How long in a chair in a&e?

[ThisMustBeMyDream]

My DH has been diagnosed with a perforated bowel. We've been in urgent care/a&e since 1pm. He doesn't care if they nurse him on a corridor, but he just wants to lie down. He's in a chair and exhausted and in pain. Lying down relieves the symptoms (he discovered when he had an ecg).
There's no sign of a bed for him. I asked about a trolley - no, none of them.
How long is it acceptable to leave someone in a chair? My head's a shed, can't think straight. I've had a hell of a week with my DF after collapsing and having CPR. He's been diagnosed with encephalitis and it's life changing. So having spent Monday night doing a 3 hour dash to my dad, then 3 days down with him. Coming back home and my DH becoming unwell today... I'm an emotional wreck. I just need a sense check on what's normal.

I have little truck with the NHS but I suspect the issue was that whilst staff like your friend were happy under the old regime, if they and people like them, didn't want to work the less sociable shifts, the hospital was left in a precarious position and the outsourcing resolved that. It would have been potentially more expensive sive just to outsource the unsociable shifts.

The bigger issue is that there are too many trained nurses who don't accept that working nights comes with the job. That creates a circle of poorer care because the gaps have to be filled somehow.

That’s a strange and counter decision to the majority of NHS trusts. There are 100,000 vacancies across all roles, so bank and agency are an important part of the mix. The NHS were going to be prevented from using agency for band 2 and 3 posts, but I’m not sure if that is still happening.

Bank working is pushed hard in most trusts and works well for a lot of people. I used to work with people that only did bank shifts as it worked well for their family and they weren’t wedded to the rota. But agency staff are needed as there usually isn’t enough bank and it fills an urgent need. Without access to bank or agency work many healthcare professionals might leave all together and without them clinics and services would just stop.

There needs to be the right staffing mix, permanent staff are obviously the gold standard as they are able to form teams, increase efficiency, improve morale and obviously are more cost efficient.

We could then talk about all the health professionals falling out of university and on to the unemployed pile. Or the fact they will have paid to train and during their training provided hours and hours of free care….

It’s a big complicated shit show in every direction.

Emergency Departments are the symptom, the bit we witness when we are at our most vulnerable and it is simply unacceptable. If I could pay for emergency care, I would. I’m awaiting surgery that my private consultant is doing 7 weeks from consultation (3 months from initial consultation with a different consultant). He told me I’d be waiting two years on the NHS. Even if I wasn’t insured I’d have to find the money and pay as I can’t work and can’t rot for two years.

My gp's out of hours service can be many miles further away than the nearest a&e and unlike the a&e not really accessible by public transport. So if they get people turning up for non emergencies but needing urgent help who can blame them. Havent needed a&e for years so thankfully no idea how ours is these days.

I know plenty of nurses including a neighbour who prefer nights because it suits them for childcare or whatever. So I think they probably cancel each other out?

I couldn't be paid enough to stay up all night but I'm sure that many registered nurses have done many nights in their time, working in the contexts described in this thread, with no breaks and earned amounts that do not make the toll on their health and personal life worth it.

That's an NHS and employment issue, not a personal failing or selfish quirk of those nurses.

But it's happened and here we are. Are we supposed to spend another 14 years trying to build it back up? With no guarantees? Labour are scratting around for money just to pay for the basics at the moment. Theres not enough money in the pot to touch the sides of the NHS. And let's be honest, the decline of the NHS started way before the Tory government too. It's a poisoned challice that's just being ignored.

A relative was in a chair awaiting surgery for a few hours shy of 4 days earlier this year. It's no longer uncommon unfortunately.

Glad to hear the update, hope all goes well from now on.

It’s easy to say fund it all from opposition, less so when in power as they’re finding out.

My friend's niece has just qualified as a midwife and hasn't managed to secure a job in any of her local and not that local hospitals yet. Apparently they all want staff with experience but how do you get experience without being employed?

Local bank staff were loyal, trained in house and familiar with the local hospital and NHS system. They usually chose bank because of their homelife, caring responsibilities or because they have retired and want to work fewer hours. They usually worked in the same place in the same shift patterns for years. Those who didn't want to be part of a national agency with off site training, different IT and uniforms etc have just left. They can earn similar money in non nursing roles or in lower stress ways in the community. The staff that the agency provides to fill the gaps have to come from much further away and stay in hotels to cover blocks of shifts, they are not familiar with local systems and have no vested interest in the local community.

The maths may work out (seems unlikely, new uniforms, hotels, big call centres, external training firms) but the end result isn't better patient care.

I think using the recruit to train model is likely to help. It’s used in many areas in the nhs, but could be extended along with apprenticeships.

It's appalling. A while back my friend had an infection in her surgical wound following brain surgery and sat in chairs in A&E for 24 hours with brain fluid dripping from her head.

How does it work?

I was traumatised by the care I received when I was poorly about three years ago. I now have health insurance. I wasn't even very poorly, nothing like the experiences others have described but I just felt and still feel actually that there was no one who would help me. The system is completely over loaded. I'm lucky, I can afford private health cover, just about, but I have prioritised it over other things because I was so taken aback by how unsafe the system felt.

