Sunday, 6 September 2020

Tackling the climbing numbers of people attending A&E: 111 First


Last Monday was the Autumn Bank Holiday. In the UK, it is the last Bank Holiday before Christmas Day. As it was due to be a bright warm day, we had decided to get up early, beat the crowds and go to the Lake District in South Cumbria. We fancied doing a bit of hill walking. I wanted to do a walk in the Langdales. The walk we decided upon started at Dungeon Ghyll and goes up to Stickle Tarn and Pavey Ark. It was a walk I had last done some 25 years ago. At that time, I would gleefully scramble up the rocks in the river rather than use the path. Now a quarter of a century on, I took the sensible if rather steep path. But TBH, I had to stop for a breather on a few occasions along the way up. Getting to the top and seeing the views made it worthwhile, however. In the early morning sunshine, it was simply breathtakingly beautiful.

I thought sitting by the water’s edge might be a good place to have our picnic lunch. Then J pointed out it was actually only 9am. We had eaten our breakfast a few hours before, but no matter. We decided to continue the walk around the tarn and up to the summit of Pavey Ark before eating.

There are two or three ways of getting to the top. Two routes involve more steep walks around the mountain and the other way is to clamber up Jack’s Rake (pronounced Jake’s Rake). Now the only sport I have ever been halfway good at is rock climbing. Having last been up Jack’s Rake 25 years ago, I was keen to take another shot at it. I think it’s fair to say that J didn’t share my enthusiasm. I reminded her of Maya Angelou’s words: ‘Having courage doesn’t mean we are unafraid, having courage and showing courage means we face our fears; we are able to say I have fallen, but I will get up’. Given that we were about to climb up a side of a mountain, it perhaps wasn’t a good idea to mention falling.

Indeed, over the past few years, four people have fallen off Jack’s Rake and died. It is a little tough in places and I had forgotten just how very exposed it can be. In places you are walking on extremely narrow ledges, with a fall of hundreds of feet just a missed step away. You can get a sense of our climb by watching this YouTube video.  It was J’s first time scrambling/rock climbing and she did exceptionally well. I’m sure, like me, Maya would have been proud of J facing her fears… …not falling off helped as well!

Once back on ‘terra firma’, and with the large promised G&T in hand, we did wonder who would be there to help those who might get injured on their walks and scrambles. Many parts of the Lake District are remote and far from local emergency services. Last year the various Mountain Rescue Teams were called out to over 500 incidents, and for many years now there has been a rise in the number of deaths of people out walking or climbing on the hills. I’m the first to acknowledge the courage of all those who go out, often in dreadful weather conditions, to search and help those in distress, lost or who have been injured. These folk are all heroes.  

Closer to home, last week I heard an update report of our ‘111 First’ pilot. NHS 111 First is part of a new national programme aimed at improving people’s experience of urgent and emergency care. It is part of the approach to keep people safe when they access help from their local health services. Crowded A&E waiting rooms must become something we don’t return to. But already at Blackpool Teaching Hospitals, we have seen a steady rise in those presenting at A&E for non-Covid reasons.

Many people seem to have lost some of their (Covid-19) fear about going to hospital. Last week, the number of people attending at our emergency department was close to 75% of where they were prior to the pandemic. The same is true for many Acute Trusts across England. However, research has consistently shown that 30% of people who arrive at an A&E department don’t need to be there to have their health needs met. The 111 First programme aims to ensure individuals can be seen by the most appropriate healthcare professional in the most appropriate healthcare setting for their needs. The programme is being piloted by one hospital in every healthcare system across England. Blackpool Teaching Hospitals was selected for the Lancashire and South Cumbria integrated care system.

Patients are asked to contact NHS 111 before they set off for the emergency department. After assessing the individual’s needs, NHS 111 will then book them into a time slot at the emergency department or at some other local service. Of course, all those needing to be ‘blue lighted’ to a hospital will still be taken there by ambulance (or perhaps by helicopter if you happen to be walking in the Lakes). If the pilot sites evaluate well, the programme will be rolled out to every Acute Trust in England.

Booking a slot to be seen at A&E might seem, for some people, counter-intuitive. If you need urgent care and attention, then traditionally A&E is where people have gone. The truth is that many people could get the healthcare they need in many other ways. And that’s the rub. Primary and community care services are often not fully integrated with Acute hospital providers. Gaps in what might be available and accessible to people are many, particularly for those seeking help for mental health problems. Naturally, in such situations, many people will pitch up at their local A&E confident in the knowledge its doors will be open 24-7.  

The pandemic has taught us many things. Healthcare can be accessed in many different ways and from many different places. Hospitals are moving closer to patients’ homes. Most importantly, more is being done to prevent people even needing healthcare services in the first place. But much more could be done to help people help themselves. There is a parallel with what’s happened in the Lake District post the Covid-19 lockdown being eased. In late July, Cumbria Police and Mountain Rescue teams reported a ‘tidal wave’ of avoidable rescues caused by folk venturing out onto the hills who were unprepared or ill-equipped to deal with the weather or what they were attempting to do.

And yes, dear reader, with hindsight I know taking J up Jack’s Rake probably falls into this category. But despite a couple of hairy moments and a few tears shed, we survived and live to tell the tale. Would I do it again? It’s a great question, one faced by anyone who might order another pint, smoke one more cigarette, have that extra large portion of chips or tell themselves there is no need to keep active. If we are to truly tackle the climbing numbers of people attending A&E, the answer has to be a resounding no!  

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