To think the a&e crisis is largely our own doing

[Diemme]

So much on the news at the moment about unacceptable waiting times in a&e departments. And it always makes me think about the few times I've been to a&e in the past few years, and noticed that the waiting room resembled a social club! Full of people eating, drinking, chatting and walking to and from the toilet, vending machine etc. Aibu to think that educating the public to stop inappropriate a&e attendances would come pretty close to sorting the problem?

I think they are trying but everyone thinks the adverts apply to everyone else.

Problem is that its very hard for some people to get a Drs appt so people go to A&E. Also, jobs that pay by the hour or are zero hour contracts mean that Dr appointments can be expensive. A&E is a cheaper option for some.

I only go when I've been referred by the telephone medical triage/advice service and A&E are actually expecting me.

You could remove all the timewasters from a&e and you would still have problems with underfunding in health and social care which mean there just aren't resources to deal with all the sick people.

Think of people waiting on trolleys for hospital beds. They've been assessed by a&e as requiring hospital beds and they're waiting for those beds, which are full of people who are also judged by the NHS as needing to be there.

That's a factor, but massive understaffing, closure of walk in clinics and other first line services, and lack of recruitment (due to perceived short staffing hence stressful career) has had a much greater impact. Don't underestimate the responsibility Jeremy Hunt bears. It's his job to provide a workable service and he's fine everything to 1. Undermine it and 2. Convince the public it's their fault, so he can privatise without opposition

Done. Not fine

ooh goody more patient blaming.

Maybe if they could get a Dr's appointment?

Maybe if they stopped building buses in every inch if grass whilst simultaneously forgetting to build Dr's and schools etc expecting existing practices to just absorb all the extra patients?

We could also defiantly use more walk in centres ajd minor injury units too.

Posts like this make me feel guilty for taking my son to a&e when he cut his head open even though it need gluing. Maybe I should have just stuck a plaster on and hoped for the best.

Buses
Houses

It is so clever what is being done to the NHS.

Waiting times are high... It's all those time-wasters/smokers/drinkers. If people didn't waste time there would be empty A&E departments with lots of staff. Just make an appointment with your GP. Oh, you can't? That would be time-wasters and smokers and drinkers and those elderly people blocking appointments. The elderly: hold on we can't get decent social care and home care so we get sick and we can't have proper repeat prescriptions so we have to block out the appointments. It must be immigrants (ignoring the fact that without immigrants the NHS would be even more understaffed). Bed blocking, that's the fault of social workers and the elderly again. But there's not social housing... That's those bastards that bought their council homes and the government didn't reinvest the money but don't mention that. Housing? Immigrants again.

There is money, there are committed staff, it's not our fault. The government wants to kill the NHS and for us to blame ourselves and each other.

I've very rarely had to go to A&E but tbh the last time I was there, a couple of years ago, you could probably have looked at me and thought I was a time waster because the nature of my illness was that it wasn't visible on the outside, and wasn't agonisingly painful either. I could quite easily have drunk a vending machine coffee and had a chat with the friend who had taken me there. Didn't mean it wasn't an emergency though - if it hadn't been treated immediately, it could have had life changing (and very expensive to the NHS) consequences.

I don't doubt that lots of people mis-use A&E, it is widely reported. But I don't think anyone can sit in a waiting room and decide who should really be there based on whether or not they can have a chat or a bar of chocolate whilst they wait.

Its a contributory factor, yes, but one very small part of a massive problem.
There are also reasons why some people end up at A&E when they would be better treated elsewhere.

I don't doubt that lots of people mis-use A&E, it is widely reported. But I don't think anyone can sit in a waiting room and decide who should really be there based on whether or not they can have a chat or a bar of chocolate whilst they wait

Given that even when brought in by ambulance the whole process from arriving to a diagnosis to getting a bed can take absolutely hours, majority of people have better things to waste time doing than sitting in a&e

You have been to a & e a few times in the past few years. People, I think we'very found the underlying problem

Some people genuinely see it as a day out and invite the whole family along.

I thought you were going to say who in there right mind votes tory.

It's our ageing population with complex health needs. I had the misfortune to visit a+e twice before Christmas and there were lots of very sick people in corridors on trolleys. Ambulance crews were queuing for some time to check patients in. While my father was having sight saving surgery a healthcare assistant was called away to support another patient. Not enough staff, not enough beds, no room on the wards to transfer patients to, no doubt due to social care shortage.
Strange how we've not heard much about this 7 day NHS recently.

Last time I was in A&E I was walking to the toilet to vomit , not that it would have been obvious. I was taken down after blacking out at my work with abdominal pain. It's quite possible that people are ill enough for urgent care but still able to function relatively normally.

Diemme Mon 09-Jan-17 22:21:01
"So much on the news at the moment about unacceptable waiting times in a&e departments. And it always makes me think about the few times I've been to a&e in the past few years, and noticed that the waiting room resembled a social club! Full of people eating, drinking, chatting and walking to and from the toilet, vending machine etc."

