Another Monday Night

Lots of anger tonight.
The local A&E departments are full, the nurses in charge are doing juggling acts in order to try and get patients in a position to be examined by the doctors. Waiting rooms are full and in at least one case there are no beds left in the hospital while plenty of patients needing admitting.

I explained to one patient we brought in that this is why she had to go to the waiting room – there just wasn't room for her and her two-day old headache to lay on a trolley…

“Fucking hospital, always some excuse!”.

It took some restraint on my part to not shout at her to open her eyes and take a look at the crowded department she was standing in, to look at the staff charging around doing a dozen things at once, and to consider that this headache perhaps wasn't the highest priority illness that night.

The expectation of patients is much higher than that which can be provided. Even when it is obvious that the department is being overloaded, the desire to get their 'serious' problem cured immediately leads to anger.

Patient tempers were flaring, likewise the doctors and nurses were run ragged. Multitasking is an important nursing skill, especially when, not only do you have to do all your normal nursing duties, but you have to run crowd control on angry relatives and the normal cast of drunks.

I'm writing this post in the middle of my shift and it wouldn't surprise me if there is violence in the department before the sun comes up.

So please explain to me why those complete *expletive deleted* morons in the Ministry of Health are going to be closing two of our local A&E departments? When the current A&E capacity isn't enough, and there is a year on year increase in attendance, shouldn't these people be supporting the A&E departments rather than cutting capacity even more?

Sorry, I forgot – we are supposed to be more 'efficient', people are going to be treated in the community (by ambulance staff at some point in the indeterminate future), they won't need to go to hospital. Remember that 60% of our calls don't need an ambulance. But, and it's a big but, they might need an ambulance, x-rays, blood tests and the like to come to the conclusion that they didn't actually need that ambulance.

Of course, people will still want to go to hospital, and we are unable to refuse. Then when they get there and see queues running out the door they'll complain and make life awful for the folks who work there.

This overloading of A&E departments is one of the things that led me to leave nursing – and I haven't haven't missed the hassle, nor the inability to properly care for terminally ill patients because there were no pillows or blankets in the hospital.

It's sad, but one of my favourite nurses is in the process of moving career because she's getting fed up of trying to bail out a sinking ship. I suppose that this is a governmental success, less departments and less nurses means fewer wages which saves money.

I don't know what they plan to do with the patients though.

This was written when most newspapers had the death of a race horse as the front page news.

26 thoughts on “Another Monday Night”

  1. It's bad enough dealing with the waiting and poor facilities and inferior standards of care due to overcrowding and understaffing as a patient. I can't imagine the stress on the staff.God knows why they want to close hospitals – they want to close our local hospital, which means the nearest A&E is 45 minutes away assuming there is no traffic (a rarity) and at least twice that at busy times. I just hope I don't need emergency care when that happens. With little in the way of out of hours GP services to take up the slack, I have no idea how patients or staff are supposed to manage.

    They closed one of the A&E departments in the area I used to live in (the best one, I hasten to add) and it was a nightmare. There were subsequently routine 5 or 6 hour waits on non-busy times at the next closest hospital, and the care was substandard and frequently diagnoses were incorrect. I don't understand why the government wants to continue to reduce our health care facilities and by default, our standards of care. It almost seems they won't be happy until we have one central hospital that can't see anyone for a fortnight for emergency treatment, and years for non-emergency care. Perhaps that is how they intend reducing costs and waiting lists; keep everyone waiting long enough and they either give up or die. Either way, they go away in the end.

  2. So we can't afford to keep A&E departments open yet we can afford to make out of court payouts to junkies in prison who didn't like the fact they were forced to get clean? It's a f**ked up world out there folks.

  3. Hi TomThis post of yours, possibly more than any other I have seen for a long time, highlights the core of the problem. Well done mate – things like THIS should be front-sodding-page news (irrespective of how good the soon-to-be-dog-food-and-glue animal was – but let's face it, Desert Orchid probably generated more return on investment than your local A&Es put togher, right? Dripping sarcasm mode over….)Two thoughts:1) “The expectation of patients is much higher than that which can be provided” <----------------- who's fault is that then, I wonder?".....those complete *expletive deleted* morons in the Ministry of Health....." <------------ ah. Easy question, wasn't it. I also have to wonder though - surely media such as The Sun or the Daily Mail are equally responsible, not to mention so-called "medical dramas" (I know Casualty tries, but I also know it's not one of your favourites.....but I always used to really enjoy the bits where Charlie goes off on one at 'Management'.........). What role might TV programmes have in dealing with the issues, or otherwise?2) "Of course, people will still want to go to hospital, and we are unable to refuse." <----------- so under The Patients' Charter (your bloid boils at those words, yes?) the point has been reached where patients' *NEEDS* (ha!) are considered far more important than the fact that the service meant to be providing those needs is grossly under-resourced (and piss-poorly managed from on high!) - and people wonder why nurses leave in droves??? What's happened to accountability? Ian Dowie loses something like 10 football games in a row or something, then gets fired. Tony Blair oversees the systematic failure to redress the faults of an NHS system ripped apart under years of Tory rule - he's had HOW MANY years to make a difference? And Labour is still in power? Oh don't get me wrong - I'm apolitical - they're all a bunch of bastards.........it's just the sickening lack of accountability amongst governments that gets to me...........How much longer will you stick it out, Tom? When ambulance personnel become 'responsible' for the on-site treatment of more cases, will you find yourself having to move on from that job too? That would be a real loss to people like us - but I don't think you'll find a single person here who'd blame you for walking out!

