Hugo Rifkind

So the near collapse of A&Es around the country is all my fault?

Had I not known that, I might have wanted to blame other people

10 January 2015

9:00 AM

10 January 2015

9:00 AM

Oh, I see. So it’s my fault. There I was, thinking that the general swamping and near collapse of accident and emergency services in hospitals across Britain might be the result of, you know, some sort of systemic problem within the NHS. With me, a mere member of the public, just being an occasional victim. But no! Apparently it’s all because I took my wailing two-year-old daughter in, one Sunday afternoon last year, to get some antibiotics for her ear.

This is good to know. For, had I not been told that all this was the fault of chumps such as me heading to such places for the sorts of trivial ailments better treated by a traditional family doctor, I might in my ignorance have been inclined to blame other people. Such as — to pick an example off the top of my head — Britain’s traditional family doctors, many of whom might indeed still agree to see a sick toddler at 3 p.m. on a Sunday afternoon these days, but probably only if you stalk them, perhaps with dogs, then chase them through deserted woodlands before pinning them to a tree with a crossbow bolt and holding up your child before their dying eyes. I’d imagine.

Or I might have blamed Tony Blair and his many, many health secretaries, who (I feel it was one of the bald ones) somewhere along the way decided to remove the responsibility for out-of-hours care from GPs and hand it to primary care trusts. Who still employed the same GPs for a while, but forced them to do the same work for far, far more money, poor loves, which was obviously a situation they resented terribly. Or Andrew Lansley, who did… well, God alone knows what to the NHS, really, but whatever it was, whoever it left in charge seems in many areas to have abandoned meaningful out-of-hours care altogether.

Or I could blame David Cameron himself, not only for putting Mr Spock in charge of the Enterprise, but also for the shape of his cuts to local government, which resulted in councils slashing social care, and those who rely upon it falling down to A&E, as crumbs fall to the tray in your toaster. Just so you don’t think this blame I’d have been spreading would have been partisan in any way. Back in my innocence. Before I realised it was all down to me.

Or more terrestrially, I might have blamed the NHS telephone service. Because it’s not as though we want to go to A&E, we trivial time-wasting nincompoops with our red-hot screaming children, is it? No, we do what we are told. We dial 111 and invariably — and really, I don’t know how this always happens — somehow manage to miss the ‘Dial 9 if you’re not a total chuffing idiot who needs to be spoken to like Forrest Gump’ option. So they do speak to us like that, don’t they, asking ‘Is the baby’s head still on?’ and suchlike, before telling you to contact your GP and then — and in quite a tinny, distant manner now, because the telephone is cracked because you’ve smashed it a million times against the wall, because why would you have called them in the first place if you’d been able to do that? — saying, ‘Oh, yeah, well you should probably go to A&E, then.’

Or I might have blamed campaigners who want to ‘save the NHS’. An odd choice, you might think. Yet it is they who have made doing anything — anything — to stall the looming, runaway train of a health service disaster so politically toxic. They lie. They do. They lie all the time. They wilfully conflate ‘the NHS buying a service from another provider’ with ‘David Cameron selling your health service to his mates from Eton’. Buying and selling. Different things. No? Is that hard to grasp? Then they shriek about ‘privatisation’, knowing full well that this makes people think of America, and insurance, and shudder, even though barely a single politician alive in Britain today believes in anything other than free healthcare at the point of delivery. And the very worst thing about these people is the way they believe themselves to be on a moral crusade. As if caring about anything other than outcomes when it comes to health was not, in fact, as close to the opposite of ‘moral’ as one can be.

Or, while I’m casting around, I could have blamed Andy Burnham, the shadow health secretary, for taking all the above guff and absorbing it, thereby filling Tory hearts with fear as much as he is filling Labour ones with arrant bullshit, and ensuring that the one conversation nobody will have in the long, long run-up to the next election is an honest one about actually improving anything. Although I suspect he’s somebody I’d be better off blaming in the future, when things get even worse.

I’m sure there are other people I might have blamed, had my ignorance continued. I’ve no idea what Jeremy Hunt has done lately, but he’d certainly have been worth a crack. Or I could have blamed immigration, albeit nonsensically, what with the way that a far higher proportion of those working in the NHS are immigrants than of those who use it, thereby showing us that without immigration things would be much worse. But no, it’s none of these people. It’s everybody else. It’s the arse end of the Big Society, in which the populace at large is no longer the solution to every problem, but the cause. It’s me, and my daughter’s ear. And all I can say is, I’m very, very sorry.

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Hugo Rifkind is a writer for the Times.

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Show comments
  • davidofkent

    The funding system for the NHS is broken. Too many people now pay nothing at all for the public services, including the NHS, that they consume. Before the NHS absorbs every last penny of our tax (i.e. the tax of those few people who now pay any), we must change the model. A part-public and part-insurance model should work. Of course Labour and the LibDems are playing up the NHS funding problem as all the fault of the Tories. It’s the only weaponry (Ed Miliband’s words) in their armoury. Hypocrites all.

