A & E Delays killing up to 500 per week

JaneJudge

Strep A has been rife here, all the staff at works kids had it. Where has the diphtheria come from?

Where my dd works, some of the population travel to and from countries that have poor vaccination records and they themselves may never have been vaccinated either. Hence something like diphtheria gets into the UK.

Growstuff, there does need to be some sort of information programme for parents, I think. These are not very poorly children being brought into hospital, these are children who’ve maybe come home from school with a runny nose or sneezing and their families want them to be seen straight away.

Perhaps because we no longer seem to have the baby clinics and health visitors that our generation remember, today’s parents may not gain the knowledge they need to made such assessments.

I agree that more use could be made of pharmacists. I used to work for one who was excellent at assessing people’s issues and either giving appropriate medication or telling them they needed to see someone. I myself have had Strep throat a few times (thankfully not for quite a number of years now!). I know the symptoms and I know what’s needed, and I’d have been more than happy to get AB’s from a pharmacist, rather than see a doctor.

Nanatoone

Recently my daughter had an infected finger. A simple course of antibiotics could have resolved it and get on with her day. Call GP, told to see a pharmacist. Ok, sees a pharmacist, you need antibiotics (really?), tried to see GP over next two days, no chance. Then phoned 111 as the infection was by now travelling and incredibly painful. Gets a text from the GP about her “swollen finger” saying ring tomorrow. In the meantime we decided it needed urgent care. They triaged and agreed it now needed lancing and antibiotics. Waited hours, then at half past eleven at night (we were the last there) they closed and sent us to A&E. Waited for more hours then went home (no chance of such a “minor thing” being dealt with, of course no one had actually looked at it for seven hours or they might have felt differently.. Demanded to see GP next morning, saw GP, who said oooo, that looks nasty, antibiotics, painkillers etc. marked it, said if it gets worse straight to urgent care. Within the hour the infection has spread again and back we went to urgent care. Lanced, after being roundly told off for her GP not doing it (!) and for leaving A&E, seriously annoyed by now. The infection was by now black. She is a senior school English teacher. Had to have a week off work. Kids had to have a cover teacher. She had endured severe pain and was so close to having sepsis. All for the want of an early treatment with antibiotics. I despair. Sorry for the long message, but seriously, how to make something simple turn into something serious. Not to mention the knock on effect on the school where she works.

You raise such a good point. All this deterring people from seeking medical advice, self diagnose etc., OK works well for most of the time but sometimes you need expert medical advice.

Watching BBC News- it is just horrendous.

One question OH just asked and to which I'd really like an answer.

WHO is owning the Companies making millions providing Agency Staff to the NHS at massive costs. Hmmmm I wonder.

I sat in a&e with my terminally ill husband while a lady ( not a word I want to use) was waiting to be seen while swigging from a vodka bottle. I could not hold my tongue!! People use A&E for the most stupid reason ever. Its a joke. When I broke my arm it took me 4 hours to decide if I was right to go to hospital as I didn't want to waste their time. People need to grow up and learn what A&E is for

I can only talk from my own experience but the agencies used for my daughter's social care are a multi national and they employ nurses directly from commonwealth countries who work in social care whilst gaining UK qualifications in order to work as nurses in the NHS. I'm not sure this is a bad thing, we have had some amazing care staff (some not so good - buy hey - that's care!)

btw fleurpepper, I was only talking from our perspective on the social care end.

Despatches from the front line. My dd has just come off a long shift in adult A&E. The dept had its usual queue of ambulances outside. Inside, they were rammed full as they were unable to admit anyone as there were no beds. They also have staff sickness so at one point there was just one nurse for 30 patients.

Dd said it was a shift from hell.

SueDonim

Despatches from the front line. My dd has just come off a long shift in adult A&E. The dept had its usual queue of ambulances outside. Inside, they were rammed full as they were unable to admit anyone as there were no beds. They also have staff sickness so at one point there was just one nurse for 30 patients.

Dd said it was a shift from hell.

Dd said it was a shift from hell

Having spent 11 hours in A&E not long ago with DH I can believe that analogy, SueDonim

Yet still the doctor remained cheerful when we saw her. She said some people were there regularly demanding painkillers which their GP would not prescribe for them.

But Callistemon my A&E wouldn't have let people demanding painkillers past the reception desk. Why don't all A&Es have that kind of system?

Oh yes, that’s a regular demand - a strip of painkillers or indigestion tablets. The thing is, all these people still have to be documented and processed, no matter what they’re there for and that all takes time.

growstuff

But Callistemon my A&E wouldn't have let people demanding painkillers past the reception desk. Why don't all A&Es have that kind of system?

Are you sure?
Receptionists cannot triage patients.

Oh suedonimlove to your daughter

SueDonim

Despatches from the front line. My dd has just come off a long shift in adult A&E. The dept had its usual queue of ambulances outside. Inside, they were rammed full as they were unable to admit anyone as there were no beds. They also have staff sickness so at one point there was just one nurse for 30 patients.

Dd said it was a shift from hell.

My sympathies for your daughter.

I expect some of the people had more than just a cold. Something really needs doing about this - long term and short term.

I'm not disputing that some people misuse A&E. Some of them are possibly there from desperation because they can't get a GP appointment or there isn't a local minor injuries unit. However, it's not good enough to blame people for wanting medical treatment because I honestly thing most are genuine. That's why I think there needs to be a big public information campaign and more investment in local community nursing and para-medics, who should be able to keep people out of going to hospital in the first place. I think it's too much to hope that more GPs can be trained in the short term (and anyway, I don't think I'd want to be a GP, if I were a medical student).

If A&Es aren't already triaging, they need to invest in clinicians to do it before patients step inside the building. It also sounds as though they need to invest in security staff.

