To wonder why A&E seems to be designed to be the worst possible place you could possibly be when ill?

In 2009 I had a fall at my caravan & broke my leg, exh rang 999 as he was scared he would do more damage moving me. The ambulance turned up within 5 minutes, I was taken straight to Xray when I arrived at the hospital, then seen by a doctor & sent to have a backslab pot put on. I was sent home with my Xrays on a disk to take to the hospital when I went home & a letter saying my diagnosis & treatment, given painkillers to take away, no waiting all done one after the other. I fell at 7.25pm, Ambulance was there by 7.37pm, at the hospital by 7.45pm & tucked up in bed back at the caravan before 10.00pm. The very efficient A & E was closed down in 2011, leaving ambulances having to travel 25 miles to Mansfield, this is supposed to be progress. Every time we had to use Newark hospital, it was well run, efficient, clean & patients got treated with kindness & respect. We had been before for exh having a heart attack & me having a miscarriage, exh as an inpatient couldn't praise the hospital enough, they had their own allotments to grow fruit & veg to feed patients, the meals wouldn't have looked out of place in a restaurant.

I know it seems mad with staff not seeming to do anything, but if they did then flow stops - everything is running over capacity so if any staff member stops in the waiting room to assess anyone there then they're not seeing the patients that have already waited x hours in the room and it was finally their turn to be assessed. Also it's not set up to assess someone in the waiting room, you'd need to bring the equipment through to 'check them out' and to do it properly you need to take a whole history etc - so effectively you now need to move them to be seen next - but now if you do that then the only people who'll get seen are the ones who collapse, be it genuine exhaustion/illness, or genuinely reasonable complete frustration with how long it is to be seen.

Also, and this will sound really cruel/heartless. But you just become accustomed to seeing people who are really quite unwell. Really the only people who should be there are the ones who are quite unwell. When you work in that environment seeing quite unwell people is just normal. For most patients going to A&E will be a persons absolute low point of their year/life. For staff it's just Thursday.

You have to detach yourself a bit as well from it all otherwise you just end up angry (because you're struggling to get to those that really need help/are really sick/yet not sick enough to bring into resus). It's really really hard not to get absolutely rageful at the overwhelming number of people who are there who for one reason or another shouldn't be there/you know they will garner no benefit from their attendance at A&E - because going through the process you have to go through is part of the reason why there's such a long queue in the first place.

The perfect example is back pain - the amount of people who come in "i've had lower back pain for x months/years now and my GP isn't doing anything about it, just keeps telling me to goto physio and take paracetamol. I need a scan" - Essentially I already know they're going to be in the department for 12-18hours taking up a seat for best part of the day, they wont get any scan, they will be told to go back to their GP/physio, maybe given a short script for naproxen or codeine (commonly available from GP for short term use), if the clinician is keen they'll go through so weight loss/exercise/lifestyle advice with you. But that's a seat they're sat in the whole day. That's clinical time revisiting the same symptoms and history that they've already told their GP, answering the same red flag questions the GP will have already screened for, even if the A&E staff think hmmm this could actually be cancer - there's still no scan done on the day, just the same referral a GP makes.

When there's a consultant on the front door it can be more efficient - a decent % of patients just get turned away/refused assessment in the first place, but that's pretty rare these days as it takes away that senior cover for the rest of the department. It comes in every now and again because a consultant has the knowledge and clout to make those decisions quickly as opposed to the rest of the staff who need to go through the motions (i.e most of the Drs working in A&E won't be anywhere near as experienced as your GP is, rotating in and out every few months and could well be newly qualified fresh from med school

honestly, if you would think it was a war hospital
This is the absolute truth. I was in A&E recently when my mum fell down and broke her knee. It was full of very unwell people who were just being ignored. People were passing out from waiting so long, and the staff were just picking them up and putting them back in the chair. One elderly lady keeled over and hit her head, and the staff attitude was just “oh aren’t you silly” and they sat her down to wait another few hours. There was no food or drink available (not even a water tap). No blankets. Nowhere to charge a phone. No wifi. People were picking up other people and trying to help them because the staff weren’t doing anything.

