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Warning signs on capacity in NHS

So lying for hours on trollies under the glare of neon is still the lot of thousands of Accident & Emergency patients.

The latest report on A&E waiting times by Audit Scotland has found that more than three times as many patients are waiting more than four hours than was the case five years ago.

That is a poor performance by anyone's reckoning, indicating that pressure on A&E departments is more intense than ever. But these latest figures do not just tell a story about miserable patients and stressed, overworked staff. They also reveal a wider picture of strife in the NHS.

"Delays in A&E can be a sign of pressure across health and social care," said Caroline Gardner, auditor general for Scotland, and so they can, because, if patients are stuck in A&E, it is often because there are no beds available for them elsewhere.

The figures bear this out. Four times as many patients who suffered delays at A&E were classed as waiting for a bed in 2012/13, compared to 2008/9. That translates into 38,000 patients compared with 8500 five years earlier.

At the root of the problem is rising demand for NHS services from the ageing population, a level of demand that it seems increasingly clear the NHS is not sufficiently well resourced to cope with. The Herald's campaign NHS: Time for Action has been highlighting the problem for nearly a year now and calling for a review of NHS resources to ensure that, now and in the future, the capacity of the system will be able to meet the demand. The figures are well known (the size of the retired population will increase by one-quarter by 2035) and, with a substantial proportion of pensioners living with multiple complex health problems, that cannot fail to put the NHS under the greatest pressure it has experienced.

The Scottish Government readily acknowledges the problem and has pledged to tackle it by reorganising the way health care is delivered, so that more elderly people are cared for in the community, particularly by using GP-led care to avoid the need to admit people to hospital.

But there is no sign of progress there either. The Audit Scotland report shows that the rate of potentially preventable hospital admissions among the over-65s has not improved in 10 years. Good intentions are not being born out in reality.

Against that backdrop, the 87% reduction in patients waiting more than 12 hours in A&E, while welcome, is a small victory. The Scottish Government has invested £50m in a three-year emergency care action plan but that is the definition of a short term fix. What happens when the money runs out? The fact that it was required in the first place shows that the system was not being resourced to the level it should have been.

The recent recession made the prospect of higher NHS funding a non-starter for a while but reorganising existing resources will not be enough. Last November, a high-level Herald summit of health and social care experts concluded that an honest debate on NHS funding was required. That must now take place.

Contextual targeting label: 
Health

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