Professor Deirdre Heenan:

I definitely agree. It is important to put this in the context that we have similar problems, issues and concerns north and south of the Border. Probably the biggest one is the ageing population. Sometimes I get frustrated when people say that because it sounds like it is a bad thing. It is definitely better than the alternative but we talk about it as if it is in some way a disaster. It is the biggest achievement of modern medicine that we now hope to live well into our 80s, but that comes with issues around comorbidities, and we know that older people are disproportionately represented among users of the service. When we get into old age we are much more likely to turn up to accident and emergency departments and to see the GP. Is it really not possible to have much more emphasis on prevention and care at home? Most people want to be cared for at home. They do not want to be in a hospital environment. We should spend more money on falls and on educating people on vaccination and on how to keep their homes warm, for example by saying that if they cannot afford to heat the home they should heat the person. These are all important messages. I think the problem is that this is so fragmented and piecemeal that we end up being pulled in this direction and pulled in the other direction. What if we had much more strategic planning and much more emphasis on the people who are likely to use the services and money where it is required at the earliest possible stage, going back to the GPs?

The BBC once did an interview with people sitting in an accident and emergency department and there were people who quite clearly had no business being there: people who wanted repeat prescriptions, people who had headaches, people who had all sorts of things that could have been much better dealt with by other parts of the service. That is not to blame the individual; that is to say we have a serious communication problem between the health service and the public as to what is best to do when something happens.