Psst don’t tell anyone, but the Mayo Clinic accepts Medicare and Medicaid so that means a pensioner or a poor person will get treated right along side of a prince or celebrity.

A & E may not have changed, but certain things have which makes everything much worse. I have been fortunate enough to have not had anything much wrong in years.
When, about 25 years ago, I had horrendous stomach pain, I got an emergency appointment with my GP. She suspected appendicitis, so she called the hospital, informing them of my case. Phoned an ambulance for me which picked me up from my home. I didn't have to go through A&E as doctor had called ahead, they were expecting me and knew what they were looking at. I was assessed in a ward and operated on that night.
Now, the GP is effectively out of the equation. Emergency GPs don't seem to really exist out of hours. You have to ring 111 and mostly they will direct you to A&E. Even if it's in hours and you get an appointment, if hospital is an immediate necessity, it seems to be A&E. No contact between the doctor and the hospital.
The occasions I have heard when people ring 111 and they suggest a doctor, but it's on a weekend, they say a doctor will telephone you. You wait hours for it, then the doctor invariably advised ambulance/A&E.
At one time, unless it was a serious accident, or something that had the appearance of a stroke/heart attack, you couldn't breathe or were unconscious,your first point of contact was your GP. And it would BE your GP or at least someone from the practice you were registered with because they used to take it in turns doing out of hours. Your GP would effectively be triaging you, then call the ambulance. Because your GP was in charge, they spoke to the hospital, gave them the information so you could go straight to the necessary department.
My mum thought I might have meningitis once when I was a child. This was in the night. Severe temperature, very stiff neck. Today, she would be driving me to A&E. Then, her first call was to the doctor, who came to our home, told my mum it was more likely a virus, but call again if I got certain other symptoms.
A&E is overloaded because the patients are having to make the decision to go because there isn't any other option more often than not. Mums with babies with temperatures are sitting in A&E because it's Saturday and they can't speak to a doctor and 111 sent them there. And you really aren't going to wait with a sick baby until Monday.
Countless people who could have been assessed by their GP are in A&E because they can't get to see their GP in a timely way. People are treating paramedics like they once treated their emergency GP, because there doesn't seem to be any such thing as an emergency GP.
No wonder A&E is so terrible. Too many people end up there who could have been seen by a GP, but there isn't a GP available to see.

I went to the Mayo Clinic in Minnesota once with a friend who was having some minor surgery.

It was like an upmarket hotel!

Squashy chairs, rugs, a little museum and a bookstore/post office. Artwork.

This was back in the 1990s when NHS hospitals were even mankier than some of them are now. I thought I was dreaming!

Maybe Wes Streeting should have a read of this thread in case he's not aware of just how bad things are. Or maybe we just accept that it's chance, not need, that gets you the correct diagnosis and treatment.

My DH, DS and I have all had first hand experience of sub-standard A&E 'care' in the past few years. I even diagnosed my son's appendicitis from 150 miles away after he'd been sent home with a 'urinary infection' having waited hours and being given a cursory examination. He had so many text book symptoms the cleaner could have probably made a good guess. Of course, his situation was made much worse by the delay and his stay in hospital was longer. I'm just glad I insisted he went back as he was naively believing their tosh. This was at leading teaching hospital.

The pressure on the system is unsustainable. However, there are ways to relieve that pressure. Over 20 yrs ago in our area we had a walk in centre, if you couldn't get an appointment at your GP, you could go to the walk in and wait in line. Our walk in was brilliant, it could glue small wounds, butterfly stitch, it had an x-ray machine so could check ankles/ wrists/ arms/legs, it could prescribe most medicines. It went a long way to taking the pressure off a+e, it was shut in 2014 and now all those people are at A+E.