At the other end of the process, there needs to be more investment in convalescent hospitals with full nursing care, but not necessarily doctor cover. Patients don't always need to be in an expensive acute hospital and could be cared for in a "step-down" unit or even at home, if there were more district nurses.

A&Es should be for people who genuinely need life saving care. There need to be more beds available for admission and more staff in A&E itself. I doubt very much if any private provider would be interested.

The whole process needs to be integrated. At the moment, each trust and GP practice is a cost centre and tries to offload responsibility to others. That's actually costing more than an integrated service would and means patients are being boomeranged from one service to another.

I have no idea how much my suggestions would cost, but I honestly don't think we can afford not to invest in what we already have.

Callistemon21

growstuff

But Callistemon my A&E wouldn't have let people demanding painkillers past the reception desk. Why don't all A&Es have that kind of system?

Are you sure?
Receptionists cannot triage patients.

They have a clinician at the reception desk. What happened with my son is that a receptionist took his details and a clinician (nurse?) took one look at his leg and agreed he needed to be admitted to the main A&E area. That was three years ago, but I think the hospital still has the same system.

SueDonim

Oh yes, that’s a regular demand - a strip of painkillers or indigestion tablets. The thing is, all these people still have to be documented and processed, no matter what they’re there for and that all takes time.

That's downright ignorance. There need to be posters all over the place stating that A&E can't hand out medications.

It's not the same system here, growstuff.

Receptionist takes details, including details of the problem, then you wait to be triaged by a nurse, in our experience about 2 hours.
Then back in the waiting room for further assessments - another 9+ hours in our case.

SueDonim I was sent by the triage nurse from A&E to Minor Injuries Unit miles away.
They could not diagnose the problem at all and I eventually saw a surgeon 5 weeks later - an instant diagnosis and urgent surgery is required.
Still waiting 4 months later.

Callistemon21

It's not the same system here, growstuff.

Receptionist takes details, including details of the problem, then you wait to be triaged by a nurse, in our experience about 2 hours.
Then back in the waiting room for further assessments - another 9+ hours in our case.

My son was triaged almost immediately. His leg was actually twisted at the knee, so I expect it was obvious that he was in a huge amount of pain. In A&E itself, he was given a painkilling injection and had his obs done within minutes. After about an hour, he had an Xray and then had to wait about another hour or so for somebody to put his leg back in the right position under local anaesthetic.

I wasn't in either waiting room long enough to know what else was going on. My only personal experience of A&E has been as an ambulance emergency, when I was seen immediately without triaging.

I know somebody who works in the department and apparently about 20% of walk-ins are sent elsewhere. The Urgent Treatment Centre is literally next door and is open overnight and at weekends. Apparently, some people are sent off to a pharmacist or dentist.

nanny2507: 'People need to grow up and learn what A&E is for'

It seems that way - but, to me, the usual 'time wasters' would be completely incapable of just growing up. Victim blaming?

There are alcoholics, those with anxiety and MH issues, personality disorders etc. - not just the patients but their panicking carers too.

Underfunding and shortages of staff mean limited access to services elsewhere - along with unreasonable delays. Therefore, in practice, people are being shunted into A&E, through a lack of choice, often time and time again.

There will be far more of them than 'usual' though. A severe lack of carers, MH teams, support for the homeless, alcoholics, ambulance crews, GP support etc. (the whole caboodle) creates that bottleneck. It all falls apart when services are run down for decades. When do we become aware and see it happening? In A&E!

People living in the most deprived areas in England had a far higher number and rate of attendances at A&E compared to other groups. A&E attendances were twice as high for people in the most deprived areas as in the least deprived.

www.kingsfund.org.uk/projects/urgent-emergency-care/urgent-and-emergency-care-mythbusters

Hmm .. I wonder why. It seems to be part of a bigger picture, which needs addressing.

It's also known that life expectation is lower in the same areas.

Hetty58

nanny2507: 'People need to grow up and learn what A&E is for'

It seems that way - but, to me, the usual 'time wasters' would be completely incapable of just growing up. Victim blaming?

There are alcoholics, those with anxiety and MH issues, personality disorders etc. - not just the patients but their panicking carers too.

Underfunding and shortages of staff mean limited access to services elsewhere - along with unreasonable delays. Therefore, in practice, people are being shunted into A&E, through a lack of choice, often time and time again.

There will be far more of them than 'usual' though. A severe lack of carers, MH teams, support for the homeless, alcoholics, ambulance crews, GP support etc. (the whole caboodle) creates that bottleneck. It all falls apart when services are run down for decades. When do we become aware and see it happening? In A&E!

Well put, Hetty.
I'd like to give an example of one Saturday night when I had to call for help for someone with MH stuff: there were just two workers on duty for the whole of my large city, (needed 6) and suicidal people ringing in: what else to but direct them to the relative safety of A and E?

Message withdrawn at poster's request.

When Tory politicians and hospital consultants and nurses give opposing accounts of the NHS 'crisis/what crisis?' who am I to believe? No brainer - the front line staff of course. The accounts in today's Telegraph of patients waiting and dying confirm this. And that a national newspaper should think it necessary to publish an advisory article by a senior clinical lecturer on what to do if the ambulance does not come is a national disgrace. We have over 10 years of Tory underfunding and micromanagement to blame - the pandemic and flu are Sunaks's alibi for his predecessors' failures. And those who think the NHS is bloated with overpaid managers should bear in mind that only 2% of NHS staff are managers.

As an article by a journalist in the Telegraph today commented, we are so used to reading horror stories about our broken NHS we’ve almost become immured to it. We read, we are horrified and we shrug.

As he went on to say imagine if there were 500 deaths a week from train accidents. People would be in uproar.