No Wonder A&E Depts Are Bursting At The Seams.
Discussion
When I was a lad the only time I went to a casualty department was when an arm or leg was pointing in the wrong direction or when someone dialled 999 for a ambulance as I lay sparked out in the middle of the road with other passers-by directing traffic round my body (biker, down-hill mountain biker and horse rider). For anything else it was doctor by appointment and that included visits for some fairly serious ailments and injuries.
Last year however I was picked up by an ambulance for an old hip injury that had turned nasty (dislocated, hypermobile and muscles around the joint is spasm (excruciatingly painful but not life threatening). My partner phoned NHS 24 looking for a doctor to visit and as an RGN and Midwife was able to accurately and concisely describe the nature of my ailment. What was needed was an arsefull of diamorphine and a diazepam tablet to get me out of spasm followed up with pain relief of a less "class A" nature and a referral to the physiotherapist thereafter.
I wasn't going to die, my leg wasn't falling off or on back to front. I knew exactly what was wrong, why it was wrong and how to fix it. I was in the care of a health professional who calmly stated my ailment, condition and needs. This being the case can anyone explain why an Ambulance my partner hadn't asked for ended up carting me off to hospital? To add insult to injury when I got there all they did was pumped me full of morphine, popped me a couple diazepam, referred me to a physio, and gave me a tub of diclofenac sodium to take for the next few days, just like my she asked an out-of-hours doctor to do at home.
Last year however I was picked up by an ambulance for an old hip injury that had turned nasty (dislocated, hypermobile and muscles around the joint is spasm (excruciatingly painful but not life threatening). My partner phoned NHS 24 looking for a doctor to visit and as an RGN and Midwife was able to accurately and concisely describe the nature of my ailment. What was needed was an arsefull of diamorphine and a diazepam tablet to get me out of spasm followed up with pain relief of a less "class A" nature and a referral to the physiotherapist thereafter.
I wasn't going to die, my leg wasn't falling off or on back to front. I knew exactly what was wrong, why it was wrong and how to fix it. I was in the care of a health professional who calmly stated my ailment, condition and needs. This being the case can anyone explain why an Ambulance my partner hadn't asked for ended up carting me off to hospital? To add insult to injury when I got there all they did was pumped me full of morphine, popped me a couple diazepam, referred me to a physio, and gave me a tub of diclofenac sodium to take for the next few days, just like my she asked an out-of-hours doctor to do at home.
And how long were you at A&E for? A GP can take up to 6 hours to attend out of hours in England and guess its similar in Scotland. How would you manage the pain in this time?
Once the GP had assessed you and decided that your diagnosis was correct and needed diamorphine how long would the GP need to stay to make sure the problem resolved, you didn't have respiratory depression and end up having a respiratory arrest leading to cardiac arrest and that's if they had diamorphine really available?
You possibly would have a GP attend that has no orthopaedic knowledge and would probably want an xray to confirm the dislocation and relocation.
In this case I can't imagine any GP would readily manage this at home.
Once the GP had assessed you and decided that your diagnosis was correct and needed diamorphine how long would the GP need to stay to make sure the problem resolved, you didn't have respiratory depression and end up having a respiratory arrest leading to cardiac arrest and that's if they had diamorphine really available?
You possibly would have a GP attend that has no orthopaedic knowledge and would probably want an xray to confirm the dislocation and relocation.
In this case I can't imagine any GP would readily manage this at home.
Lots of place's out of hours doctors would take hour's to turn up.
In North London where I work most A and E's close at 8 to ambulances so all cases go to one hospital. Also there does not appear to be any increase in the current staffing levels. I think this will very quickly turn into the regular waits of 6 /8 hours to be seen if not more. Also several of the departments that close at 8 are due to close completely shortly.
In North London where I work most A and E's close at 8 to ambulances so all cases go to one hospital. Also there does not appear to be any increase in the current staffing levels. I think this will very quickly turn into the regular waits of 6 /8 hours to be seen if not more. Also several of the departments that close at 8 are due to close completely shortly.
Surely they can't rely on the diagnosis of effectively a 3rd party, they would get shot to pieces if they did that and something went wrong. You were in a lot of pain and as a precaution they wanted to get you looked at. I didn't think doctors did home visits these days so it seems like the only option unless you could get in a car somehow and down to the nearest 24 hour drop-in place.
I can't help but think that most people in this situation would have been glad of the relief and impressed that the service was there when they needed it. Typically in my experience the NHS provides the minimum (at least) that is needed, when it is needed, no more, and in my experience no less. People slag it off but it is a remarkable service. Don't intend to turn this into an NHS bashing/praising thread but that is my view.
I can't help but think that most people in this situation would have been glad of the relief and impressed that the service was there when they needed it. Typically in my experience the NHS provides the minimum (at least) that is needed, when it is needed, no more, and in my experience no less. People slag it off but it is a remarkable service. Don't intend to turn this into an NHS bashing/praising thread but that is my view.