Again, about 20 years ago the nurses at our GP surgery could also glue or stitch minor cuts. Now you have to go to a+e for that.

My childhood town growing up, my husband's childhood town and my current town all had small hospitals. They had maternity wards, had X-ray machines, performed some minor surgeries, had a minor injuries section. All 3 have disappeared and we are all funneled to the big hospital in the bigger town.

We really really need to get these smaller but significant pressure relievers back up and running. With the govt wishing to build on every inch of land it's time that most medium sized towns had their own hospitals again.

We also really need to look at social care and elderly care. It's going to be incredibly expensive to sort out or need vast reform and therefore need the political will to do so.

I actually dont think it is that deliberate. The people who build hospitals are not the same people who actually work in them. IME there is not a lot of communication between the two groups.

I remember going with a relative who was having a serious medical emergency and it was awful. My relative was very ill and taken straight into treatment where there was not a single chair to sit on or drink of water to be had. I'd been on my feet at work all day and having to spend the entire night in hospital in such physical discomfort made a horrible situation even more stressful and decision-making even harder.

I later accompanied a friend who'd had an accident to a different hospital. She waited for hours, bleeding and in terrible pain, before being seen but what really shocked me was a woman who was in agony and obviously in a very bad way (I reckon she had sepsis or peritonitis from things I overheard) being left to lie across several uncomfortable hard plastic chairs for hours. The staff just seemed so indifferent to her suffering.

The most obvious solution is to staff and have information for everyone about a) GP services 24/7 and not closed on weekends and unable to issue basic prescriptions b) Minor Injuries with scanning machines to siphon off a good proportion of the next level up of sprains, possible fractures, cuts and so and then c) leave A and E for more serious cases. You cannot blame people who can't get care within the system for going to the only place in the system they can get care- in fact, 111 tell you to go to A and E all the time because there's nowhere else to send you. It is not the fault of the patients that they need to seek medical care, there are some time-wasters but these are vastly outstripped by the people who do need medical attention and can't get it within the current system except there.

The trouble is that our local A&E is so awful that I would definitely put off going unless I was I really bad pain, it just puts people off going that really should be going!
Last time I went to pick up my father in law from there, the corridor in A&E was rammed with mostly old people in various states of undress, looking really sad 😔 I got a lady some water who was thirsty and helped another lady put her jumper on (she was cold, with no blanket)
honestly, if you would think it was a war hospital, staff running around completely frazzled.
I can’t ever remember things this bad

@Alifemoreordinary123

I think some are missing the point - it’s designed to deter people from going! ED was intended to provided resus / emergency care for really sick people. Only around 20% of those attending ED fit that bill"

Exactly- because it is free at the point use demand will always outstrip supply - which is managed by queuing. Abit like how in communist countries where say bread was heavily subsidised in price - this meant the demand was way higher than supply which was managed by queuing and only those that had the time to queue got bread. Whereas in capitalist countries the price would rise until supply meets demand and only those that can afford it get bread.

If you made the entire A&E process more pleasant then even more people with available time would go along to A&E making the queues even worse.

What I find bonkers about A&E is that absolutely everyone is channeled through it. When my dad was late stage cancer the consultant decided he needed to be admitted - but he had to go though A&E. just why? The consultant had made the decision, surely my dad could just have been sent to the cancer ward on his say so?

As it was my mum had to queue for half an hour outside the hospital in the rain to even put his name down. No wonder A&E is full to bursting since it appears massively inefficient.

Too right! Minutes really matter if there's any nerve or vascular compromise in a hand.

I attended a 19year old quite recently who amputated his thumb climbing over a fence to retrieve a ball - really cleanly done - looked like it had been surgically cut off (so a lot easier for surgeons to reattach). But he'd waited just over 2 hours in the heat for us (ambulance service in a city) to attend. Several of his friends there had cars.

