Chorley A&E closure: A cautionary tale?

A/E nurses Image copyright SPL

The problem with central dictats is they can have unintended consequences in an organisation as large as the NHS.

When ministers in England last year announced they were going to cap how much hospitals could pay agency staff, they felt they had found a solution to a factor increasingly cited as a cause of the financial problems engulfing the health service.

But the temporary downgrading of Chorley's accident and emergency unit from next week suggests it merely tackles the symptoms of the problem rather than the causes.

Bosses at the Lancashire hospital took the regulations seriously. They started phasing them in from November, but it soon became clear they had a problem.

Like many A&E units, Chorley relies heavily on locum staff. This is because there is a national shortage of doctors willing to work in emergency departments full time.

The Royal College of Emergency Medicine says young medics are being put off by the relentless pressures in the system and the lack of work-life balance that comes with the regular weekend and night shifts.

When Chorley realised it had a problem, bosses stopped implementing the cap - this is allowed as there is a clause in the regulations for exceptional circumstances.

But, despite this, the trust that runs the unit - Lancashire Teaching Hospitals NHS Foundation Trust - still couldn't fill the shifts, prompting the announcement it would be downgraded to an "urgent care service" that will no longer take the most seriously ill patients and will close at night.

Image copyright Google
Image caption Chorley hospital's accident and emergency department is to close temporarily

The interesting question is why - despite this U-turn - the hospital still struggled.

Its location - relatively close to Wales, where the cap is not in place - could mean doctors have simply moved across the border to work, while it is also possible the introduction of the cap has prompted some locum doctors to take permanent jobs elsewhere (one of the aims of the policy).

But another suggestion put to me is that some hospitals are playing fast and loose with the cap regulations to make themselves more attractive options than those who follow the rules to the letter.

One ruse apparently involves locums being paid for additional hours they never actually work so they can effectively get a higher rate, while some trusts - I am told - are paying extras, such as accommodation allowances, to top up pay.

It is unclear at the moment just how widespread this is and whether other hospitals are struggling like Chorley.

And, certainly, it is fair to say bigger hospitals in major cities find it easier to attract doctors than a site located in rural Lancashire.

But what seems clear is there is no quick fix for the growing problems in A&E.

The news about Chorley came as NHS England released its monthly performance report for February.

It covers everything from cancer care to routine treatments, such as knee and hip operations.

Many of the key targets were being missed. But none as badly as A&E.

Fewer than 88% of patients were seen within four hours - well below the 95% target.

That is the worst performance since the four-hour target was introduced in February. The second worst was recorded in January.

Meanwhile, in the coming months the NHS is expected to post its most dire set of financial figures (the ones for 2015-16) since the creation of the health service.

As one person put it to me: "The problems being experienced in the health services are simply too great to be resolved by knee-jerk government policies - no matter how well intentioned they are."

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