Tuesday, 22 December 2015

Only God and the bed manager

The consultant was clear – you need to be on an IV drip getting antibiotics in your local A and E within the hour because of complications with chemotherapy treatment.

The patient, my partner, was already very ill, had developed a high fever, and was forbidden to drive because of radiotherapy treatment for five brain tumours.

The nearest A&E had once been local but had been shut down. So our new nearest A&E was now around 30 minutes’ drive away from our house.

I was worried as I was over an hour’s drive away from home. The extra distance to the hospital and the Christmas traffic combined would eat into the ‘one hour to get treatment’ ordered by the consultant cancer specialist during a phone call.

So the next phone call was 999 to the regional ambulance service. No help in this emergency.

All that was on offer was a phone call within the hour from a doctor who would carry out triage – to assess the urgency of the request. The ambulance service was told that a consultant had instructed A&E attendance and treatment within the hour, half of which would be travelling time.

Still no go from the ambulance service. Only a phone call in the next hour from their doctor who would assess the urgency on behalf of the ambulance service.

In the event there was no phone call from the doctor. But an ambulance did arrive an hour and a half after the initial call for assistance, by which time my partner was being taken by a neighbour to A&E.

Eye opener
Not a great start, but then as a family we had little experience of using A&E. It was an eye opener for me when I arrived at the hospital.

It was an ordinary, mild December day. No ice causing slips, trips and falls. No cold snap creating problems for an ageing population, no flu warnings.

I checked and there were no major accidents on any of the major road routes nearby. Nothing out of the ordinary at all.

At the A&E there was the roofer who had fallen off a ladder. A young lad who had tweaked his ankle playing football the day before and had woken up unable to walk.

There were broken bones, kids with high temperatures and really awful coughs. And a few elderly patients with a range of ailments.

So why did the A&E build up during the eight hours I was there to being standing room only in the waiting room? By the time I left there was a row of patients on trolleys, every seat in the waiting room was taken and people in pain were on the floor because there was nowhere to sit.

On our arrival we waited around two hours to get into a cubicle to be seen by a nurse. And that was only because the need for treatment within an hour and the risk of picking up further infections and viruses had put us on the fast track.

The cubicles were being bogged down by patients waiting for acute beds. And there were far too few cubicles to start with.

This A&E now serves a much bigger catchment area than it did five years before. It was one of only three to survive in the area, the other two were closed.

So emergency cases which had gone to three A&Es were now being crammed into one.

Pressure
According to the health service staff I spoke to, the other two hospitals had also lost acute beds, putting even more pressure on this hospital.

And the area has a seen a big increase in population – it’s a major London commuter area which has seen a huge amount of house building. But neither this A&E, nor the hospitals nearby, have seen an increase in capacity to cope with a rising population.

This A&E did not have the physical space to handle the number of patients arriving. When you did see a medic it was highly professional and the care wonderful.

But this was a medical staff battling against the odds. Doctors were going in and out of cubicles looking for the only portable electro-cardiogram (ECG).

Another was searching around looking for ‘the’ lamp to help with an examination. None of them had a flat surface to place their notes down to update them.

The nurses were run off their feet. The work was a slog. They barely had time to draw breath.

And all the time they could see the A&E waiting room filling up, getting more and more full. This is clearly not an NHS that is coping – and you could see the stress and pressure on the staff.

It took us eight hours to get out of A&E, the last four hours simply waiting for a vacant bed in the acute unit to which my partner could be discharged. When we asked when we would go we always got the same reply – ‘that’s up to God…and the bed manager.’

Shocked  
At eight o’clock that night we made it to an acute bed. But I walked back through an A&E filled to capacity. I was truly shocked by what I saw.

Older people waiting on trolleys in the corridors. Every seat filled. Standing room only.

People in pain on the floor, one woman curled up holding her stomach. It was all reminiscent of the health service in the 1980s , in the bad old days of Thatcher.

This should not be happening in the UK in 2015.

Put all the figures and statistics and funding claims aside. What I saw was a health service which has not kept pace with a growing and changing population, and which clearly cannot cope.

An ambulance service which can only offer an emergency patient assessment on the phone within the hour is not acceptable. And what sort of response time is an hour and a half?

It is not that paramedics are unwilling. Not at all. It is an ambulance service running on empty and a wing and a prayer. That’s just not good enough for a 999 service.

Re-organisation – and when is the NHS not being re-organised? – has not helped. From what I have seen A&E re-organisation has been about cuts and leaving us with less capacity than before.

A highly trained team of medical specialists is not good enough if the team is not big enough. And if it is big enough, it needs the physical space, beds and back up to handle the numbers of patients it is now dealing with.

More worrying is that we are not yet into the worst of the winter. What I witnessed was an NHS unable to cope even on an ordinary day.

I can only hope God – and the bed manager – helps us when the frost comes.

A&E in crisis: a UNITElive reader's personal account
UNITElive reader, Monday, December 21st, 2015 

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