Recruit to train means you are recruited as a trainee and employed whilst you train, when not at university / placement you work in the department at a trainee / assistant level. At successful completion of the course you then move to the substantive role. If you don’t pass your course or choose not to continue the course then usually your contact ends.

Recruit to train is (in my experience) paid at the band below the substantive role.

Apprenticeships are similar, but are paid at the apprenticeship rate which is very low and often requires staff to supervise and train in situ. Which is hard when staff are overburdened and potentially could lead to a two tier system of training.

am I missing something?

isnt a perforated bowel classed as a life threatening emergency requiring emergency surgery? And they wanted to send him home on iv abx, conservatively manage (both not okay anyway) and instead left him in a waiting room for over 35 hours?

I think the fact they found him a trolley in majors and hooked him up to abx so quickly when realising he’s still sat there after a senior medic and bed manager got wind of it shows quite clearly someone somewhere down the line has mismanaged this.

I know you work there @ThisMustBeMyDream but the shit needs to hit the fan and you need to be the one to sling it. This is terrible.

The level of emergency will depend on the size and nature of the perforation. It sounds as if he has been scanned, discussed and it is small / local / sealed and currently not leaking massive amounts into his peritoneum so he is fit to wait with iv antibiotics and close monitoring. It needs sorting, but medically he isn’t a right this minute emergency (thank goodness) and other people are. The medical and surgical staff will be making hard decisions about who can wait and who can’t. Who has already waited or been cancelled and will deteriorate (or die) from being put off further.

Unfortunately the NHS has become a place where if you aren’t dying or at risk of loss of function someone else probably is and they come first. It’s not ok.

My housing association sent out a guy to fix my guttering i said it leaks from three parts front and back he said you only get one blob of mastic pick your worse spot so I pointed above the door he fixed that ONE spot i complained i got new guttering front and back

It's not just the NHS

Good God, poor you and your husband. When you get your energy, definitely complain

It's not that there are secret beds that there are a shortcut to, it's just that there are no beds - every ward will have 3-4 additional patients that are placed in a bay where there is no official bedspace e.g. under the window, and the corridors around A&E are still full of patients.

I dont agree with the above. Are you telling me that Starmer, Streeting, Rayner and even the shadow front bench will be found queuing with everyone else?

That's interesting. I lived and worked in France for five years and the standard of care I received over there was phenomenal, for routine, hospital and dental. My experience in the UK is the care is okay when you can actually get through the waiting lists, which are horrific. Six weeks for a GP appointment, a year for a hospital appointment, meanwhile all the problems just get worse to the point where you will never get back to your original baseline. I've been waiting a year for a colorectal appointment for something that causes me a lot of pain, and limits how much I can work. In the end I had to use a lot of my savings to go private as I just couldn't wait any longer.

I have a lot of medic friends and they say the working conditions and wait lists are awful, unless it's a matter of life and death you're screwed.

I think this is part of the problem. NHS consultants are also doing private work which extends the waiting lists causing people's conditions to deteriorate and then end up in A&E in terrible pain. Not judging you for going private, most people would do the same if they could afford it.

Regarding the question about politicians and I guess royals, high net worth individuals etc.

They often do not need accident and emergency as they will have a team of private physicians. So we the people might have trouble accessing primary care for varying reasons and then present to an emergency department when we can’t go on. They instead will have good preventative care and access to private physicians. If they had a trauma though, they’d end up in ED for the most part. There are then security issues which may mean they have to be treated separately.

Consultants are not incentivised to work more hours in the NHS. Consultants have job plans with 10 planned activities, PAs. A PA is 4 hours between 7am and 7pm and 3 hours over night. These hours are either direct clinical care, admin or training (and other bits and pieces). They agree with their manager their job plan and can choose with their manager how they are worked. They must get permission to carry out private work and the trust can tie that into working addition PAs.

Having a system where they can work privately will ease the burden on waiting lists in some ways and should be clear to the trust so they can plan around their availability.

My private surgery means I’m not taking a space in the six month prehab programme, physio, clinic appointments and obviously the surgery and recovery. I have private physio and hydrotherapy that is part covered by insurance and part self funded.

Its all very complicated, but consultant contracts aren’t necessarily the issue, it’s capacity, staff for clinics and theatre, more complex cases (due to the wait time, poor health in the population, older population, more secondary conditions), more admin and everything else.

Our population has grown and the capacity in the system simply hasn’t kept up.

This is so terrible; why can't whoever is in charge of running these places recognise that people's health and injuries can be badly affected by sitting uncomfortably for hours and hours? It's not just that they are getting no treatment, it's that they are being made worse.
I can't sit on an uncomfortable chair for more than an hour without being in quite severe pain and last time I went to A and E I asked permission to lie on the floor, or at least sit on the floor with my back supported by a wall. They found me a trolley within a few minutes. I understand why DH didn't want to do that, but it did work, for future reference, though I hope he gets proper treatment soon.

I was on a waiting list for 18 months for an appointment. When I finally went it was discussed how a lot of the back log is because of lack of suitable space to hold the clinic.