To think this is a fucking joke - A@E wait?

[CanNeverThinkOfAName]

So our local hospital serves 350,000 residents from a large area.

Arrived at A&E at 11pm. Expected it to be packed and to have a long wait. There were around 15 patients waiting. At 3am there were 4 still in the waiting area plus us.

From that time only one person has been called to see a doctor and at least 10 people have gone out after being seen.

Ambulance staff check patients in near where we are sitting and only 3 have checked in since we got here.

Obviously not a busy night.

AIBU to think this is totally piss take and the staff must be on a bloody go slow or something?

Absolutely this.

Make no mistake: the Government can afford to pay the junior doctors what they're asking. The opposition to paying junior doctors more is driven by ideology.

@houseydnc

After my NHS emcs in Nov I stayed on ward for 24 hours and there was a system whereby my meds were in a little safe in my cubicle, I was given a chart and a pen, and I dispensed them myself when they were due.

This meant I had all of my meds when needed, without taking up the midwife's time.

I wonder if this will soon be commonplace as leaving these women without pain meds is horrendous, as you say.

@NotQuiteHere i don’t really understand your question, but my comment related to someone saying that A&E is often used inappropriately. Surely you can see that if A&E doctors are seeing patients who neither have an accident nor an emergency, then the system will become overwhelmed?

They do have emergencies going on behind the scenes. If you have to wait most of the time it means it’s not life threatening.
Haven't RFT but hope everything’s ok.

@CanNeverThinkOfAName - emergencies don’t just happen in A&E, though - it could be that patients in ICU - or on any ward, in fact - have suddenly crashed, and all the available doctors are dealing with those emergencies. Or that the patients you have seen admitted are requiring a lot of staff to treat them.

It is awful that a patient in such pain as your dd is having to wait, but this is because successive governments have cut NHS resources to the bone, and then carried on cutting.

I hope she is seen soon.

I work in the NHS (mental health) as does my mum (RN).

Blaming the staff themselves is not ok or helpful.

But equally, blaming the patients and telling them to just sit down and shut the fuck up and be grateful for shit service - is also not ok.

Both have been represented on this thread.

We should not be normalising and accepting staff having to work at unsafe ratios for too long hours without adequate breaks.

We should also not be normalising or accepting of 10hr waits with minimal or no intervention or care while you wait, to the point where people are DYING in their seats waiting.

The system is broken - imo it’s now beyond repair. The problem is it’s not just the NHS acute services that are broken - it’s all the services surrounding that, that enable it to function (or not) - primary and secondary care services, community services, social care services, mental health services, ambulance and police services - in a well
funded world, they are adequately funding individually and are able to connect and support each other as they should - sharing the load - but all have been equally systematically destroyed by this government for so long they are no longer functioning even in an individual level - all of these services are fighting for their very survival and having to pull back to the bare minimum, they are no longer able to work together and support each other.

It’s not falling apart - it’s already fallen - and the sooner we all stop fighting about whose fault it is (it’s the governments!!) and start having proper discussions about wtf we don now and next to build a new and functioning system that still works for everyone in society the better. I don’t know what that solution is - but the current system is already dead - we need to start thinking about what happens next.

Ive had a couple of different experiences at A&E, with my son sat in a chair for 2 days on drip etc as no beds and long waits (which is absolutely all down to funding and local care out of hospital to free up beds in some cases) and recently myself, went to gp as felt breathless and really not myself (post long haul flight) so referred to A&E, chest x rays clear but the dr was incredible and said I have a gut feeling something isn’t right so more bloods to check for clots, came back positive so scan and blood clots in lung identified. It was super busy, everyone I met was just bloody lovely in the circumstances whilst under a clear obscene amount of pressure, I did wait about 6 hours total but super impressed with all these people working in a detrimentally underfunded area and doing their best.
Despite the government quite clearly on a mission to continue to screw over the NHS I would gladly pay an extra £20 a month in my tax with the guarantee that the £20 goes directly to the NHS and pretty sure a lot more people would do the same on top of the paltry amount they currently have.

