AIBU to wonder what the heck is going on in hospitals right now??

[Rinoachicken]

Before I start, I want to make it clear I am NOT blaming the hospital staff in any way.

13 hospitals have declared state of emergencies or whatever it is.

Why is everyone suddenly descending on A&E all over the country all in the same week? Has there been an outbreak of something I don't know about?

I don't get it. A&E is always stretched to the limit, but Why this sudden crisis all over the country?

Am I missing something??

Rino I guess that would depend on whether it was the timing of appointments that was the problem, or the total number.

I have been to A&E 8 times in 10 years (once for me, 7 times with the children). On 2 occasions visits were in normal GP hours and at advice of GP. 6 were 'out of hours' incidents. Of these 2 would have been prevented by quick access to local GP, other 4 needed hospital treatment. So a shift system of GP's might help A&E a bit but only if there were enough appointments to go round.

I am ex A+E, I'm currently working in the private healthcare sector (such luxuries). I am still friends with many A+E nurses and Drs, GPs, paramedics, ward staff, so have lots of opinions.

I feel one of the main problems is discharging patients. Discharging the elderly can be a nightmare. They may need care packages in place before they can go home, arranging this is a huge huge hassle to ward nurses and very time consuming. The 'system' is awful, you can spend hours phoning different services to be told they don't 'deal with it' or 'you need to speak to X service'. This puts a delay on discharges all around, ward nurse tied up trying to make arrangements=/=ward nurse delayed to see other inpatients. Often their family are reluctant to take them home, even if it's just caring for them for one morning or night before the carers come in.

Staff sickness is at an all time high, this is across the board, everyone has been off with that cold/flu bug that's been going around.

A+E admissions at this time of year tend to be:

• Granny dumps. Care homes and families taking little old Doris to A+E with 'x' (normally nonexistent problem). Doris gets admitted, takes pressure off care home/family over Christmas. Also happens around Easter but less so.
• Falls. Although it's not really been icy down south, it may well be elsewhere. Typically fractured wrists and hips, majority needing admission for surgery to fix this fracture.
• Chest infections, pneumonia, lots of kids with bronch.

Most hospitals HAVE enough beds...they are just full of medically fit patients awaiting discharge.

lljkk it's funny you say that because about 5-6 years ago every junior doctor I worked with was going into General Practice. Now I know them all as working in GP surgeries...many hate it. Of course

Where an older adult has complex care needs,yes there are often delays
The hospital shouldn't necessarily hope or expect families to help out in care for the older adult.as the care needs are often continence,,feeding and self care.also most adult children have their own commitments eg employment that can't accomodate a sudden care need.i get that its an acute medical bed,and bed blocking but it cant be presumed family should pile in .also there an inherent gender assumption that in a family the female can act as carer til care package established

A hospital I worked trialled consultant triage.

Consultant sat in waiting room assessed everyone first. On paper it's a waste of money having a consultant do what a staff nurse can.

However...

Consultant had the authority to send anyone who didn't need to be there home or to an appropriate service.

No waiting time at all during the trial...

Same as when they shut guys poisons in favour of a computer database. If the computer can't answer the question they get admitted or have to wait for a consult, rather than a staff nurse being able to pick up the phone.

This is not helped by the fact when gps conditions were re negotiated they were told you no longer have to work weekends or do call outs

We have almost double the amount of older people useing a&e add drunks to that also add people who can't get to see ther GP as they want to try and having banking hours

Also people missing appointments and immmergants who don't have GPs

Slow news month

Tory cuts; fewer staff

Christmas period.

Nothing new tbh.

And yes, absolutely elderly discharges.

