The recent apogee of the Accident and Emergency crisis saw up to 15 hospitals declare a significant or major incident. Before the crisis this winter there were a record number of patients attending A&E over the summer, with many failing the ‘95% within 4 hours’ treatment target. Amid the rightful outrage and consternation over this outcome, did government and the media miss an opportunity to push back just a little bit on those of us who aren’t frail, elderly or disabled yet who use the service when not truly in a state of accident and emergency? Put bluntly, are too many of us using A&E as an appointments-free GP surgery?

This article from the 5th December issue of the HSJ (Health Services Journal) ‘Solve the A&E puzzle for smarter patient care’ carries an important survey of A&E patients between April 2012 and March 2013. 80,000 people were interviewed on the reasons for their visit. The results are revealing. ‘A&E is viewed as a quick, efficient and reliable way of receiving treatment.’ And, unlike a GP surgery, you don’t need to book. Further, there is a seemingly widespread belief that A&E staff are more qualified than GPs.

Importantly, the majority of people said they attended A&E to gain reassurance. Reassurance that their ailment is not something serious. As a gold card-carrying member of Hypochondriacs Anonymous I can empathise with this view. But within the existing NHS framework, even if it is sometimes difficult to get a GP appointment or if there are a significant number of inappropriate A&E referrals from NHS 111, there was an opportunity to resolve the crisis at the margin and in the short-term through a clear message from the media and from leading politicians along the lines of: please think hard before resorting to A&E for minor, non-urgent conditions. There is also scope for pharmacists to help with minor ailments. Only 22% of those surveyed thought their condition was an emergency.

Hopelessly naive? Would A&E queues dissolve overnight? No. But at the margin, appealing to all of us on a crisis displacing the elderly, frail and disabled could work. Spirit of ’45. And as the survey points out, it’s not just patients that are using the service inappropriately, doctors’ receptionists (and NHS 111) are seemingly too often deciding that patients need to go to A&E rather than get a GP appointment. A clear message would reach them too.

In an age of outrage, the failure of our Accident and Emergency service on this scale is a subject worthy of our anger. But with any service that is free at the point of demand, we also need to ask to what degree any failure is down to the service or its funding and to what degree it’s down to how we are using it. Though the media did a reasonable job of explaining that it was pressure in other parts of the health and social care service that helped create the crisis, the overall tone was: vent on the NHS. That doesn’t give anyone outside of the NHS pause for thought, the idea that their actions count too. Admittedly, it would be a brave politician who took a line that might be construed as ‘oh, it’s OUR fault is it?’, but I suspect that, providing it was supported with evidence that the service was being misused, many of us would accept that the quickest way to solve the crisis would be for us all to think hard about how we use that service. That brave politician might get some respect.

I attended Andy Burnham’s speech at the King’s Fund on Tuesday. Despite growing up in a family where I’m the only one who doesn’t work in the NHS, I’m still in the foothills of knowledge of the health service. Nonetheless, my short take on Labour’s plan is that I can see that the integration of health and social care would ultimately improve the quality of service, but it’s not obvious to me how it would result in significant cost savings. This overview from the Guardian seems right. With that speech and Liz Kendall’s talk at the Fabian New Year Conference, be in no doubt that the Labour team have an excellent command of the detail. It’s obvious that they have put in a huge amount of time on the ground and voters should be reassured that Labour would manage the quality of care well. There’s just a bit more work to do to convince on the finances.