I try to sew a and e as a conveyer belt where there are say 10 stops each of these stops need a dr and at each stop someone could need help more or there may not be a dr on their stop going to another stop and there could be a clog of patients at any point waiting for the next point. Just because you can't physically see the belt doesn't mean there isn't one. And like all machines sometimes works better than other times

The ward need not be unstaffed. In the case I witnessed, four nurses were griping loudly about 'starving' and doing absolutely nothing fifteen feet away from the poor soul whose surgery was repeatedly postponed. Nobody told him that a decision had already been made to delay matters, he was simply left hanging.
They were just very poor at their jobs with no sense of empathy or respect for patients.

I used to work in a hospital ward where patients all had their own rooms.

On a few occasions we’d hear visitors remarking to each other that their’s “not a nurse in sight” … “it must be really quiet “ , or “They must be dinking tea somewhere “

In fact, nursing staff were out of sight, busy attending to patients in their single rooms ! Invariably, we’d be short staffed and under a lot of pressures and to hear people not in the know say things like that felt like a slap in the face.

The patients in their single rooms also would comment on how “quiet” it is today because they couldn’t see or hear much from their rooms.

To those who’ve never worked in a hospital, let alone A&E, it’s not wise to making broad assumptions !
You just have no idea !

Oh right so all NHS should work 13 hr shifts without food or breaks because you made a judgement about 4 nurses. Seems a bit disproportionate.

@ApiratesaysYarrr private healthcare is moving into emergency care though, because they have to. The performance of the NHS being poor also impacts the cost of private healthcare - late referrals means the cost of a claim is increasing.

All Private healthcare firms now offer first line agP services and the first round of private urgent care is opening up in London.

In ten years that will be national and the nhs will be reduced to tertiary care and research. All very valuable, but that's what's happening.

The cost meds will be based on which big pharmaceutical is supplying which hospital, and deals done direct with insurers.

Thank you so much for that. The current situation is despite Tory governments spending nearly two thousand BILLION pounds since 2010. Doubtless, many billions have been siphoned off through privatisation and pet projects that don't improve outcomes but it's not for the want of taxpayer contributions.
It would be lovely to see a focus on just one ward, anywhere in the country to be run perfectly, to learn what is or isn't appropriate in 2024. Having been an in-patient several times in 2023, what was required from the hospital was sixty or seventy actions to take place sequentially, in a timely manner; obs, tests, x-rays, medication, meals through to discharge. I have yet to be on a ward where the specified care was able to be delivered as outlined by doctors.

They are on their unpaid break. They aren’t being paid to do anything and most staff I work with don’t take half their breaks due to pt workload. And also never leave on time. So again are working for free.

I will say OP you can’t know what was going on behind the scenes. I was taken to A&E by ambulance last year. Going into shock from blood loss. I was taken around the back and went straight to the resuscitation ward. The same happens for those who go straight to majors. Just because it seems quiet doesn’t mean there aren’t life threatening emergencies.

I hope your daughter makes a speedy recovery soon. I understand the wait would have been horrible.

Staffing levels are unbelievably low.

I waited 4 hours with a 2 year old that was screaming with measles like rashes at 10pm , wanting sleep etc.we finished up at 1130pm.

I got an amazing dr that checked her throughly and I was utterly grateful to her. She diagnosed daughter with tonsillitis and an allergic reaction on her entire body.

I do not blame the NHS for a moment , they are a gift from God.

I came back home saying it was only for my daughter I would wait that long not for myself.

However, remuneration in the NHS is futured. Hence part of your salary continues to be paid to you when you retire. So in effect, your service is continually rewarded. NHS staff aren't the only industry to go without breaks or asked to work over.
The NHS has an issue with strategy and operations, most publicly funded companies are over-subscribed with poor management structures. Has anyone read a document produced by those on the boards of these trusts? Goobledgook wordy claptrap with NO clear aims or explicit ends.
A private company would go bust within less than 12 months operating similarly.

The clear choices are complementary private health care and a rise in income tax to pay for our health.

OP
I feel for you and we've been where you have been, IE similar situations as you in another hosptial, but once they got to us all good

However, another doctors strike, 5 days of it coming soon but I guess A&E will be fully manned just appointments delayed yet again on the already 1,37 million cancelled

The Institute for Government in June 2023 did a report on low productivity in the NHS. They identify a lack of funding in capital investment, insufficient bed capacity, low staff morale plus less experienced practitioners and the NHS being chronically under managed as the main contributing causes.

