Most of the media has cooperated with the idea that the enormous amount of extra money put into the NHS has made it good enough. This, of course, is not at all true. It is accepted by most people that at least the waiting lists and waiting times in emergency are now fine. Even these things are not true.

Here is a doctor who works in accident and emergency writing about the manipulation of waiting times:

But what about the 98 per cent success rate for meeting the four-hour target?

From the patient's point of view it sounds marvellous - it means you have a 98 per cent chance of being seen and sorted from arrival in A&E.

Right? Wrong. You haven't had a Department of Health maths lesson.

Say you come in to hospital complaining of abdominal pain. You wait three hours to see a doctor -they organise a scan and blood tests and transfer you to a ward next to A&E.

The results come back two hours later and you can be discharged. In the real world, three plus two is five - that's five hours you've been waiting.

But in fact, because you were transferred to the A&E ward before four hours, officially you weren't actually in A&E all that time.

Confused? Me too - and I spend my working life in A&E!

It is even worse if you are a patient referred by your GP for emergency treatment. You bypass A&E and go straight to a ward.

As there are no targets for patients who bypass A&E, you may wait four hours before even being seen by a doctor, but this is not even recorded in the official figures as you went to an emergency ward and not the accident and emergency department.

If you are starting to understand the logic, a job in NHS management awaits you.

As well as the rules being "bent", the fact is the figures are often "fiddled".

This is done in numerous ways, from simply changing the discharge time - it is amazing how many patients are discharged at three hours 59 minutes - to delaying when ambulances are allowed to hand over patients to the hospital.

The most cynical way the figures are massaged is when patients are "moved" on the computer when in reality they are not physically moved at all, but perhaps go from a trolley to a bed, have a curtain drawn round them and the light turned off.

You don't have to be a brain surgeon to know this shouldn't happen, but it does, because A&E staff are concerned that if they have too many breaches, then they will face the Spanish Inquisition from management the next day.

But the saddest thing for me as a doctor, and you as a patient, is that I often have to see people not according to the urgency of their need but simply to satisfy a government target.

I remember having to treat a bloke who had called an ambulance for an ingrowing toenail and wanted to sort it out there and then as he was "off to Ibiza that evening".

Because his four-hour target was nearly up, he was seen before a patient in severe pain with a dislocated shoulder.

So Government claims that everything is lovely-jubbly are inaccurate.

In my experience, the real picture is that between 5 and 10 per cent of patients end up waiting longer than the four-hour target.

At peak times that can rise to 15 per cent - that's a million patients nationwide. And it will probably only get worse.

There has been a year-on-year rise in A&E attendances; many factors have contributed to this - an expanding population (in number and waist size), more alcohol and drug-related attendance, lower-quality GP out-of-hours services, and an increasingly elderly and frail population.

However, there has not been a corresponding increase in resources.

In A&E there are not enough nurses treating patients and there is a lack of senior A&E doctors to make treatment decisions.

When we do decide to admit a patient, there are not enough beds on acute wards, so patients have to wait unnecessarily in A&E.

Why is it that France and Germany have double the number of acute hospital beds that we do in the UK?

The doctor is Dr Nick Edwards. The full article in the Daily Mail is here. He has also written a book, IN STITCHES: The Highs And Lows Of Life As An A&E doctor.

Posted by James Bartholomew • Indexed in NHS

Comments (1) TrackBack (2)

Comments

Add a Comment