Oh and throw in 111 telling every fucker to go to A&e because it's no longer nurses taking calls it's some random who's been on a two week course

As someone who works in the NHS its because a ridiculous amount of people attend A&E for non emergencies. I have seen people in A&E with a sore finger, a bad cold and sickness and diarrhoea. People turning up at A&E for an xray they could be referred for through their GP, a walk in centre, or a minor injuries unit. Then there's the drunks and drug addicts on the weekends. You have got the mental health patients arriving at A&E because there is nowhere else to take them. NHS direct seem to refer everyone to A&E 'to be safe' and thats why a lot of people believe they should be seen in A&E. NHS Direct air on the side of caution because its near on impossible to correctly 'diagnose' on the phone. We are being stretched to the limit, little recruitment due to constant restructures, budget cuts, and timewasters are the problem. Its not a new issue, its just been raised now. NHS is spiralling out of control and mistakes are going to be made. The team I work with in work very hard and are so frustrated with the constraints on them, its embarassing for someone to sit and wait for 4 hours when we are capable of so much more.

Apologise haven't RTFT
Double bank holiday also means fewer patients being discharged from wards. Fewer beds to put the emergency admission patients into
The rise in Emergency dept attendances also due to normal winter rise plus lack of GP access in double BH weekend

5 years of Condem government. This is not the usual, but I am old enough to have worked in A&E in the 90's (and I believe the 80s were worse) older people waiting on trolleys, ambulances queueing to get in. Back to the dark ages....but with an ageing population.

I work in a small community cottage hospital and think some of this is to do with social cuts also as pps have said. I've only been there since October and I couldn't believe the amount of admissions we had come straight from a&e the 2 weeks over Christmas, we are a rehabilitation unit, aiming to get patients up and home which is pretty much impossible as physios etc are off over Christmas and them there are the ones who have been there for months on end when our aim is 30 days maximum to get patients rehabed and either sent home or into a care home. It really is becoming a 'dumping ground' rather than a step up/down scenario

Our GP surgery has triage nurse, she sees people who ring up with emergency appointments, she then asses if they need to see a GP (and will arrange for them to do so) and it also ahs a walk in clinic every afternoon.

Our nearest walk in hospital units at a weekend or night though are 23 miles in one direction, 48 in another and 43 in the third direction.

DH works in a hospital (not a doctor or nurse and the one he works in have a policy that all A&E patients who are nearing the 4 hour slot get taken to a bed - so they can meet the figures and say all patients are treated within 4 hours

I'm ex A&E and now helping the 111 in Scotland. Considering they can have 600-700 calls in a quiet day, they do a bloody good job. The service can't do right for wrong, we know most things do not need A&E but thanks to the over cautious system that's what happens. As pp have said on here it's generally down to majority of the public using the wrong services.

I've spoken to people that have called ambulances as they were unable to remove false nails! And people that have demanded a doctor out to the house for an annoying itch (and no they didn't have other health problems/issues)

We need to go back to basics and teach people general care. How to deal with coughs, colds etc

A friend's mother (70 & with dementia) was admitted to hospital with sepsis and was in IC and on IV antibiotics. 4 days later, she was deemed well enough to be moved to a care home, not a nursing home, with no accompanying meds or notes at 7pm in the evening. The GP who saw her the next morning said she wasn't well enough to be out of hospital and should in his opinion still have been receiving IV antibiotics as the infection was still very present. She died 3 days later....

The pressures in the hospital system (and a hospital renowned for it's crap decisions and currently in "special measures") had resulted in this seriously unwell lady being discharged too early and whilst there's no way of knowing if it caused her death, it must have been a contributory factor.

Its an election year and the NHS cuts mooted by the Tory party are an election issue.

The NHS is a Labour totem and the people who work in it and especially senior management are deeply politically opposed to any reform. They are in control and declaring an emergency is obviously something that has political impact just before the election. Saving the NHS from cuts is a major Labour theme for the election and lo and behold the emergency appears as if by magic right on cue. We don't have a flu epidemic going on and no really serious bad weather. This could have occurred just by engineering shift patterns over Xmas to create a shortage of staff.

This from Guido Fawkes blog today

"Andy Burnham is gleefully touring the TV studios this morning demanding a summit where he can tell Jeremy Hunt how he “repeatedly warned throughout this Parliament that severe cuts” would cause an A&E crisis. Forget the actual long-term structural causes, this is a political gold mine for Labour…"

Sorry but its just all a bit too well timed and I am deeply cynical of the way the public sector works.

