PROFESSOR ROB GALLOWAY: The best way to resolve long and risky waits in the emergency room? Improve people’s diet.

We Brits are famous for our ability to queue, even for hours, but there is one type of queuing that is inappropriate and potentially dangerous.

Last week the latest NHS performance data was published. Those of us who work in the NHS knew only too well what this would mean: longer waiting lists, people with cancer waiting too long to start treatment and patients waiting too long in A&E.

As someone who has worked in A&E for 22 years, I am shocked to see what is happening in emergency departments across the country. But that pales in comparison to how patients suffer.

Twenty years ago, the Labor government introduced a target for 95 per cent of people in A&E to be seen and treated within four hours. In Northern Ireland and Wales, that goal has never been met. In Scotland, it last occurred in July 2020, at the height of Covid, when patients were afraid to go to hospital. In England this was last achieved in July 2015.

Not only have A&E’s objectives not been missed, they have been catastrophically missed. Only 54.7 per cent of patients who attended A&E in England in December were seen within four hours. In that month alone, one in nine people waited more than 12 hours to be discharged or admitted to a ward; that’s more than 150,000 patients.

The main reason for this is the increasing number of frail and elderly patients who need to be admitted (with a 5.7 percent increase in the number of admissions compared to December of the previous year), but without an equivalent increase in resources .

And the dangers of this were demonstrated in a landmark study published in the Emergency Medicine Journal in January 2022. It found that for every 82 patients who waited more than six to eight hours in the ER for a hospital bed, one additional patient died. That means 300 to 500 more people die unnecessarily each week due to long waits for hospital beds. That’s the equivalent of two plane crashes a week.

But the solution is not some kind of retry to strictly enforce the four-hour rule. Let me explain why.

When I was a new doctor, I used to feel frustrated by the four-hour rule, specifically its unintended consequences that weren’t always in the best interest of my patients.

For example, if I were caring for a patient whose ED care had been manageable in five hours, I would often find that they had been taken to an empty bed on a ward at three hours and 59 minutes to avoid a four-hour appointment. . time of ‘default’. But the care they needed would be delayed since there was a different group of doctors in those wards.

It was a blunt but otherwise effective tool: the key was that it was backed by sufficient funds to employ enough staff in the Emergency Department, with bed capacity for patients who needed admission. Only looking back do I realize his success: he rarely saw patients in the hallways.

But anything done now to meet the four-hour goals is a band-aid and not the definitive answer. Within five to ten years the problem will appear again because we are not addressing the real problem.

Missing targets is not due to missing GP appointments, or patients ‘abusing’ the system, or poor management – the reason A&E departments across the country are failing to achieve achieving goals (leaving our patients suffering) is a simple case of the demand being greater than we can cope with.

So what can be done? My thoughts on this have changed dramatically after so many years in the NHS.

Yes, we need to solve the problem here and now, and that means investing in more beds and staff. But long-term investment is most needed in social care and GP services.

This will help ensure continuity of care from experienced doctors who know their patients and have the experience to make decisions to treat people at home rather than sending them to the hospital. This should at least prevent things from getting worse. But this will not solve the problems, as demand will continue to increase.

After years of working in A&E, I know that what I do most of the time is undo the damage caused by unhealthy lifestyles. I have realized that we must focus our efforts on reducing demand first; We need to create a national welfare service, not a sickness service.

Western medicine has focused on treating conditions such as strokes, heart attacks, and cancer rather than preventing them. Even when we talk about prevention, such as high blood pressure pills, we do not address the reasons for high blood pressure.

This reactive medical care has led to an increase in life expectancy. But it is often at the expense of a worsening “health span”: the number of years in which we enjoy good health.

For example, the NHS has been brilliantly set up so that, after a heart attack, most people receive immediate care from the ambulance service, A&E and specialist cardiologists.

They have saved your life, but the years you have left could be of poor quality. If your heart has weakened, you will have difficulty breathing, you will not be able to walk, you will need frequent medical care, unfortunately all too often in an emergency room hallway, and later possibly residential care. We are creating a population of sick patients, who go for years not feeling well and creating ever-increasing demand on the NHS.

Regardless of what different politicians say, increasing hospital resources will help, but will never solve this health crisis in the long term.

If we really want to improve the NHS and hit the targets not just next year but every year, and prevent them from falling again, we need to address lifestyle issues; poor diets full of processed foods full of sugar and fats, lack of exercise, loneliness, excess alcohol, smoking and obesity.

We need to tax junk food and use this to subsidize healthy foods and sporting activities. This is not ‘nanny statism’; These are simply sensible policies to give everyone the opportunity to make healthier choices.

We need to make healthy living the easy choice. In many workplaces, vending machines only offer junk food. That needs to change, as do the “buy one get one free” deals on junk food.

Children should be taught to cook healthily. We must also address the pandemic of inactivity, not only by encouraging people to play sports, but by having schools make all children walk or run a mile daily.

It’s not just the government, we all must act. Unless we do this, we will never meet the targets, and the NHS as we know it will not be here in ten or twenty years.

@drobgalloway