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?

As for GP appointments for meds - quite often if you ring up there are none available to book for 4 weeks and can't book more than 4 weeks in advance - how can people schedule in routine appointments for meds checks when there are none?!

@BravoPanda

Ah, so that is not normal? Maybe they were particularly understaffed that day. I thought it seemed a little odd!

Experts from the Royal College of Emergency Medicine say that removing time wasters will do nothing to alleviate the pressure the NHS is under.
They are seeing much more ill patients who are elderly, with complex needs. The social care system is a mess which is putting huge pressure on the NHS.
Blaming the public for going to A&E is just a tactic used by Hunt to divert attention from the real problems, including chronic underfunding

This really pisses me off.

First of all, the NHS is free at the point of delivery. It is not a 'free' service: people pay national insurance to cover it. The resources should be there as shitloads of money goes into the national insurance pot. Where is the cash going? Thinktanks? Management? Someone's pockets?

Secondly, every time I see a 'should I go to a&e?' thread I can't stand all the 'you're wasting resources' comments. The services are there to be used. If you get to a&e you will be assessed by the triage nurse. If they think you could be dealt with elsewhere, they will send you off there. If they send you into a&e that's because you need to be there. If you are unsure about whether you should go, you phone 111. The system is a flowchart of questions that start off serious (eg is the person bleeding badly) and gradually get to the crux of the matter. If the problem can't be solved by an out of hours doctor or at home, or is something that you can't wait with, then you get advised to go to a&e.

Thirdly, the NHS is not just the a&e department. There are surgeries, hospitals, out of hours doctors, community nurses, outpatient facilities. If a&e is taking on the burden of other services, it's because the other services are failing. Not because people should't get ill.

This is a government issue. An NHS trust has targets to reach, set by the government. If the targets are not reached, then they get LESS money next budget. LESS MONEY!!! Anybody with half a brain knows this will make whatever problems they have worse. So their ambulances are always late? Give them less money - that will help them sort it out NOT. This is a plan put in action back in the thatcher era and continued ever since to scupper the NHS and force privatisation. That's what is failing the NHS. Not the sick people who get directed to the wrong service.

This argument is very similar to the whole austerity argument, which is to blame 'the poor' (haven't heard people called that since pre-war) and not the superrich/the system that keeps them poor and exploitable.

Stop blaming the wrong people. Yes there are probably lots of drink related injuries and mental health issues, but these people are still sick and need help. People chatting away on 24 hours in a&e - so what?! Unless you are unconscious you can still have an emergency injury but still be able to chat. If the triage nurse thinks it can be dealt with elsewhere, they will send you off elsewhere.

I think the Government want you to think that, but as a Bed Manager who's job it is to maintain the 4 hour target at a small DGH I can say that hardly any of our long waits are caused by unnecessary A&E attenders.
In fact, as the numbers are worked out as a percentage across the day it's actually the patients that are seen and sorted quickly who boost the numbers!

Our main delays are caused by chronic bed shortages, waiting for transport to other hospitals and poorly patients that are just too ill to move on in less than 4 hours.

I'm not saying that people don't attend A&E unnecessarily when they could see their GP or pharmacist but they are not responsible for the NHS meltdown every winter.

There are lots of answers on how to fix the system. Trouble is, do the government want to fix it? Because that is the bottomline here. Speak to any nurse/consultant/doctor and they can tell you what the main issues are and what needs to be done to fix them. There is no secret. Yet the gov still allow the blame to be redirected to patients themselves. No one goes to a&e for a jolly. They go because they need help. Even those who have no physical symptom, they are going because they have a mental health issue.

Our main delays are caused by chronic bed shortages, waiting for transport to other hospitals and poorly patients that are just too ill to move on in less than 4 hours

I think also the fact that you can be cleared to go at 10am and still waiting around to be able to leave despite having your own lot of prescription meds with you several hours later doesn't help either.

I actually left once and sent someone back fir the medication Cos I'd been hanging around all day waiting fir some iron tablets. Ffs hand me the script I'll get them from the pharmacy that's 5 mins from my house

we really need to educate the public a lot better if someone thinks being seriously ill means they have to stop eating, drinking or talking. Of course this is BU.

Fund the NHS better and treat hard working professionals with a bit more respect and there wouldnt be these problems. But of course there are a few people who dont need to be there - Jeremy could have gone to his private gp with his sick children.

I think that if children are running around an A&E, they probably shouldn't be there

Looks can be deceiving. When ds1 was 3 he suddenly doubled over one afternoon clutching his stomach and screaming in pain. It took about a minute of this for me to make the call to take him to A&E and he was rushed straight in. On the way he vomited continuously because he was in so much pain and looked on the point of passing out.

When we got there he saw a paed straight away who took one look at him and gave him a nasal shot of morphine. It took less than 5 minutes and he was then up and playing as the pain was gone.

When we were waiting for bloods to come back to check for appendicitis etc, they put us back in the waiting room - and you would have seen a boisterous 4 year old playing and laughing, apparently fine. Half an hour before that he was vomiting and near passing out because of the level of pain he'd been in but you'd never have known.

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You say that people assessed by a triage nurse and then sent elsewhere if appropriate.
That simply does not happen here. Where else are they sent in your area?
Ooh GP service is totally inadequate. Our OOH refuse to do home visits, you have to go to a clinic at our hospital, or in one instance for us recently the hospital in the next town at 10 at night with a sick child - actually drove past our A&E and was tempted!
My mum who is largely housebound recently requested an OOH appointment on a Saturday at 2pm via 111. She was told she would be called back within 2 hours. Despite repeated calls a GP eventually came 19 HOURS LATER!! We kept phoning to be told that if it was urgent to go to A&E, she was in too much discomfort to get in the car so that would have involved an ambulance as well.
Unfortunately in this area at least there is nowhere else to "send" people at the moment. Don't even get me started on general GP appointments!!