A large part of the problem is that many people use services inappropriately. Nobody has any common sense any more and picks up the phone at the first hint of being not-quite-100%.

You only have to read posts on MN to see "OMG you must go to A&E" with a baby that has puked once or a toddler that has an earache .

If the general population paid more attention to this then it would ease the pressures

I am a practice nurse - we are working 10-12 hour days. The GPs and Nurse Practitioners are working 12-14 hour days. Then it rolls over to Out of Hours (111) who err on the side of caution and make sure EVERYONE is seen, either in an assessment unit, at their GPs within 24 hours (so more pressure on our appointments) or in A&E.

Add in an increasingly elderly, complex and sick population along with the usual winter pressures, bed reductions, staffing problems due to sickness/stress/recruitment difficulties and you've got a recipe for disaster.

Every time they build a replacement hospital or merge hospitals beds are cut because primary care and social care are apparently going to care for everyone so nobody needs to be admitted and patients can have a quick discharge ... And then they cut funding to social and primary care.

Cutting beds and not building big enough car parks are my bug bears every time a new hospital is built.

Social worker for older people here. It's been a frigging nightmare trying to discharge people from hospital. Why? There aren't enough beds in care homes and agencies are at their full capacity and cannot take on any more clients.

This time of year is particularly difficult due to carers not coping, older people have more falls in winter and people are at higher risk of infections. Most of my service user case load are in emergency respite beds or in hospital. We are at crisis point.

Even a simple thing like our computer system causes problems. We have one and health have one. We can't read each other's notes and have you ever tried to speak to anyone on a busy hospital ward? They are so busy caring for patients on under staffed wards that the phones ring and ring. Communication would be 100 times better if we could share notes and information.

There's a very insightful piece here about some of the factors contributing to the crisis, including perverse incentives in the NHS 'internal market', poor links between the NHS and social care, patients being more numerous and more demanding and GPs being less available.

I so agree with Morebeta having had experience of a relative in hospital recently. Relative could have been discharged over the weekend but everyone wanted the consultant to sign off so she waited until he came back Monday morning. Effectively she was ready Saturday but no one wanted to take responsibility.

Nurses were awful (sorry but they were!).

I do wonder if we do need to think about charging (I know not policically correct!). Calling an ambulance for false nails or because you cannot be bothered to fight through the GP system is just an abuse of the service. All these people calling ambulances and complaining they are taking hours to reach them, I know its not relevant in all cases but what stops someone getting in their own car and driving the patient or paying for a taxi? If my DS or DD was in pain I wouldnt necessarily wait for an abulance, I would get in my car, ring a neighbour if I needed extra help etc and just get there!

crumblebumblebee Agreed - father who has dementia problems, but otherwise fit and healthy was being kept in a random ward (heart and lung) while care plan was being sorted (he was to go back to own house with more support) Consultant was despairing too, in the time it was taking, she also had another patient just bed blocking for months while social services sorted something. My dad was a constant distraction to the few nurses there were as he kept walking off and around hospital.

Breakingdad did you not think it was your responsibility to get your father out of there ? I wouldn't leave my parents on a hospital ward if they didn't need to be there.

Unless you have an underlying medical condition flu and a nasty bug are NOT reasons to go to A&E.

Several factors could be looked at, age of population - older ie more likely to need critical care, availability (and skill) of GPs, how many and why are they referring to A&E?

Availability of community care, my sister was involved in patient discharge and said often they could not move people on - bed blockers - because there was not an appropriate package of care in place for them.

Agree re using an ambulance, a friend posted on facebook about their child breaking an arm skateboarding and they called an ambulance, unless the child was unconscious a trip in the car (15 mins from their house to hospital) would have been quicker!!

Internal systems: I had a suspected fracture, saw a triage nurse, waited for about two hours and then saw a doctor who said it would need an x-ray. I could have told them that!! Why didn't the nurse get that organised (she can't as it is ionising radiation and only a doctor can permit that apparently) so by the time I saw the doctor he would have had the films and been able to say what was wrong.