Thread by @drphiliplee1

Ok, I'm not a health expert, or a politician, just a low level, acute care grunt who look after sick people and the elderly.

But here's my idea of why the #NHScrisis is happening, and how to (maybe) solve it.

The government and Hunt are quite right, spending on health is at record levels. Even accounting for inflation, growing needs etc, why are things this bad? With record trolley waits, ambulance queues, mental health crisis, surely something must be wrong?

Where is gone badly wrong is this:

Social care

Social care, which includes everything from care homes, meals on wheels, carers, day centers, are largely funded by the local councils.

Since 2010, local authorities' budgets have fallen by 26%, with a 40% decrease in central government funding.

fullfact.org/economy/local-…

As a result, older people ready to leave hospitals cannot, either because it takes longer to get care, or the local authorities have no choice but to stall for time wth lengthy assessment processes for care home funding.

Not only does this cause flow problems in ED, it can kill.

Hospitals are designed to handle capacity, my colleagues in emergency medicine are excellent at stabilising sick patients, and making decisions about who needs to be admitted.

Similarly the Acute Assessment Units are good at ensuring a rapid and safe turnaround of patients.

But we cannot operate safely when patients cannot be safely discharged from specialty wards.

Stopping elective operations is fine, it will free up some beds in general wards and critical care, but who will look after those beds? Consultant physicians are already at full stretch looking after medical patients, surgical wards are not the right place.

What would I do? Commission extra intermediate care beds in the short term, purchasing capacity from the private sector if needs be, so we can get patients moving again.

In the longer run, social and health services need to be integrated, so we can work from a single budget.

Stop the cuts to local authorities, or at least ring fence social care funding.

If we're closing acute beds, fine. But for every bed closed there needs to be an alternative that's safe and caring. Be it "Home First" initiatives, community hospitals, or care homes.

Because people's needs don't just disappear when hospitals close.

And right now Jeremy, you owe us 15,000 beds.

I'm not an expert in primary care, so I'll leave its commentary to those who know, like @HelenRCGP. Suffice it to say the loss of the workforce and the mounting workload, coupled with poor investment and mountains of paperwork, is disastrous for the NHS's backbone.

Fin.