Seldom out of the headlines lately, the accident and emergency pressures debate is no doubt set for many more outings in the run up to the election.
But while political leaders point fingers and commissioners grapple with how the new models set out in NHS England’s Five Year Forward View might help them shift more care upstream into the community, let’s hope a short but important exchange in the House of Commons didn’t pass them by. It involved care and support minister Norman Lamb - and could secure one of the most effective quick wins in the battle to cut A&E attendances and unnecessary emergency admissions.
It’s hard to keep track of all the tactics that have been used over the years to free up urgent care capacity. None seems to have properly addressed the issues and, although the Five Year Forward View has been rightly hailed as a thoughtful step in the right direction, there’s still no silver bullet in sight.
So perhaps we need a different approach. One not dissimilar to the “marginal gains” philosophy credited with the success of British Cycling. Take dying for instance. According to the Office for National Statistics, 40% of patients who die in hospital have no medical need to be there. We also know that while 70% of people say they want to die at home, around 60% actually die in hospital.
In trying to get under the skin of this paradox, Conservative MP Philip Davies asked Norman Lamb what estimate the government had made of the number of admissions to A&E in the last three years for patients with palliative care needs in (a) areas with a 24-hour palliative care help-line or palliative coordination centre and (b) areas that do not offer such services.
Answer came there none. It’s not really surprising because, worryingly, nobody really has a handle on the data. But Mr Lamb acknowledged that local examples show a marked reduction in A&E admissions where 24-hour support is available.
It’s also what people want, according to our own research for our campaign, Dying Doesn’t Work 9 to 5, which calls for dying people and their families to have access to 24/7 coordinated care and support.
Our recent survey revealed that eight out of 10 people said they expected round -the-clock access to support and advice to be available. A similar number said they want policy makers to prioritise it. But the fact remains that only 8% of clinical commissioning groups currently provide a comprehensive package of 24/7 support that includes a specialist helpline and coordination service. And this is where the philosophy of marginal gains - or quick wins - comes in.
There’s a wealth of anecdotal evidence from our own specialist coordination centre PEPS, in Bedfordshire, that getting the right advice at the right time can help families plan and manage dignified home deaths for their loved ones.
When the right support is there, they are less likely to get into a crisis situation where contact with emergency services feels like their only option - particularly at night, over the weekend and on bank holidays when they cannot contact their usual GP.
On its own, 24/7 support won’t solve the A&E conundrum. But it will make a positive difference, not just in unplanned attendances but in the inevitable admissions that follow, many of which end in an inpatient stay and, all too often, a hospital death.
We’re grateful that Mr Lamb used his Commons questioning to encourage commissioners to expand the provision of 24-hour support. We just hope the commissioners and policy makers were listening above the din of a forthcoming election battle.
Heidi Travis is chief executive of Sue Ryder