All I did was walk him to my ambulance car and drove him to A&E, I had a quick conversation with one of the Doctors ?whether it could still be reattached - the answer was no not viable anymore - so he got put in the waiting room to wait for wound closure essentially.

If they hadn't waited, just done what I'm fairly certain anyone 10-20 years ago would have done (put the thumb in a bag/cinefilm then in something cold - then gone straight to A&E hand in tea towel likelihood is he might still have a thumb - now he's spending the rest of his life without it because he delayed getting care! Such a waste. His partner followed us in a car for goodness sake!

I did want point this out to him (which I'm sure would have been received as a telling off/shouting or something), purely out of frustration for how stupid the whole thing was, he could have avoided a lifelong disability (I know there's quite a lot worse, but missing a thumb will definitely have consequence). But just felt what's the point...

I think some are missing the point - it’s designed to deter people from going! ED was intended to provided resus / emergency care for really sick people. Only around 20% of those attending ED fit that bill. Unfortunately, the rest of the system (general practice, pharmacies, community services, diagnostic services) haven’t got enough capacity, or were not designed, to meet these other needs hence we all tend to revert to ED.

What’s the bank idea?

You find a chair and let’s see your idea.

The temperature?! No one’s ever going to be universally happy with the temperature.

I agree that in your situation you are definitely in a better place here than you would be in the US. But that's because you have a diagnosis. In my experience once you have a diagnosis the NHS is usually pretty good. It's the getting there that's the problem. So many people can't get seen or do get seen and get dismissed. I personally know a few young or youngish people who have very sadly died because they couldn't get anyone wrong take them seriously until things were too far gone.

I don't think that is actually reasonable. I always hear about these "family days out" at A and E but I've never witnessed it.
I did accompany my nan WITH my dad once. She was very VERY unwell and actually died in A and E a few hours later. My poor dad was her only child and was too distraught to be on his own trying to deal with everything after having found her collapsed at home. Neither of us took up seats, we were both sat on the floor in the corridor outside resus and frankly if anyone had tried to enforce a "one companion" rule I'd have told them where to stick it.

Part of the excessive times is the complexity they're expected to manage now. Conditions which people would have been referred and managed by specialist teams before it got to A&E stage are now exacerbating waiting for diagnosis under a team.

i.e. if you goto A&E with the traditional - i've fallen over and twisted my wrist it's really sore ?fracture - clear assessment plan easy to get done/diagnosed. I've got chest pain worried I'm having a heart attack - also relatively simple for an A&E. However what they're now getting is lots of complex multimorbid patients - I've been having abdominal pain for 6 years, i've been trialled on x treatments, had mri, us, bloods, they thought it was this, then not sure, then be referred to this specialist team not heard anything for 6 months now - these symptoms have gotten really bad the last few weeks and I can't cope anymore so here for help.... There's no short cut to jump the queue for the specialist so that probably still wont happen, but now the A&E team have to run multiple different tests to consider lots of different dx, they won't have the specialism of the Drs you're waiting to see, they probably won't be able to work out what the cause is so ends to time being a diagnostic factor - run x tests, then run them again x hours later - no change then discharge back to GP. It kinda works because A&E really only need to know if it's something that needs immediate treatment/surgical emergency - if there's no change over a long time period then likely not and whilst the cause is still not properly diagnosed everyone is happy it's not an emergency and you can go home. But because you're never admitted that most likely means waiting in the WR...

I know that now

Fingers and hands is the one thing you can't leave until later. It is an emergency.

I'd dislocated a finger and leaving it made it harder to put it back, causing ligament damage. The nurse shouted at me for being so stupid and not going straightaway. She was right, I still can't bend it and am having regular physio 2 months later, but at the time, it seemed sensible (to me) to wait until I could find out if there was an alternative to A&E.

@SleepyRich I know its been a while. The Conservatives destroyed the NHS.