To be fair, there are circumstances under which somebody could be like that and still be in A & E. I was sent to A & E by the walk-in centre the other week: sudden bleeding from where I shouldn't have been bleeding, needed seeing immediately. But I felt perfectly well in myself; it was just that the condition was potentially urgent and serious.

Otoh there have been several other times when I have felt completely shit, not been able to walk without support, no doubt looked like death, but actually only needed a quick check-over by my GP and some antibiotics.

Also, on the occasions when either I or a family member do have serious worries, I tend to go into expansive, pleasant, competent, smiley mode. It's a kind of defence mechanism. I smiled pleasantly throughout my biopsy- and will no doubt go on smiling pleasantly if I am diagnosed with cancer. I'll probably keep on going to go the loo, too (what is the alternative if you get to wait 5 hours in A & E?- they're hardly going to bring a chamber pot to your seat).

We spend less on health care, as a proportion of GDP, than almost every western country. Demographics are aging. Due to developments in treatments, a lots more people with serious chronic illness are surviving longer, but that does cost more. NHS 111 is sending hordes to A&E who probably don't need to be there, but as they're using non-clinicians with computer algorithms, have to play ultra safe. Cuts in social care make it increasingly difficult to discharge people from hospital, making it harder to admit other people from A&E. General practice is in crisis, with not remotely enough GPs to do the job properly. Government imposed insanities are driving more and more clinical staff to retire early, or emigrate, or reduce hours before they have break downs, or just have the break downs, as more and more clinically-irrelevant crap is imposed from on high. Oh, and yes, some people are attending A&E when they shouldn't. But that's not the big cause. It's just one tiny last straw.

Pharmacists, 111 and walk in Centres are better alternatives
Educating the public about appropriate use of GP appointments is also a factor. I know, I work there. Like most GPs we hold a number of " emergency" appointments for booking on the day. These are often filled by people who have forgotten to order their routine medication on time and run out. We are obliged to regularly review patients on repeat medication, and print reminders to book reviews on the prescription. So many just ignore this however then urgently need seeing. The appointment they take up may prevent us seeing the patient with an acute sore throat/ chest infection who then presents to A and E.
Good alternatives when you know it's not really an emergency are pharmacists, 111 or Walk in Centres.

You don't tend to see the unconscious ones out front. 30th December there I walked (slowly) in mid asthma attack. Was out front for about 3 seconds before a reception lady took me to triage then straight to resus without booking in.

So I do agree a big problem but the seriously ill are either coming in by ambulance or getting straight through. Then are in resus/majors so won't be lying around in minors.

Bed blocking a huge issue. No where to move the well but need support at home patients to if nothing in place

Same shit every year.
Managers who can't manage blaming everyone else.

Cool names I agree with you about 111. If it had better funding would be enough money to staff with clinicians rather than call centre handlers. At the moment though, it's what we've got.

nursy1
Yeah. There's an argument that triage is hard, and over the phone triage is incredibly hard, so should be done by the most senior/experienced people...but there's neither the money, nor indeed remotely enough such people, to do that. Because we don't have enough clinical hands on people as it is, without putting them on the phone lines. Years of resourcing dwindling compared to need has been a nightmare.

Of course, it doesn't help that successive governments have provided insufficient resourcing to meet need, and then happily stoked the media up to encourage people to demand want as well. Without, of course, any funding for it. And now....well, if the Secretary of State for health has been appointed to head up the NHS in knowledge that he is co author of a political book describing how to break up the NHS to privatise it...well, basically we're fucked.

Yeah no. I'm a frequent flier, been in A&E > admitted 13 times in the past 14 months. As I sit in Resus I can always see at least 3 ambulance crew waiting with patients. Frequently for over an hour.

The ambulance crew can't leave their patient until they've been handed over.
The patient can't be handed over unt there's space to treat them.
There's no space to treat them until someone else has been discharged or moved up to a ward.
And there's no beds on the wards.

Seriously. I've been put in the Day room in a bed before now because I HAD to be admitted sndbthat was the best they could do. I've had an ITU nurse one to oneing me on an normal ward because there's been no space in ITU for me.

The beds are full of elderly people who basically don't need to be there, but aren't well enough to be discharged home because they're too frail/ill to cope. And there's no spaces in homes, no rehabilitation beds, not enough care for them to be able to go home. So beds that are desperately needed are blocked by the elderly and frail, dementia patients, people who would have been discharged to a convalescent home.

That's what's wrong. No fucking funding for what's really needed. Deliberately.

And then they throw us the sop of more 'investment' in MH, which a) isn't actually investment because it's money taken from elsewhere, and b) they're giving it to secondary school teachers to be trained in MH counselling. Like they don't have enough to do for the pittance they're paid. It's a fucking joke.