    • Mary Ann

      Cost a fortune in paper work.

  • JonBW

    We should blame those who insist that for every problem there must be someone to blame.

    The root of the problem in my view was the change to out of hours GP care but if we recognised that finding fault is only useful as a step towards finding solutions we might do better.

  • bunty

    Turn away drug addicts and drunks. That would go a long way to sorting A&E out. Spent eleven hours waiting after being advised to go by NHS helpline several years ago. This was through the night and a majority were drunk fighters with injuries and obviously drug addicts. Why the triage nurse didn’t send me home I’ll never know. So I had to sit and wait all night because of the latter. It amazed me the types who turned up through the night. I didn’t want to be there.

    • Partner

      Sorry, let me get this straight. You read the Spectator, so presumably you are not Sun reader level of IQ. You rang some telephone helpline, manned by non medical personnel, who can’t see you or examine you and are in all probability as thick as two short planks, to ask them if you needed to go to A & E? I had heard of people like you but really doubted whether any existed. Anyone with any kinds of symptoms who spends 45 minutes on google these days will probably end up with as much information as the average medical student, and be able to make an informed decision on whether to go to A & E. Nine times out of ten the answer will be no, this is not an emergency. If it is you will know soon enough without talking to some goon on the telephone. Unbelievable.

      • bunty

        Supercilious or what! NHS local help line, recommended by out of hours surgery. You really appear to me to be a Sun reader of low and ignorant intelligence. How rude you are. You really shouldn’t be so quick to judge. I will not explain what had happened to me because it is none of your business. Had it been open surgery hours then I would have gone to them. Let’s hope you don’t need emergency help, because I would certainly tell you to go away. Smartarse of the highest degree.

        • Partner

          I can assure you when I need emergency help I will know it without ringing up a speak your weight machine to seek its views.

      • bunty

        By the way, reading the Spectator doesn’t make one intelligent, as you have shown.

  • Mitzi

    As a child the family doctor was just that. He came any time you called him out for emergency treatment such as myself when a sore throat turned overnight into quincy and I was really poorly, he trundled into my bedroom at 3am, gave me a shot in the bum and told my Mother he would be back at daybreak. A wonderful doctor who dedicated himself to his patients, was loved by them and which I am sure the memories of those long ago days must still live with any still around. Today we have lost sight of what a family doctor means, if you are really ill and manage to get a doctor out he will not know you, speak little English if you are lucky and will be gone in a flash just about making out a prescription which you cannot get till the morning. Other than that we have to call out the paramedics and get taken to AE departments if they think you need extra treatment. The NHS that was has long gone in it’s place is a system that is not working, will not work the way it is run and we will be lucky to have one in the near future.

    • Partner

      Any middle class person who relies on the NHS for anything routine needs their head examined and deserves everything they will encounter in Aand E on a Sunday afternoon. It is a service for emergencies, life threatening situations, and the poor, old and those too mean to fork out for private care.

  • P Henley

    Hugo, this is a little bit naughty. No one is saying that everyone who visits A&E is to blame but even you must suspect that there are people visiting who really don’t need to. This article was way below your normal standards of intellectual challenge. I wonder if it was a quick scribble and pocket the cheque.

  • Perry Grafham

    You forgot to mention the “internal market” from the late 80s/early 90s that caused the whole bloated management structure in the first place

  • Paul Wonnacott

    too many people use trivial illness to get attention, add to that the drunks, the incompetent DIY/gardeners who hire plant machinery and power tools, but don’t bother with safety boots or goggles
    Here’s another one, now can these nurses and doctors tell people that being overweight is the cause of their problem, when more than half our nurses are officially overweight?
    You will also find that the number of drug addicts wasting the NHS time is actually almost negligible, and that eating the wrong food is causing far more problems than alcohol and tobacco, and the tax on those more than covers cost, it actually subsidises a lot of other things in the NHS
    I’ts about time we started taxing the SUGAR industry like we do alcohol and tobacco, however much we like it, we don’t need it and it’s harmful, it is also the first drug people get addicted to, Sugar is the “gateway” to all others

  • SeaBeeUK

    I would hazard a guess that the drug most used/prescribed in A&E is paracetamol.

  • dareisay

    Much discussion about A&E crisis on the BBC this week. It’s all the fault of elderly people – for being old, young people – for being drunk, and those with trivial ailments. I thought the addition of millions of new immigrants to the (why should they be?) patient queues might be a significant factor. But PC policy forbids any mention of the flippin’ obvious. Free speech is another subject…but what hypocrites! And here we go again – the very silly, lazy argument that suggests the NHS could not cope, or function at the same level or even exist without cheap labour from third world countries. I’m sure we would manage.