I think that if children are running around an A&E, they probably shouldn't be there

Ha clearly never seen a child on pred

Been to a&e 4 times in the last year.. one time I was drinking almost continuously and drank a few pints of juice while I waited. 2nd time unless I got up and walked you wouldn't think anything was wrong. 3rd time I was lying over the chairs in the waiting room and when I tried to go to the loo I collapsed. 4th time I was drinking, chatting, H was eating, talking about going into work later.. it was the fourth time that I was most seriously ill although I hadn't realised. Think the docs thought I was a bit of a time waster too until they got my bloods back.. attitudes changed pretty quickly!

When I was on the ward out of four beds I was the only one receiving actual treatment for the whole of my stay. The other three patients were bed blocked and were waiting on social care reports, care plans, places in residential settings etc. The problem is so much deeper than what can be judged from a waiting room snapshot

DD2 had severe asthma as a child, but was a 'happy wheezer', ie she'd be happily running around and playing with sats that would have floored someone else, plus she never actually wheezed (same as me), but she 100% needdd to be there, and was always triaged v quickly.

However some of the hospital policies don't seem very well thought out. When I was pregnant with both of my children I had HG and was very very sick. Every few weeks the dehydration got so bad that I needed IV treatment in hospital. I was told that I absolutely had to go through A&E instead of coming to the gynae building even though i knew from experience that I would be sped through triage and admitted to the gynae ward for treatment just like every other time. Because of the layout of the hospital you have to walk outside for a few minutes across little roads etc to get to different parts of it. If you're admitted through A&E you have to be taken to which ever building you need by two porters in a tiny little ambulance.

I always felt so guilty about wasting everyone's time. It would have been so much more efficient for me to have just gone to the gynae building in the first place but they just wouldn't allow it. That's 1x triage nurse, 2-3x A&E staff and 2x porters time I had been forced to waste. Not to mention all the people working in the background doing blood tests and what not. The A&E bed and bay I was in would have to be cleaned as well as the ambulance.

Blaming other people for being feckless is much easier than looking to your own contribution (or lack of it) to the political landscape which is causing the collapse of the NHS.

Lost the first part of my post

*Our A&E seems to be well triaged and everyone in the waiting room usually looks like they actually need medical attention. However some of the hospital policies....

It seems obvious that the pressure has been put on primary services for years. As they creak and fail, the problem is pushed further and further into the NHS until the buck stops with A&E.
People who could see their GP but can't get an appointment for weeks.
People who could go to the MIU but it's only available in office hours.
People who got sent by the 111 script.
Undoubtedly there are people misusing the system but a bit of triage would sort that out if the system worked.
Make General Practice attractive. Sort out social care etc etc. More MIUs, open longer.
Our OOH unit takes forever to access but on almost every occasion we've used it, it's been deserted.

My husband was rushed to a London a & e during working day.

The doctor that saw him said he was the first person he had seen on that shift who was not there due to a drug related issue.

Not sure can be done about that. But it was an interesting observation.

A&E should only be for life and death cases. A&E departments in London for example have too long propped up failing GP/urgent care/sexual health clinics (not the case everywhere, where I am for example). Local A&E for example now tells patients waiting for morning after pills that they will not be seen. I was kind of shocked by that - couldn't believe some people went to A&E for thar

In my whole life I went to A&E twice: once when my GP referred me for what seemed like appendicitis but was actually gall stones. And another time when I had what seemed like a heart attack in a shopping centre that even had the paramedic called in stumped as my bp was through the roof- and eventually after a number of tests I was diagnosed with anxiety attacks.

I haven't used A&E in any other capacity. Will always go to Urgent Care/GP/pharmacist first.

I can support some of the criticism of 111.

I have asthma which makes me prone to chest infections. I got one out of hours. In the past our GP OOH service was run by the local PCT but now it has been transferred to 111. Rang 111 looking to see a GP. "Have you got chest pain?" "Yes - it's a chest infection". They wanted to send an ambulance! It took a lot of work to persuade them that all I wanted was a telephone consultation with a GP who could start me on antibiotics.

"A&E should only be for life and death cases."

I thought we were supposed to go to A&E in the event of, e.g. a broken arm or leg? Those aren't life-threatening?

I've said this before, but I think we need a combination of funds invested in elderly/social care, GPs sited in A&E, and charges/fines for the off-your-face-Friday brigade, who need to go somewhere else rather than clog up A&E.

There was a letter in today's Times that setting up a "drunk tank" in Cardiff substantially reduced A&E attendance on weekends and got the police back out on the street quickly rather than hanging out in A&E supervising drunks.

holly yes plus as shown by DailyFail's subsequent post, it's hard to tell what is and isn't 'life or death'. With education, support and an understanding of alternatives that might be easier to determine.

I thought pharmacists could give out MAPs.

"A&E should only be for life and death cases."

That doesn't make any sense. DD had a bead up her nose. I didn't want to go to A&E but was told to go, they took her in immediately when we arrived & fished bead out so we were on our way. It wasn't going to be life or death until the bead went into her lungs.

Or when someone needs an x-ray to assess severity of a break, many people can't go to MIUs (none around) so A&E is the place, even if the break isn't life-threatening.