First off go and read this. Some of the comments are pretty good as well.
The article has changed somewhat from when I first read it, but it still seems to place a large part of the blame on the ambulance service. The last section tends to stick in the mind, especially the paragraph that reads.
It had failed to meet response time targets and was branded “appalling” and “unacceptable” in a report by a committee of AMs in March this year.
If things are unchanged since I was a nurse on a Medical ward and a Care of the Elderly ward then I can explain exactly why patients are waiting on ambulances for A&E trolleys.
The routine for a patient who needs a trolley and then admission to the hospital goes something like this.
1. Patient calls 999, ambulance turns up, does clever medical stuff and drives them to hospital.
2. Ambulance gives patient to A&E department by putting them on an A&E trolley.
3. A&E department doctor sees the patient, does even cleverer medical stuff, and decides they need admitting.
4. A&E nurse calls the bed manager, bed manager finds the patient a bed on an appropriate ward.
5. A&E transfer the patient to the ward.
6. Patient gets treated on the ward and either goes home or, if unable to return home, is referred to the social workers who arrange a care home/warden controlled place/home care package.
So where is the most common delay? It's at step 6, and this trickles back all the way to step 2.
When a patient cannot return home (for example following a stroke) the social workers need to sort out who is going to fund the care home, they need physiotherapy reports, they need occupational therapy reports, they need to run 'Multidisciplinary team' meetings and they need to do all the other arcane and hidden things that they get paid to do.
Then there needs to be an available place at a care home that the patient and family are happy with. And this all takes time, and so the patient becomes a 'bed-blocker'.
(The record for me when I was a nurse was a patient staying on the ward unnecessarily for six months while funding was sorted out)
Even if the patient can return home but needs assistance, be that daily carers or just a stairlift installation, the delays are much the same.
If the ward beds are full there is no place for a new patient, so the patient stays in A&E taking up a trolley that could have been used by the next patient rolling in by ambulance.
Which means that the A&E department turns into a medical/surgical/psychiatric ward by knocking the wheels off some trolleys and hiring and expensive agency nurse to look after the patients for a few days.
There are other delays, like ward nurses 'not being ready' for a patient even though they have an empty bed, or A&E departments being reluctant to accept new patients because it would impact on their four hour government target. But generally I would say that these are fairly minor and can be fixed by a Matron with a big stick. Or an angry A&E nurse threatening ward nurses with bloody murder…Ahem…
I think that when Mike Cassidy says, “We've experienced some difficulties, maybe one or two days every couple of weeks just when the system overheats a bit and when demand is extremely high for us.”, he is highlighting that this is a cyclical thing, and perhaps people should look into why it is a cycle. Is it because in the hospital social workers and the like vanish at the weekend, leading to a Monday/Tuesday backlog of patients?
However – both the hospital trust and the ambulance service blame the number of 'inappropriate attenders', people who should have gone to their GP for their minor illness. 'Inappropriate attenders' don't block beds – they tend to slow down the transit of people through A&E, but as they seldom need trolleys to lie on they can't really be blamed for making ambulances wait with their patients for trolleys. What 'inappropriate attenders' do is make other minor injury people wait to be seen.
We can blame 'inappropriate attenders' for a lot, I know I do, but in this case their influence is tiny.
What is needed is more social workers, more care homes and more hospital beds with the nurses to staff them. There needs to be a way to move people who no longer need hospital treatment into appropriate placements much faster and there needs to be a streamlining of the discharge into care process.
But that requires money.
And I'm not the minister for health.