unfilled – a situation that the nurses union the RCN has described as the worst staffing crisis in NHS history.
And the staff who remain are overworked and subject to the relentless pressure of having to do more with less.
Estephanie Dunn said that staffing levels could be making the crisis harder to deal with.
She said “Staff are forced to work more hours just to keep the system up and running.
“So in hospitals very professional staff are working hundreds and hundreds of hours and extra shift to keep the system working.
“It isn’t just in hospitals – district nurses are being forced to see more people in a single shift, meaning less care and that can lead to people reporting to A&E.
“Add to this that nurses haven’t had a pay rise above inflation in years and you’re looking at a staff who have understandably low morale.
“If we want to solve this crisis long term we need to fill these vacancies – you do that by offering staff financial security, contracts that last longer than six months and by making them feel respected.”
Tory cuts are pushing the system to breaking point
But at the root of this crisis according to Cllr Brant is Tory austerity and the cuts to local government made in Westminster.
He told the ECHO: “Liverpool’s drastic underfunding is a direct result of decisions this government has made.
“The national funding settlement given to the local Primary Care Trust and latterly Clinical Care Group has been slashed – we are owed £32m, I want it back.
“Local government cuts have also had a knock on effect – when they cut our budgets it becomes more difficult to get people out of hospital.
“It is robbing Peter to play Paul and just shows the lack of joined up thinking from the government, it is like they don’t speak to each other.
“Until someone commits to paying what the NHS needs the problems will keep happening.”
On Friday Minister of State for Health Philip Dunne unveiled how part the £100m set aside by the government to help ease the crisis would be spent – announcing funds for individual hospitals.
He said: “The funding supports NHS England’s wider plans to improve A&E performance in England by 2018. In particular, it will help hospitals hit the target of admitting, transferring or discharging 95% of patients within four hours.”