Edited by silverous on Thursday 16th May 08:17
OllieC said:
deltaevo16 said:
The reason that this happening, Is political meddling. Why is it each successive governments have to f&ck around with the NHS.
be seen to be doing something ? FWIW, having been recently operated on a one of the press 'black list' hospitals (Stafford) I'd say it works fairly well (now), but there appear to be too many bodies doing bugger all and not enough focus on the very basic fundamentals of patient car- which is, after all, the business this state-backed entity is in.
As for A&E, non-emergency cases need to be told politely, but firmly to GTFO and certainly the system should not be referring any to this expensive, but valuable resource.
IroningMan said:
A&E is overloaded because GPs don't have to provide out-of-hours if they don't want to - consequently the cover they provide is sketchy.
See the contract that the last Government negotiated with GPs for details.
This. And I do wonder if Doctors must share some responsibility for such successful negotiating skills on their part!See the contract that the last Government negotiated with GPs for details.
Digga said:
As for A&E, non-emergency cases need to be told politely, but firmly to GTFO and certainly the system should not be referring any to this expensive, but valuable resource.
it's a great idea, but the reality is by the time the patient is seen by a doctor who can check they really are a non emergency case, you're 90% there. It seems petty to kick them out and send them back to their gp. Also it's easy for me to say whats emergency/non emergency but they don't have the training and knowledge, they just know they need help and are worried. There is stuff which we can't do anything about and do send back to the gp, but it still needs to be seen for that decision to be made.There is a shortage of A&E docs, basically the pay and hours are crap, so they either go to Australia or go into GP.
The demand keeps going up, but we don't get paid for all the work we do, thanks to to government rules to encourage A&E departments to discourage patients from attending ( like we go around asking people to come in) and the amount we get paid per patient was based on the cheapest hospital they could find and ignores all the local factors.
Pay us for what we do, let us charge properly for our time, make the job attractive to go into and if the patients want to come we'll see them promptly 24/7, even if the gps won't
piquet said:
Pay us for what we do, let us charge properly for our time, make the job attractive to go into and if the patients want to come we'll see them promptly 24/7, even if the gps won't
If there weren't so many hangers-on, the NHS would have a bit more to throw at the frontline surely? That's the impression that I (as a 'customer') generally come away with on both emergency or scheduelled visits - would you agree with it?I agree with the OP, he sounds well enough to be helped without an ambulance and A&E, I know people who are calling for the gas and air and a helicopter for the slightest things, some people just go all wobbly - anyone see 24hours in A&E last night? the 3 main cases I remember - an Old Lady with a chest infection, a middle aged lady with a sore back and a small child who'd fallen down some concrete steps with possible brain damage / bleeding on the brain, the first two seemed to consider it a sort of drop-in doctors surgery.
We're pretty lucky in Cardiff, my GP service is in one of the large 'super surgeries' with physios, and specialist nurses, there's a 24 hour OOH GP service based next to A&E, a non-emergency call in clinic at another hospital if you think you'll need x-rays or an admission but you're not all smashed up and bleeding and of course finally A&E. There's even a town centre 'field hospital' at the weekends to keep most of the pissheads out of A&E.
We're pretty lucky in Cardiff, my GP service is in one of the large 'super surgeries' with physios, and specialist nurses, there's a 24 hour OOH GP service based next to A&E, a non-emergency call in clinic at another hospital if you think you'll need x-rays or an admission but you're not all smashed up and bleeding and of course finally A&E. There's even a town centre 'field hospital' at the weekends to keep most of the pissheads out of A&E.
The main reasons from first hand experience.
- Try getting a GP appointment in some areas it's 1-2 weeks! How this doesn't get flagged I will never know. What is the point in a service that doesn't work when you need it to?
- The above leads to ambulances being misused and being sent to inappropriate calls.
- Due to the skill level of Paramedics being held back due to budget/banding issues more patients need to taken to hospital. For example a small skin tear on an elderly patient needs to go to A&E due to paramedics not having wound care training. If they have wound care training then they are entitled to be paid band 6 instead of band 5 pay.
- This in turn leads to beds in A&E being taken up and back logs growing due to lack of staff.
- Alcohol related incidents from either addiction or nights out places massive demand in departments, if you go out and over indulge to the point of being covered in sick and unable to get home, why shouldn't you pay for the ambulance/police/hospital care? On the flip side it's the NHS and free care for all, regardless.
- Try getting a GP appointment in some areas it's 1-2 weeks! How this doesn't get flagged I will never know. What is the point in a service that doesn't work when you need it to?
- The above leads to ambulances being misused and being sent to inappropriate calls.
- Due to the skill level of Paramedics being held back due to budget/banding issues more patients need to taken to hospital. For example a small skin tear on an elderly patient needs to go to A&E due to paramedics not having wound care training. If they have wound care training then they are entitled to be paid band 6 instead of band 5 pay.
- This in turn leads to beds in A&E being taken up and back logs growing due to lack of staff.
