Accident, Emergency, & Pandemonium

I’m sure you’ve all read the headlines, some of you may have seen the chaos for yourselves, either as a patient suffering from the chaos, or a staff member trying to work amongst it. A&E departments across the country are at breaking point. Or so the media would have you believe. In reality, the problem does not lie solely within A&E, and this is rarely the case when reports such as these hit the news.

Pretty much the only time an A&E department can solely be the point of failure is when a lot of people attend with acute injuries which do not require admission or long term treatment, such as sprains, cuts, etc. The problem that we are actually having is that the whole hospital is unable to cope, not just A&E.

In an ideal situation, where the NHS is properly funded, staffed, and resourced, here’s what would happen:

George has a stroke. His partner notices the signs immediately (due to the well advertised FAST public awareness campaign) and calls 999, and a well stocked ambulance with two paramedics (who have just enjoyed a 1 hour lunchbreak outside of their vehicle) arrives within 15 minutes and they quickly assess George and bring him to the nearest stroke unit. The thrombolysis team are waiting for him, he’s given a head CT scan on arrival, they see it’s ischaemic, and they decide to thrombolyse immediately having discussed the risks with George and his family. He’s moved out of resus and onto the stroke ward where the specialists can administer the clot-busting drugs and monitor him properly. Two days later he’s fully mobile and back to his old self, and goes home with his partner, and has regular visits from the community care team.

In the current situation where NHS funding is catastrophically low, George may have died at home, waiting for an ambulance. Or in resus, waiting for a CT scan, because one scanner was broken and the other one has a huge backlog. Or he may live, but the delay between the clot reaching his brain, and him being assessed by the stroke team is too long, and his condition worsens. There are no beds on the stroke ward so he stays in resus for 8 hours waiting to be moved. Eventually one of the stroke team calls in a favour from her friend on ITU who has just had a bed become free. She would prefer not to, as they’re not equipped for neuro patients, and the on-call reg will have to dash from one end of the hospital to the other to see George if his condition changes during the night, rather than being able to monitor him from the neuro unit. The next day a neuro bed has opened up, but three more stroke patients have arrived since George was admitted so there is some competition to get in. George’s partner has so many questions about his recovery, but there’s never a specialist available when she visits, so she has no idea how much longer he’ll be on ITU. A journalist submits an FOI to the trust about hospital admissions, and refers to George as a “bed blocker” in his front page article on how rubbish the hospital is.

“Bed blocker” is a ghastly term which seems to be adored by journalists. It makes you think of some useless lump of a person who refuses to leave the hospital and solely exists to inconvenience others. In reality that could be you, your mum, your dad, your gran… they’re human beings in need of care, but being inappropriately managed by the system. They’re rarely perfectly healthy people who enjoy being in hospital and don’t want to leave. Even in the case of people who are healthy enough to be discharged, it’s a lack of community care which is keeping them on the ward; ethically we can’t just send people out into the wilderness without follow-up care.

Another group which everyone seems to love blaming are so-called timewasters who come to A&E with the sniffles, or a minor rash. While this is a genuine issue which the NHS has to deal with, it’s not the cause of the current chaos. Minor ailments can be dealt with very easily, assuming that the healthcare staff aren’t completely overstretched dealing with not so minor complaints. A patient who comes in to A&E and then goes home rather than being admitted is really easy to see, assuming the resources are available. We investigate their illness/injury, treat it or provide advice, and then send them home, something which is (on paper) completely achievable within the 4 hour target. If they genuinely do not need medical intervention, or can be referred to their GP or a pharmacist, this can be dealt with by triage, and if the waiting room is heaving, they’re unlikely to want to wait hours and hours to get a paracetamol and a plaster.

So what’s causing the problem? Well, quite simplified, it’s an increase in acutely unwell patients and a decrease in facilities to treat them. The money isn’t there to provide the staff, and beds are being closed across the country. Due to fantastic medical and social advances, the population is getting older, and therefore becoming more vulnerable to illness, but unfortunately health and social care funding is barely meeting the rate of inflation.

The government are “dealing” with the situation by selling off any services that can generate profit, and chastising health workers for not being able to keep their heads above water.

We’re constantly getting patronising emails from the health secretary “reminding” us of the 4 hour target and all the other arbitrary benchmarks which do nothing but create further problems.

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