21st February 2017

Hot topic: A headache for emergency care

Reflections on the A&E crisis and why headache care is crucial

By Hannah Verghese, Policy and Campaigns Manager

Today I attended a meeting in Westminster to discuss and hear different perspectives on how to address the crisis facing our accident and emergency (A&E) services in England.

The unrelenting pressures facing emergency departments are well documented and widely reported in the media.  The elderly and unwell waiting on trolleys to be admitted, ambulances lining up outside A&E because of a lack of space inside, and fears for patient safety have become all too familiar.  The demand on A&E services, we’re told, is compounded by our ever-growing ageing population.  As people live longer, often with several co-existing long-term conditions, the complexity of their healthcare needs intensifies, increasing the demand on these services.  Despite the heroic and relentless work of our emergency department health professionals and staff, who go above and beyond on a daily basis, the services are struggling to cope.

NHS building

Emergency care is a barometer of how the health and social care system is operating under pressure.  What we are seeing in our A&E departments is symptomatic of an entire system that is bursting at the seams and patients that are being failed within it.  To hope to address this crisis we must look to the reasons why so many people have to fall back on emergency care and where else the solutions could lie.

Headache is the most common neurological reason for A&E attendance and emergency admissions account for over 80% of all hospital admissions for migraine and headache disorders.1 While headache can be a symptom of a number of serious underlying medical conditions which require urgent medical condition the vast majority of these patients attending A&E would be best treated elsewhere in the system and in the community.  It is widely agreed that as much as 97% of headache cases (this includes migraine cases) can and should be wholly treated in primary care.2

So why do so many people with headache and migraine end up in A&E?  The short answer would be that it is a cry for help.  In the face of excruciating and unexplained pain, a lack of reliable and readily available information, and the inability to access same day GP appointments, there can seem few options left for those suffering.  Clinical diagnosis and management of headache disorders is, on the whole, inadequate and inconsistent.3  GPs are often ill equipped in terms of their knowledge, resources, and crucially the time they have, to identify, diagnose and treat headache disorders appropriately.  There are often lengthy delays in referrals to specialist support with huge variation in access to headache specialists across the country.

NHS England is very focused on tackling the crisis.  They are promising long-term reform and long-term change.  Today’s report from The Kings Fund hails the new sustainability and transformation plans (STPs) as the main vehicle for transforming health and care services in England in line with the NHS five year forward view.  Yet opinion on STPs at today’s meeting seemed divided.  Questions around their legitimacy, ability to engage with and respond to local community needs, and investment levels were left unresolved.

In the face of pressure, new models are emerging and will continue to do so.  Two key take away messages from today’s discussions were the not to be missed opportunities to invest – both in the NHS workforce and in the people who use the services.   Care outside of hospitals requires investment in a workforce that is skilled and able to support it.  Who and where is that workforce? What happens to that workforce as Brexit looms?  Nurses and allied health professionals have a critical role to play, both in supporting A&E and primary care services, but they require committed investment to be able to do so.  As more people are living longer with chronic health conditions, such as headache and migraine, our reactive health care models must change in response.  Investing in the people living with these conditions, equipping them with the skills and the confidence to self-manage, and working with them as partners to co-produce services that meet their needs is essential.

This month The Migraine Trust was one of 69 leading charities and patient organisations to co-sign a letter to the Prime Minister setting out our concerns about the current extreme pressures faced by the NHS and social care and offering our collective help on behalf of the voluntary sector.  The solutions, wherever they lie, are complex and will not be achieved overnight.  There are no quick wins.  Long-term, joined-up approaches, investment and commitment are required and will take time to come to fruition.  Just how long this will take and what happens to patients in the meantime remains to be seen.

  1. The Health and Social Care Information Centre.  Migraine. Copyright © 2013, Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. www.hscic.gov.uk/catalogue/PUB06348/hes-on-migr.pdf
  2. Latinovic R, Gulliford M, Ridsdale L. ‘Headache and migraine in primary care: consultation, prescription and referral rates in a large population’. Journal of Neurology, Neurosurgery & Psychiatry 2006. 77 p385-387
  3. The All-Party Parliamentary Group on Primary Headache Disorders. ‘Headache Services in England’ 2014

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