Dozens of NHS walk-in centres have shut since 2010, depriving patients of easy access to medical help for minor ailments without having to wait days for an appointment, and adding to the pressure on A&E units.
A total of 95 walk-in centres – 40% of the overall original number – have closed since the Conservatives came to power, or are due to shut soon, says the campaigning organisation 38 Degrees.
Critics claim the loss of the centres has piled even greater pressure on hospitals, many of which are suffering in the face of the NHS winter crisis.
Q&A Why is the NHS winter crisis so bad in 2017-18?
A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.
NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.
Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.
The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.
At the end of last week Lister hospital in Stevenage joined the Royal Bournemouth hospital in Dorset and a number of others in asking anyone without a “life- or limb-threatening” emergency to stay away.
“The closure of walk-in centres on such a dramatic scale is depressingly shortsighted. This has been happening under the radar, but will doubtless be driving some of the pressure that is pushing A&E units to breaking point,” said Liberal Democrat MP Norman Lamb, who served as a coalition health minister.
“The rhetoric from the government is always about how we can reduce the need for admission to hospital and A&E, and yet the reality is endless closures of the very services that help to avoid these admissions. It comes down to crisis management to keep within budget at a local level – but the chaos in hospitals this winter shows that the consequences are disastrous.”
Yeovil health centre, which opened in 2009, closed in September. The Somerset NHS clinical commissioning group said it was because too many people were misusing the facility, situated in the town centre, because it was “convenient” for them.
Last week 38 Degrees highlighted how Yeovil district hospital became one of at least 21 NHS acute trusts in England forced to declare a “black alert” because of winter pressures – an admission that not all patients needing care can be looked after and that patient safety may therefore be at risk.
Somerset CCG defended its decision in the summer to shut the centre. It had found “a large number of people were there for the convenience of location, with relatively minor ailments that could be solved by a pharmacist or by ringing 111”. The centre has been replaced by an urgent care service, based at Yeovil district hospital, but it is only open from 10am to 6pm on Saturdays and Sundays and is not a walk-in service.
Q&A What are your experiences of the NHS this winter?
We will be monitoring the situation in hospitals over the next few months and want to hear your experiences of the NHS this winter. We are keen to hear from healthcare professionals as well as patients about the situation. Have operations been cancelled? Has pressure led to certain wards being closed? How are staff coping? Help us document what is going on across the UK.
Similarly, Worcester walk-in health centre closed in 2014 despite the then Labour shadow health secretary Andy Burnham pleading with NHS England to retain “a valued and important local service” and warnings that it would lead to more people seeking help at the town’s Worcestershire Royal hospital. That hospital has been one of those worst affected in recent weeks and has been forced to divert patients to the A&E at the Alexandra hospital in nearby Redditch because it could not treat arrivals quickly enough. The walk-in centre has been replaced by a GP surgery, but patients need an appointment – they cannot just turn up and be seen.
Walk-in centres were one of the last Labour government’s flagship NHS policies. About 230 of them opened in England in the 2000s when Tony Blair and Gordon Brown were in Downing Street.
Designed to provide an alternative to A&E and GP services, they were popular with patients, but critics said from the start that they were not cost-effective.
In 2014, the health regulator Monitor found that 51 had closed since 2010. Research by 38 Degrees has found that another 44 of the remaining 185 have since shut. Some have been replaced by urgent treatment centres or other forms of easy access to NHS urgent care centres.
Holly Maltby, a campaigner at 38 Degrees, blamed the closures on government underfunding of the NHS. “Each time an NHS service is cut through lack of funding, it piles pressure on remaining services.”
Lamb added that the closures “fly in the face of Jeremy Hunt’s grand promises of better access to out-of-hours services and the so-called ‘seven-day NHS’. Unless the government changes course and invests properly in the health service, we will see more service closures and more patients needlessly ending up in overcrowded A&E rooms.”
The Department of Health declined to comment. An NHS England spokeswoman said: “There are almost one and a half million more patient visits to walk-in centres, minor injury units and urgent care centres compared with five years ago, so obviously that means nationally these services have been growing fast, rather than the opposite.”
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