  4. It's a sign of the times. My wife has just come back from a night shift (she's and A&E Doc) to inform me that there has been a 12 hour breach, and no beds in any of the Bristol Hospitals. Apparently all the wards that can be have been opened, and there is no more that can be done. Well tell that to the patients who need urgent treatment. I start days tommorrow on the RRV, I wonder how long i am going to be sat there with a poorly patient waiting for an ambulance to arrive because every vehicle is stuck at A&E?The local council have shut all the council run homes locally (except for the odd one), so all the older members of the local population who can't look after themselves are bed blocking in hospital. It's not just about the NHS it's about the system. Locally they have been cutting things like home help, all little things which have a huge knock-on effect. It's other little things like Out of Hours GP services (and GPs come to that) often they just tell people to call an ambulance without a visit. A little old lady was mortified that we had been called the other day!

    As for the crowd control thing…i agree, the nurses and docs deserve medals. They do an extremely hard job (incl. the 4 hour wait thing!) But hey, locally nurses have left for other jobs and not enough money to replace them. They are opening up wards to direct admissions when the ward and the staff (through no fault of their own) are not equipped to deal with them, as I found almost to my Dad's cost this weekend, they don't follow the correct treatment pathways, there is one doc per 4 medical wards…paracetamol for cardiac chest pain?! I really don't know anymore! *frustrated*

  5. Tom, do you think people view ambulances as a golden ticket for being seen by A & E staff, rather than having to wait in the waiting room like everyone else?It is odd that you had to take a person with a headache to A & E. Why couldn't you just turn her away?

  6. I know what ! We could divert patients to all those shiny new hospitals we have been building in Iraq. I know the transport times might be a tiny bit longer, but it would be nice to get some return on all those billions of dollars (pounds) of investment. Plus, they would get a nice sunshine holiday as a bonus.

  7. Better yet, we could fun and arm a 'coalition' of forces from Iraq, Iran, Syria, North Korea and whoknowsmore to conduct a precise bombing raid of our hospitals (evacuating them first of course) and let them pay for the construction of new ones! After all, it's in their interests, since we live in a society which needs to be freed from the shackles of tyranny and such a campaign is bound to enable those respective nations' leaders to remain in power………………(!)

  8. …And this is why your writing and your blog are so important: they bring a reality check to all of us out there who aren't on the frontline – something government ministers could do with having too.Keep up the good work Tom; it doesn't go unnoticed.

  9. I don't know why, but of all the things mentioned in that post, the one that is getting me most is the “pillows and blankets”. I mean, for pity's sake, pillows and blankets. It's hardly a state-of-the-art scanner or an operating suite or even (heaven forbid) ten extra nurses and three extra doctors for the department… it's a few bits of textiles per bed.

  10. But to cover those two A&E's there will be the new, shiny, round Queens Hospital. Have you been there for a look see yet? Its like.. well, a Holiday Inn is the closest I can think of!

  11. Recent survey say that 50% of people think that if they call an ambulance they will be seen quicker in A&E.They are wrong.

    (It's also one of the things I moaned at the writers of Casualty about)

  12. Lets put it like this…Currently I am unhappy with the direction the job is going.

    But I can't see myself leaving, as I can't see myself doing any other job.

  13. Well, I hope things can change back in a postive direction so you feel happier – it's more than abundantly clear how much you love the job (in spite of the negatives) – or at least the positives must outweigh the negatives.Could you see yourself doing the same or similar role in a different country and/or culture though? Perhaps in a country whose government actually gives a damn about medical care, that is? Lord knows you must have a few good contacts by now πŸ˜‰

  14. Like most things, it'll pass.As for another country or even county. I'm just too much of a London boy at heart. Sad I know, but true – I get 'itchy' if I'm not in London.