  • Jeffrey Vernon

    Is the A&E problem structural or individual, Hugo asks. Beats me. But I do wonder why he wanted instant treatment for his daughter’s earache on a Sunday. My mother would have given me a poultice and an aspirin and taken me to the doctor if it didn’t get better after a few days (most ear infections clear up spontaneously, as my completely uneducated mother well knew; she was one of 6 siblings). The view that all ailments need a prescription is far more prevalent than it was a generation ago.

  • Lillythefilly

    I can understand how Hugo feels, but I Have to say that I do get furious at the yobs that take up space in A&E areas, full of drink and unable to control their own stupidity! But what I find hard to get my head around is, why, all of a sudden so many people are swarming to get medical help, surely we should be more healthy than ever these days, after all, it is pumped down our throats how to live healthily at all times of the day, mind, I have noticed all the fatties, perhaps that is what it is all about, plus all those filthy black tattoos, God knows what they do to the bloodstream.

  • gf

    yes I am afraid you and your daughter are the problem. An ear infection is neither an accident or an emergency. You are only one family attending A+E when they shouldn’t be multiply that a
    cross the whole NHS, then add those who are drunk, fighting, addicts (some of which know how to play the system). Then there are those who attend because its too inconvenient to take time off work to see their doctor, those who go because they are constipated and didn’t think to go to a chemist, or they hurt their finger three days ago and just decided to have it checked out, or started running and hurt themselves when they haven’t moved off the sofa for years. Why can’t you get into the GP, because nobody can be bothered to phone up and cancel their appointments add to that the fact that GP’s are bogged down in red tape and we have a nation of people who are told they are not responsible for their health. That is why the NHS is at breaking point. The older generation do not go to A+E unless it is an accident or emergency, why?, because they remember a time when it wasn’t here and they had to pay.

  • HappyNewYear

    the NHS is an expensive toy for the country and everyone wants to play with it, so if you let in milions and millions more people that haven’t made a contribution to it over the years and let them play with it as well – a disaster. I don’t think anyone will do what is needed to be done to the NHS – that is privatise it

  • BritWit

    Our local GP surgery used to have an open door, first come first served, policy until recently. Patients were happy to arrive and take their turn, there was a steady flow of patients receiving treatment, GPs were busy the entire time they were at the surgery and because there was no appointment system, there were no ‘no shows’. Then the local health board, in its infinite wisdom, said the surgeries must move to an appointment system! Needless to say, it was difficult to get an immediate appointment, mostly taking anything up to 10 days, ‘no shows’ increased, fewer patients were seen by their GP and numbers attending A&E went through the roof! Well I never!!!

  • Robert Marsh

    If as stated by George Osborne that at the Country is back on its feet and doing just fine,
    Then why are the Tories allowing our NHS to be run down. The reason is that the Tories don’t need much of an excuse to Privatise our NHS, this they have wanted for many years, and this is their excuse for doing it. The Labour Party cannot be trusted with our finances or anything else comes to that. Vote UKIP its our only option.

  • Partner

    Yes, you are part of the reason A and E is a disaster zone. Are you seriously telling me you daughter couldn’t have waited until she saw a GP? I don’t know about your father, but my parents would not have dreamed of taking me to A and E as a child unless I’d had a bad ACCiDENT or was an EMERGENCY – which I never had or was. i’d have had to be half dead before they would have gone to hospital on a Sunday afternoon with me. You see that’s why its called that- geddit?

  • Retired Nurse

    Hugo – they engineered this – read this ‘Act and Early to Avoid A & E ‘ – it was issued in 2011, for the NHS Commissioners who were due to take over in 2013 – it encourages putting a range of patient subgroups on an end of life care register, but doesnt specifically insist on asking for their consent! All you get on EOLC is ‘symptom relief’ at home…the ambulance treats you as a non admission if you phone 999 – the definitions on page 4 are the old, the frail, those with chronic health conditions – they blame the ‘ageing population’….I blame corrupt MPs and Lords trousering our money for lucrative service contracts….

    And as for ear infections and a temperature – you did the right thing getting antibiotics – sooner the better – can leave a child permanently deaf.

  • post_x_it

    So in your part of London there is no out-of-hours GP service you could have used? Really?
    I live in Hackney. I recently needed to see a GP on a Sunday afternoon. The problem was far from life threatening, more an unpleasant inconvenience that required a quick prescription.
    I rang the City of London and Hackney out of hours number and left my details. A doctor called me back half an hour later and booked an immediate appointment for me to see a GP at Homerton hospital. Two hours after my inital call I walked out with my prescription. No need at all to bother A&E.
    I’m wondering – did you even TRY to go down a similar route, or did you just ASSUME that there is no suitable service available?

  • Mc

    “So the near collapse of A&Es around the country is all my fault?”

    No, Rifkind is just responsible for his own crappy articles.

  • pdhan

    Why can’t they just charge £20 per visit to A&E? Even communist Sweden does it.