- Alcohol related incidents from either addiction or nights out places massive demand in departments, if you go out and over indulge to the point of being covered in sick and unable to get home, why shouldn't you pay for the ambulance/police/hospital care? On the flip side it's the NHS and free care for all, regardless.
Digga said:
f there weren't so many hangers-on, the NHS would have a bit more to throw at the frontline surely? That's the impression that I (as a 'customer') generally come away with on both emergency or scheduelled visits - would you agree with it?
yes and no, ok i should explain thatThe main departmental costs are the nursing budget, followed by the medical staff budget, the true cost of the management is difficult to see as it comes under different budget but i would wager it nowhere near the first two. We need some managers, but we need really good managers, managers with a proven track record, there are too many nurses promoted because they didn't want to work weekends any more. Sorry if that sounds harsh, but we need people who can make decisions and take responsibility if they go wrong, not only if they go right.They need to get if you want to work in healthcare it's a 24/7 job, they can be very difficult to get hold of out of hours. Personally i feel we need to move more clinical staff up to take on a greater responsibility, they're used to making big decisions, they're used to the 24/7 concept. So less better paid, better trained, more experienced managers.
The main reason we have so many of the damn things is we end up worrying about things that don't matter because the politicians keep giving us new targets to hit so they can claim they're making the service better, it's like this treated and discharged from A&E within 4 hours, the 4 hours was plucked out of the air by a committee of non medics, yes patients should be seen promptly, but the effort should be about them being seen promptly not that get them out within this window.
NHS obviously broken, we need a system like the US...
http://www.independent.co.uk/news/world/americas/t...
http://www.independent.co.uk/news/world/americas/t...
People in Rochdale who need A&E at night can either go to Bury, North Manchester or Airedale (near Skipton!) Hospital A&E Departments - these are the three nearest A&Es for the extremities of the Rochdale council area.
There is to be (or might have recently been, it's all gone quiet) a "consultation" on the future of A&Es in Greater Manchester, with the "plan" to trim them down from the original ten (one in each 'town' or 'city' in Gtr Manc) down to 4 A&Es located towards the southern side of the conurbation.
In the Calder Valley, there were two main A&Es - one at Blackburn and one at Burnley. The Burnley A&E was closed some years ago, all casualties must now go to Blackburn (there's a shuttle bus). People have died due to the delay.
Smaller A&Es in Lancashire, such as that at Rossendale Hospital (now fully closed anyway
) in Rawtenstall, have all been closed - people from the Rossendale area must go to Blackburn, Bury or even Airedale to seek A&E intervention.
A&Es bursting at the seams? As another poster alluded to, we ain't seen nothing yet
. The increased transit times to get there won't help survival rates during "the A&E journey" either...
Rant over - the great unwashed really DO need to be educated as to the purpose and role of A&E and when a visit is appropriate
.
Yet I'd guess the OP was "blue lighted" in, as the answer to the question along the lines of "is the patient having difficulty breathing" was positive - but who wouldn't have 'difficulty' (as per the telephone list of questions) breathing if in such agony??
There is to be (or might have recently been, it's all gone quiet) a "consultation" on the future of A&Es in Greater Manchester, with the "plan" to trim them down from the original ten (one in each 'town' or 'city' in Gtr Manc) down to 4 A&Es located towards the southern side of the conurbation.
In the Calder Valley, there were two main A&Es - one at Blackburn and one at Burnley. The Burnley A&E was closed some years ago, all casualties must now go to Blackburn (there's a shuttle bus). People have died due to the delay.
Smaller A&Es in Lancashire, such as that at Rossendale Hospital (now fully closed anyway
) in Rawtenstall, have all been closed - people from the Rossendale area must go to Blackburn, Bury or even Airedale to seek A&E intervention.A&Es bursting at the seams? As another poster alluded to, we ain't seen nothing yet
. The increased transit times to get there won't help survival rates during "the A&E journey" either...Rant over - the great unwashed really DO need to be educated as to the purpose and role of A&E and when a visit is appropriate
.Yet I'd guess the OP was "blue lighted" in, as the answer to the question along the lines of "is the patient having difficulty breathing" was positive - but who wouldn't have 'difficulty' (as per the telephone list of questions) breathing if in such agony??
Maybe a victim of its own success. A&E targets mean there is little wait, so those with minor complaints go there rather than get the runaround from doctors. Although average wait 4 hours seems a long time to me. Perhaps triage should maintain the 4 hr average by seeing those in need straight away but let the time wasters wait 7 hours. Maybe then it won't be an easy option to misuse A&E and local doctors will need to sort their act out.
aw51 121565 said:
the great unwashed really DO need to be educated as to the purpose and role of A&E and when a visit is appropriate .
Yes, if it wasn't for those damn patients it would be perfect. I'm guessing you are both in the public sector and a union member. .The public should not be expected to do triage. They are not qualified.
Gassing Station | News, Politics & Economics | Top of Page | What's New | My Stuff