Letters: Why A&E units are struggling

These letters are published in the print edition of The Independent, 22 May, 2013

Your report “Top A&E doctors warn: We cannot guarantee safe care” (21 May) is very concerning. An examination of the causes should be completed.

For those of us who have campaigned against the loss of A&E units from district hospitals, the situation is even worse. Patients may travel over an hour, in a critical condition, to receive a below-expected level of care.

How many of us now live or work outside the “golden hour”? How much of our road and rail network is now a substantial distance from the nearest fully operational A&E unit?

The centralisation of our A&E services is putting us at risk. The restoration of our fabulous publicly funded A&E safety net must be a priority. Cameron cannot tell us funds are not there when he is happy to let the chief executive of Google walk away.

Charmaine Morgan, Chair, SoS Grantham Hospital, Grantham, Lincolnshire

It is clear that we need to address the problems facing emergency care, but it is completely wrong to blame GPs and suggest they are sending more patients to hospital because it is cheaper to do so (“No wonder A&E can’t cope when GP surgeries have lost faith in their users”, 16 May).

There is no evidence that GPs’ referral habits are being influenced by the hospital tariff. In fact GP referrals to emergency care only account for a small proportion of those patients who attend emergency departments, and are not significantly rising. The reality is that attendances in A&E have increased at 1.7 per cent per year over the nine-year period to 2011-12, as against 1.5 per cent per year over the preceding nine years. This does not suggest that there has been a dramatic distortion caused by the GP contract changes.

The article also fails to mention many other factors placing strain on emergency care, such as increasing levels of activity across the NHS, declining resources, the recent disastrous launch of NHS111, and staff shortages. Out-of-hours care has been historically underfunded, with its budget remaining static in recent years despite a steady rise in the number of patients who need access to this service.

The only way we are going to address the problems facing the NHS is to find a holistic solution that draws on the experience of healthcare professionals and patients. We will not make any progress by attacking NHS staff who are increasingly undertaking more work on fewer resources.

Dr Richard Vautrey, Deputy Chair of the GP committee, British Medical Association, London WC1

Jeremy Laurance is right to point out that we are in danger of reversing the improvements we’ve seen in health care (16 May). However, he misses a crucial point – if you look at the data, our A&Es are not swamped by out-of-hours patients from GPs. The apparent large increase in A&E volume is an artefact of another change that happened at the same time: we started opening minor injury units and walk-in centres and counting the numbers attending those. Neither of these are open 24 hours, so they can’t be dealing with out-of-hours patients from GPs.

We are identifying problems and proposing solutions neither of which are consistent with the evidence.

Dr Stephen Black, London SW1

Admit it: this could be global warming

While one cannot know whether the tornado that hit Oklahoma would have happened without climate change, what we do know is that extreme weather events such as storms and hurricanes will become more frequent and more severe as the oceans warm and the amount of energy in the atmosphere increases. Events that previously happened once in a lifetime will occur every decade, while once-in-a-decade events will occur annually.

Yet the media seems all but oblivious to these phenomena. No one has mentioned climate change in the aftermath of Oklahoma. Hurricane Katrina and Sandy were treated by the US media as acts of God. The modern media resemble medieval soothsayers before microbes were discovered. Infectious diseases were regarded as divine punishments for human transgression; the standard response to outbreaks of the plague was more prayer and fasting.

And like the medieval pundits, do not expect the media to change their perspective soon. It took the Catholic Church 359 years to admit that Galileo was right. I don’t expect Ukip or the swivel-eyed loons in the Tory party to respond any quicker.

Robin Russell-Jones, Stoke Poges, Buckinghamshire

Shall we quit Chiantishire?

Have those who advocate leaving the European Union considered that this might mean all those people who have retired to warmer parts of Europe losing their right of abode; and have they done the sums?

House prices in places like south-west France are attractively low by comparison with the UK, and would drop even further if all the Brits retired there had to sell up, so many returnees would need housing at public expense. And then there is the bill for all the medical and social care that the elderly so notoriously need.

Not to mention how it would affect our future holidays. Without all those retired people keeping the economies of Chiantishire and Angleterre-sur-Dordogne going in the off-season, those wonderful markets and little places to eat would struggle, and either close or become much more expensive.

