The A&E crisis and the supply and demand game- the need for a new politics of health

As an avid teenage fan of Douglas Adam's Hitchhikers Guide to the Galaxy I remember particularly enjoying the fact that the answer to life, the universe and everything was 42. And in belated homage to the book of my youth, I'm going to ask the reader to suspend their disbelief and accept that the answer to the current A&E crisis is 35. That's right, 35 is the single number that can properly explain the meltdown in A&E services across the nation this week. To understand this however you have to understand the supply and demand game that our mainstream politicians indulge in during times of crisis.

10922397_10152502169805163_4860425678604030766_o.jpgWe currently have an unprecedented meltdown in our capacity to treat those with serious acute injuries.  This is reflected  nationwide where we hear health professionals warn that the NHS is in "crisis" after waiting times in accident and emergency departments plummeted to their worst levels in more than a decade across the whole of England. 

Now let’s suppose for a moment that overstretched wards are not the fault of frontline NHS staff. I popped into my local hospital in Worthing and I can confirm that there was no queue of doctors and nurses on prolonged cigarette breaks outside the hospital or paramedics snoozing in their ambulances with do not disturb signs on the windows. So who is to blame for this?

Well, now we introduce the political supply and demand game. The rules are quite simple.

Rule one- you need an NHS crisis. Without this you can't play. This is as important as the dice is to trivial pursuit.

Rule two- if you are the party in power you talk a lot about how the problem is one of demand. That is, there is an overwhelming and unprecedented demand on services that could not have been predicted and that is regrettable. And an aging population of course. If you are the party in opposition your role is the supply role. You say that the crisis is due to problems of supply - of supply of doctors, supply of nurses, supply of funding, supply of ambulances, supply of social care. You mention this a lot.

Rule three - regardless of your current role, make sure that you organise lots of  media appearances where you look serious and concerned (either about problems of supply or problems of demand, demanding on what turn is yours at the time). This changes if its a general election year. In general election year,  look very serious and concerned. Both Andy Burnham and Jeremy Hunt are good at this game. They looked on the verge of tears at times about whichever supply or demand role was theirs.

Rule four- get your 35%. If you get your 35% in the polls you win the election and you get to change position and be the demand team. The aim of the game is to stay the demand team for as long as possible. Now it may be that your overall share of vote is diminishing year on year and that the number of people voting diminishes too. But that's okay because you just need your 35% to become the demand team. And so on.

Now of course patients and staff don't play this game. Their responses are quite difficult. For the staff it's fatigue, overwork, work stress, demoralisation and in many cases leaving the service. For patients it's being discovered at 7pm still holding their breakfast bowl and with soiled clothes. Or it's mourning the loss of a loved one who didn't make the journey to hospital because they were diverted by 20 miles because their local hospital couldn't take them. Or it's sitting confused in an ambulance while apologetic ambulance staff do their best to keep their wounds from deteriorating. These people don't play the game of supply and demand. They are instead the product of the game. They are what comes out of the sausage machine at the end of this process. But they are not the obsession of our two dominant political parties. Nor are statistics, or waiting times or cost benefit analyses or closing hospitals or the crises itself. The obsession is 35%.

35, plain and simple.

Now please forgive the frankly flippant rhetorical flourishes above. But what has become crushingly obvious in recent days is the enormous gulf between those suffering the A&E crisis and those charged with addressing it. If you watch enough newscasts over the last two days, you see the supply and demand game and you see real genuine political failure. There is little more clear case of the disjunct between our tired two party political consensus and the real problems of our times. We need real political plurality and new voices to enter the political fray, that aren't compromised by three line whips, or party donors or special interest groups or lobbyists but who drive forward real and meaningful change to our woefully underfunded health service as their primary priority. Its time to replace the supply and demand game. As an electorate we need to reject our role as pawns in the 35 obsession and instead vote for genuine change that supports our beleaguered doctors, nurses and patients.


Article by Dr Carl Walker, ECPA Task force on Austerity and mental health and National Health Action Party

Image by Chris Bird


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