  15. Our ED (large south coast teaching hospital) ran out of blankets on Sunday night. The security man (singular) was 'too busy' to let our HCA into the laundry to get some more. And this in a department where the air conditioning ensures freezing temps in winter (and breaks in the summer). I was wearing a fleece (despite this being 'against infection control policy' I am reliably informed) and was still cold. God only knows how my 80yr+ patients in their pyjamas were feeling. Absolutely bloody amazing. Still, good job they can afford to employ Night Managers, whose sole job it is to stand in front of the ED board, write down breach times on a clipboard and whinge when you don't yet know whether you'll need to admit your asthmatic patient as you only saw them 3 minutes ago and haven't yet given them any treatment….

  16. I saw first hand experience of someone in an ambulance *NOT* getting seen quickly (she thought she would).It was absolutely hilarious.

    Completely pissed. In a ball dress. Ambulance dropped her outside the main entrance and left her to walk in on her own.

    Bloody priceless!

  17. Just after reading your words I heard someone on the radio talking about the same isssue in the States. He was reminding people of what happened in Toronto when a patient with what they thought was pneumonia was left waiting in an over crowded emergency room for hours. Turns out she had SARS and infected almost everyone who came near. Hundreds of people got sick and over 30 died.

  18. “They are wrong”Not entirely true. I've turned up at A&E under my own steam and by ambulance in identical clinical condition* on several occasions. Every time I've been seen much faster if I came in an ambulance.

    *Asthma, PEF ~ 50% expected, resps > 25 etc. etc.

  19. As an asthmatic I've spent lots of time in Whipps Cross A&E (my asthma is under control on the whole, just infections can take it over the edge). I've been there at times when it's fairly empty, and I've been there when it's heaving and I've been left on a trolley in the middle of the corridor in a hospital gown. However I've never felt anything for respect for the people that work in the department and care so well for their patients, even at 3 in the morning – and when they're dealing with people that really shouldn't be there. I guess I'm just trying to say thanks to them and people like you Tom for doing your jobs the best way that you can. And mention my claim to fame of being one of the few people to be wheeled into resus and walked out (I was taken in there to change back into my clothes!) (and I have to say I've never been in an ambulance yet – I've also been taken by my mum!)Debs πŸ™‚

  20. Here in Buxton, derbyshire, we don't have an A&E dept at all. Nearest is Stepping Hill or Chesterfield.When my daughter had a severe asthma attack (I'm not one to panic as I am ex military medic and can handle most emergency situations – but this one had me almsot frantic trying to get her to breathe), ambulance came and paramedics said “Don't piss baout with NHS Direct – next time this happens call us straight away.

    I like to think that the ambulance service do know when it is being tried on and when it isn't and can determine whether a patient should be seen straight away on admission to A&E, or can just wait their turn.

  21. Can't think of a more challenging place to do A&E work, for me that was what drew me in and that's what keeps me here. Besdies London is also full of all that is good (as well as bad) about the country, a multi-cultural 24hour society. I'm still proud to be an adoptive Londoner, I'm proud to work in the NHS and proud of the LAS. For all of their faults it can still be the best job in the world.DSO

  22. Sod the race horse….The NHS is in such a state that the whole thing needs shaking up… my partner recently had a motorcycle accident and the whole NHS thing/help/non diagnosis was appalling. 2 ambulances attended and the 4 paramedics that arrived were great, i can not fault them at all, it was from arriving at Basildon A&E things went down hill. OH Also the coppers attitude was a different kettle of fish intirely, i dont know how I didnt end up being arrested for assulting a plonker in a hat… but anyway…

    I am lucky my employers offer private health care and thank the little dude in the sky they agreed to add my partner to the scheme to free me from the NHS all for a 150 excess fee.

    Also I have had a weird cough for 7 weeks, my GP said, chest infection, then asthma, now an allergy to 'something', i am on the verge of murdering the incapable GP with the DIY book of things it could be.

    (The full details of the whole accident and annoying cough senario can be found on my blog… Tom your views are more than welcome in the comments section…. i bought your book last week ha ha)

    My point is… I would rather a choice of private or NHS to pay into each month…. I would chose a private health scheme to contribute to monthly and opt out of paying any National Insurance out of my salary… this way the NHS has lost me as a patient, freeing up time and waiting lists for those that do not have a private scheme and in turn you have less patients for the poor nurses and doctors at hospitals and GP surgerys to then give the time and care to which patients deserve. also waiting lists would shorten… etc… Hey who knows they then might be able to diagnose correctly.

    so I can see a private doctor specialist etc if i am poorly with no waiting time.

    Dont get me wrong the NHS docs and nurses do a hard job and you cant knock them for making a few mistakes when worked into the ground by a failing system… they are human after all.

    But when it is my health / life that is on the line… is it too much to ask for decent care that I have actually paid for? maybe I am loosing my faith in the UK health system and “specialists” entirely….

    Maybe my idea wouldnt work at all… worth a try though??

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