Accident and Emergency in Trouble….Quick, Paint Out The Signs.

So, Accident and Emergency Departments in English Hospitals are in crisis, around the U.K. there has been a huge increase in demand in Ambulance Service 999 calls, G.P.’s are ever more fewer and far between during out of hours periods, the alternative for low acuity calls the 111 service is in meltdown and the Care Quality Commission warns that the situation is out of control with over an extra million patients in one year for England attending Casualty.

 The answer according to some politicians and another think tank in 2013 is to charge people who are drunk and turn up at A&E. It is an eternal question in every Ambulance Station rest room in the U.K. and one I posed on this blog back in May 2009 when a think tank reported on the same issue for a Labour Government.

I stated then and I re-affirm now that there should be a sliding scale which wouldn’t capture the “real” and “genuine” patient who falls ill at the time he or she is drunk but  targeting frequent flyers with a three strikes and you’re out (or charged) approach.

“I’m all for a sliding scale of charges based on number of trips to hospital /calls to Control for same person with same determined waste of time symptoms.
3 strikes and you’re charged. Simple.” Should Drunks Pay For Their Own Emergency Care? This blog May 2009.

But the principle of “free at the point of need/use/delivery (there are variations since 1948)” are polarised at A&E where in many cases the need may not be fully established and triage, examination, diagnosis need to occur before treatment commences unless it is a life threatening emergency.

I fully support the work undertaken by Ambulance colleagues in city centres on weekends with a triage set up in the night club district supplemented by the charity of the Street Pastors mean that hundreds of people who may be a little bit drunk, and in a little difficulty and not suffering a life threatening episode are dealt with sympathetically and appropriately usually avoiding a trip to A&E at the time when the unit would become most stretched with the four hour target put under strain for all attendees.

There should be more initiatives such as the “drunk tank” and available for more than a few hours a week, there should be pathways of care that cover many of the patients that attend A&E that could be treated in an alternative environment. The elderly, frail, patients with dementia, children and mentally ill patients should be conveyed to an alternative NHS provison unless they have either an accident or an emergency.

There is a call for and promises of extra staff for A&E without actually stating if there are to be more Doctors, Nurses, Practitioners or Health Care Support Workers or a mixture of all of the required groups. In Wales there has been a shortage of A&E Doctors and a worrying difficulty in recruitment of Junior Doctors to populate the A&E rota with an interesting side debate that is ongoing where Senior Health Officials are considering painting out the road signs on the motorway that read in red “Accident and Emergency” and replacing them with the words “Emergency Unit” so that they can advertise in New Zealand and New South Wales to attract Doctors to Old South Wales.

Making drunks pay for care and changing the name of A&E are just diversions from the real issues. It is nearly as diverting as the latest Government proposal that NHS workers have to check that illegal immigrants do not access health care that they are not entitled to when they are not even entitled to be in the country. It’s a diversion from the crisis.

We have an ageing population, England have scrapped NHS Direct and replaced it with a semi- privately run 111 service, the demand for the service has escalated beyond belief and a huge amount of the extra 10 million extra population since the last decades census have not even registered with their local G.P. surgery even if they were lucky to find one who does home visits in the 20 hours of the day that aren’t surgery hours. I have the utmost respect for G.P.s and even have two relatives who are G.P.’s but they should be used in this crisis as part of the solution instead of exacerbating the problem.

I propose that G.P.’s who can work in the local A&E/Casualty/Emergency Unit one day per month until this crisis subsides are encouraged to do just that. It happens in other countries for example the Beaumont Hospital in Dublin has a rotation of countryside G.P.’s who all have to do a stint in A&E and deal with the admissions that other G.P.’s send in for a second opinion.

I believe it is their duty, that after their years of dedication to their patients, being trained in and benefitted from the NHS we ask them to make a small sacrifice to help out at the alternative provision, the sanctuary at the end of the pathway of care, the fact is we need them to help, by admission avoidance, treatment in patients homes and non conveyance of patients. We need upskilled Paramedics too, the pathways of care available to the patients they are sent to open for referrals. We need direct access to poisons units for patients who have taken an overdose, we need assesment centres for patients who are having an emotional crisis or displaying undiagnosed symptoms of mental illness and there should be more nursing of frail elderly patients in nursing homes rather than packing them off in the middle of the night for an assesment by a Casualty Doctor when an out of hours G.P. could have called in on Nana on their rounds.

There must be a fundamental re-think of the way the sharp end of the NHS is run because when Casualty sneezes the NHS catches the cold.

Will G.P.’s ever be asked to step up to the plate, roll up their sleeves and save the NHS?

Or will we change the signs, make drunks pay for care and do a border agency check on migrants prior to treatment?  Check this blog in four years time.