Julia Cresswell, Oxford

Perhaps the EU actually wants the UK to leave. I wouldn’t blame them – we have become a political pain. However, it would be a big mistake to opt out, despite obviously stupid bans such as this latest olive-oil nonsense. The greater picture is what counts – the UK needs Europe.

Jules Palliser, Walmer, Kent

D Stewart (letter, 20 May) condemns the EU’s democratic deficit. His dedication to democracy is laudable. I wonder if he might explain to me how I can go about voting for my constituency representative in the House of Lords.

Michele Pacitti, London W6

Mega-farms and the price of milk

I was surprised to see Terence Blacker’s criticism of animal-welfare groups for failing to campaign against mega-farms (14 May) since the World Society for the Protection of Animals’ (WSPA) campaign against factory dairy farms has been well documented over the past three years.

Mr Blacker is right to be worried. Our campaign has shown how intensive dairy farms damage the environment, pose a risk to human health and subject dairy cows to a greater risk of laminitis, mastitis and a considerably reduced lifespan – all a consequence of attempts to exploit economies of scale and in the pursuit of ever-increasing volumes of cheap milk.

That is why we have been leading the fight to keep British cows on grass, and out of factory dairy farms, by successfully opposing plans to build a factory dairy farm in Nocton in Lincolnshire housing thousands of dairy cows, and more recently, aiding local campaigners in their fight against an application to build a 1,000-cow intensive unit in rural Wales.

WSPA understands the enormous challenges faced by many struggling dairy farmers. However, the outcome of the impending decision in Wales will ultimately affect more than just one farmer’s future: it could set a precedent for a wholesale change that would for ever alter the rural landscape of Britain.

WSPA is urging the Welsh and UK governments to choose a future that is economically, environmentally and ethically responsible and sustainable for British cows, consumers and the countryside.

Simon Pope, UK Director of Campaigns and Communications, WSPA, London WC1

While it may seem self-evident that larger farms are more of a disease risk and have a worse environmental and welfare record, the truth is that this is a lazy assumption with no basis in fact.

There is any amount of evidence that it is the quality of management which is the decisive factor, and larger farms commonly have the resources and ability to do a first-class job.

The NFU does not envisage a future where there are only large farms – there is room for all scales – but if we are to increase production in this country, as we must, we will need some larger farms in the mix.

Martin Haworth, Director of Policy, National Farmers’ Union, Stoneleigh Park, Warwickshire

Gay and straight marriages

The gay marriage Bill and your coverage of it (“Couple in homophobic attack tell MPs: you are legitimising the bigots”, 21 May) confuse equality and sameness. True equality will only emerge when the fundamental differences between homosexual and heterosexual relationships are openly celebrated and respected. Redefining marriage denies these differences and undermines rather than advances the dignity of same-sex couples and society as a whole.

David Culley, Bristol

As a happily married couple, we can see no way in which the introduction of same-sex marriage would diminish our own union. Opponents of same-sex marriage insist that they are not motivated by homophobia, but it is difficult to understand what else lies behind their opposition.

Jonathan Wallace, Kyra Wallace, Newcastle upon Tyne

Curbing Google

It is not quite as easy to use consumer power to alter the immoral behaviour over taxation of a company like Google as it is Starbucks, but it is possible. Whenever an advert pops up on a Google site I now contact the advertiser to let them know that I won’t be buying any of their products unless they care to deal with ethical companies. We have the power, let’s use it.

Christopher Anton, Birmingham

We carry on

Further to your article of 14 May, I confirm that Canterbury Cathedral is not closing its doors. Your headline “Canterbury Cathedral faces closure unless it can find £10m for repair bill” created a drama where none exists. Although disappointed that we were not awarded a grant from the Heritage Lottery Fund recently, all at Canterbury Cathedral will continue to welcome pilgrims and visitors each day, and we will carry on holding our regular daily services.

John Meardon, Receiver General, Canterbury Cathedral

Right split

If defecting to, and voting for Ukip, is the answer, then the question has to be, “Do you really want another Labour government in 2015?” If all those committed, long-serving Tories who are quitting the ranks really think their party has been filched from them, surely the best thing to do is fight to get it back.

Alan Carcas, Liversedge, West Yorkshire