[Editorial] Beyond political rhetoric to new ideas for a sustainable NHS (Lancet)

Delays in accident and emergency departments across England have featured regularly in the news over the past month. The delays are the worst in a decade and have led several hospitals to declare a major incident because of the pressure on facilities. Compared with the previous winter, departments have seen an increase of 20 000 patients a week, ascribed largely to unrealistic algorithms used by the 111 telephone advice service for patients. Compounding problems are challenges in moving patients out of hospital because of decreased access to social care (estimated to have affected more than 500 000 patients in 2014), staff shortages, and perverse incentives from commissioning contracts that make presentation at an accident and emergency department the final common pathway after other alternatives to receive care have failed.