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The Friday Surgery

The REAL reasons behind the A&E crisis- a Martian perspective

Imagine that a neighbouring planet decided one day to send a medical ambassador out to see if they could learn anything from the way that they provide healthcare in other parts of the galaxy. Now they've never held Earth in particularly high esteem but since they’ve finished all the other planets in the solar system they decide to give it a go and try to keep an open mind. The first thing our little Martian would need to know is where on Earth they'll find the best healthcare. His colleague, who had visited a few years earlier, told him to check out the Commonwealth Fund for up to date international comparisons. So as he sits in his hotel scouring recent health data trends he finds that the British NHS appears to the single best healthcare system on the planet. This is where he’ll start.

Being an assiduous little Martian he picks up the papers on the way to the UK to find out what's going on. He comes across an article from a few days ago entitled ‘NHS in crisis: The worst reasons people visit A&E when they shouldn't’. He’s more than a little confused. How can it be in crisis if it’s the best health system? The newspaper article talked about how visits from people with broken false nails were the number one example of inappropriate trips to A&E departments. It said the top 10 most ridiculous reasons people have been to A&E included splinters in fingers, shaving cuts that weren’t visible, paper cuts, hiccups and being unable to sleep. These bloody earthlings. He should have known.

So anyway he tries to put this out of his mind as he starts his two week ethnographic study of Accident and Emergency wards in UK hospitals. Using his handy invisibility cloak he watched carefully what happened in these A&Es. He was expecting a long line of malingers rocking up, wasting public money and stopping real emergencies from receiving much needed care. Indeed he looked at the notes on the end of patients beds. Humans have such ugly hand writing but he could make out that the beds were filled with road traffic accidents, attempted suicides, hearts attacks and other things that humans seemed to consider serious for their bodies.

Moreover when he listened to the doctors on the ground he heard them talking about a different NHS crisis. As his days passed on Earth a different picture was beginning to emerge about why so many people were visiting A&E. He learned about the massive financial cuts to social care that meant more and more vulnerable people were having to use A&E as a substitute for previous care networks. He learned about a GP crisis with increased waiting times due to increased workload and decreased funding. He learned that sustained mental health cuts to funding and beds for the treatment of desperate people who can no longer manage to secure crisis care means that A&E have to cope with the aftermath. He learned that A&E also has to cope with the fallout of the delayed discharge mess where vulnerable people who are fit to leave hospital can’t leave because the community services needed to help them have been so decimated. And there was the overall health and suicide impacts of what Earthlings were calling ‘austerity’. Then there were the continued health impacts of the housing crisis where people who were struggling to see a GP go to their A&E to have their children’s asthma attacks seen to.

Why weren’t any of these on this top ten list? All of a sudden he wasn’t sure at all about papers cuts and broken nails.


It was only on the spaceship back that he thought again about what he was going to tell his superiors. Something was nagging away at his little Martian brain. Why was there such a mismatch between what happened in A&Es and how they were reported? He remembered that the initial report about paper cuts and broken nails was from data publicly released by UK health officials to the press. Why would it be that health officials would release this data when it wasn’t the real cause of the NHS crisis? He flicked through the other stories that had come out on the same week as the top 10 story. This time he saw a report that said that the NHS was currently forecasting the highest deficit in its history and so NHS trusts were being placed under pressure from the Government to change the way they reported on their finances. Critics described it as a desperate attempt to ‘fiddle the figures’.
He also saw a report that said the NHS had a shortage of nurses because of ministers’ “desire to save money”. The report also said that holding down nurses’ pay may have been a factor in driving trained staff to leave the NHS to work for agencies.

Something didn’t add up for our little Martian.

Back in Mars he prepared a list of recommendations to the Martian Health Bureau. He made a number of recommendations regarding the need for a free, comprehensive and fully public health service staffed by the kind of brilliant, compassionate and committed professionals he saw saving people’s lives in the UK.

And he had one final recommendation.

If ever their health bureau was criticised in the Martian press, they should meet the criticism head on and improve their services rather than release misleading data to try to divert the public away from their own mistakes.

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