Key findings

We identify the slow flow of patients through over-capacity hospitals, covered in Chapter 1 of this report, as the most immediate cause of the problems:

• Bed capacity in England is now at significantly lower levels than in other developed countries, with hospitals running at unsafe levels of occupancy even before the pandemic.
• Lack of capacity has been exacerbated by the worsening problem of delayed discharges that leaves around 10% of the total number of beds - equivalent to 20 hospitals - occupied with patients who have no medical need to be there but, usually, remain there due to a lack of available care outside the hospital system.
• Outpatient activity has also dropped relative to staffing, which seems to be linked to stalled diagnostic testing. The UK has the fifth lowest number of CT and PET scanners and MRI units per capita in the OECD. More than half a million outpatients have been waiting more than six weeks for a diagnostic test.
• This is a result of the UK's long-standing minimal capital spending on health care relative to other countries. This has been worsened by the Department of Health and Social Care (DHSC) raiding its capital budget to cover gaps in revenue funding.
• Capacity problems lead to less productive use of staff time as they expend more effort navigating around the lack of beds and equipment. Higher staff numbers could be being used to bring down the backlog - but only in a higher capacity system.
• There is a risk that GPs making fewer referrals - in part to address hospital capacity concerns - is creating a 'hidden backlog' by allowing treatable conditions to deteriorate and possibly leading to more unplanned admissions.

Chapter 2 looks at how changes in the composition and morale of NHS staff could be exacerbating the problem:

• Despite a big increase in the overall number of doctors and nurses, the balance looks to have shifted towards less experienced practitioners, who may be less able to speed up patient flow. There has also been an increase in staff churn, which is disruptive in hospitals.
• There is a lack of staff at the most critical points for patient flow - namely ward nurses and managers. This increases the impact of capacity problems. On top of these structural factors we have heard a lot about low morale, due to burnout, backlogs and the ongoing pay dispute.

Chapter 3 investigates the system within which the interaction of capital (like beds) and labour (staffing) occurs -the targets and incentives attached to hospitals and how well placed the management is to meet these:

• The NHS is chronically undermanaged. Management levels have fallen from an already low base, and managers lack the analytical capacity to identify blockages and solve them.
• However, recruiting more managers without changing anything else is unlikely to be sufficient. Surprisingly, some evidence shows that more managers can have little impact on performance. Given the wide-ranging management literature - including on hospitals - that demonstrates its importance, this is likely to be because of how the NHS is currently operating. Managers have insufficient ability and freedom to lack the analytical capacity to identify blockages and solve them.
• •However, recruiting more managers without changing anything else is unlikely to be sufficient. Surprisingly, some evidence shows that more managers can have little impact on performance. Given the wide-ranging management literature - including on hospitals - that demonstrates its importance, this is likely to be because of how the NHS is currently operating. Managers have insufficient ability and freedom to make consistent decisions.
• • Much of the New Labour-era system of targets and financial incentives was diluted before the pandemic, and then abandoned altogether, which has made it hard for managers to act with clarity. While there are good reasons to move to an integrated care system (ICS), which incentivises preventative and joined-up care, that system needs to be clear to those operating within it.
• • The current ICS system -though admirable in its aims - is arguably too convoluted to help: it will not, for instance, support greater hospital activity or clear accountability.

https://www.instituteforgovernment.org.uk/sites/default/files/2023-06/nhs-productivity-puzzle0.pdf

https://amp.theguardian.com/politics/2024/feb/06/rishi-sunak-accused-of-personally-holding-up-deal-to-end-doctors-strikes

Sorry for the 3 hour wait, your Doctor is in the hospital treating PRIVATE patients

There is no excuse for being vile to people

@Crispedia thanks for that document. The bit about less experienced staff making up the numbers, but not improving patient flow, rings true to me.

The target is to be seen within 4 hours at A&E and that's not been achieved in many years. So if you arrived at 11pm, you wouldn't expect to be seen before 4am anyway.

You could ask at reception if the A&E staff are all having a 3 hour tea break, I expect the answer would be no 😂

The only way to jump the queue I know of as an adult is to have attempted suicide, then you get seen much faster.