DOC NHS WINTER CRISIS IS COMING
With patients waiting 24 hours on trolleys, consultant warns that A&E units are on the brink
SCOTLAND’S top emergency doctor has warned that our NHS is facing a crisis as winter approaches.
Dr David Chung said that over the summer, some patients were forced to lie on trolleys in corridors for up to 24 hours as emergency departments came under siege. He added: “I fear for the winter.” Dr Chung is head of the Royal College for Emergency Medicine in Scotland. He is also a consultant in emergency medicine in NHS Ayrshire and Arran.
He said A&E departments had been under the cosh all summer – a time when, traditionally, the service is less busy.
Chung added: “Everyone talks about the winter crisis but this is the first year I can remember with no variation.
“It is the first summer with no rebound, no recovery, across the UK. That is a new thing and it doesn’t fill us with hope.
“If we can’t do it now, what will it be like in winter?
“The capacity and demand match is creeping close to where it won’t cope.”
Chung said the 24-hour waits on trolleys were at the “extreme end” but had happened several times over the last two months across the country.
He added: “When you are seeing eight-hour-waits, 12-hour waits, there must be patients on trolleys in corridors overnight for long periods of time.
“Ask the staff. Management aren’t very keen on staff talking because they don’t want to broadcast that it’s happening – but it is.”
Chung said departments sometimes get so overcrowded that they have to fit extra people into resuscitation rooms.
He added: “Resus rooms may be built for three but you put four in there because you have to juggle it a wee bit.”
Worldwide research indicates the longer the delays in patients being transferred to the type of care they need, the more likely they are to suffer complications or even die.
Chung said: “There is not an exact X amount of adverse events and Y amount of deaths but research is going on throughout the world, so we might have better answers soon.
“There isn’t a huge amount of a safety problem if someone waits five hours instead of four. But if the long waits, the eight-hour waits and the 12-hour waits, are increasing it indicates the system is becoming more unsafe – the whole system, the whole hospital.
“If you are not meeting your four-hour (waiting) standard, it is like a warning indicator.
“It is like the engine warning light that flashes on your dashboard – you don’t know what’s wrong but you know you have a problem.
“You take it to a garage and they plug it in to find out where. The problem won’t be on the dashboard, the problem is somewhere else and that is very much the case with the four-hour-standard.
“It is (a problem with) capacity somewhere and you need to do some kind of analysis to find out where that might be.
“Sometimes, it might be the emergency department but very often we find we can’t move patients from the emergency department into beds inside the hospital as quickly as we’d like so they wait around.
“We are the canary in the coal mine for the entire system.
“The solutions are always about increasing capacity somewhere, opening extra beds, putting on extra services.
“We need to sort out what capacity we need to prevent problems like patients waiting a long time in emergency departments.
“Scottish patients, I have found, are incredibly stoic about this. They put up with it but they shouldn’t accept it as normal.
“It is also about nurses and doctors feeling bad because they know they have had to look after somebody in a corridor on a trolley rather than in the area they should do.
“That takes its toll on them, too. They come back from work thinking, ‘Did I do the best thing?’’”
Chung accused the NHS of “allowing backlogs to develop”. He said: “If you look at it like a kitchen, you have so many plates and need to work out how much washing up you need to do. But we get to Friday and say, ‘Let it pile up until Monday and we’ll do it all then’.
“But you need to clean as you go within acute care.
“What is the essential to make sure every day goes into the next
I would be happy to change name back to casualty because what we are seeing are the casualties of austerity
day without a backlog? Backlogs create the problems in health and social care. Backlogs cause the winter crisis. Backlogs cause long waits.”
Chung went on: “In some ways, I would be happy to change the name of emergency departments back to ‘casualty’ because what we are seeing are the casualties of austerity.
“People come to emergency medicine because of a crisis of some kind and it needs someone to reach out to them and say ‘I know your life’s not great. We are not going to sort it here but someone is going to come to talk to you within the next couple of days and have a sit down and say what is wrong that we can fix’.
“If you have tripped over a pot-hole and broken your ankle, that’s easy but it is often more than that. We are seeing an increase in mental health issues and this isn’t the place for them.
“They come because we are open. What we need are the resources to get to people to prevent them from coming here.
“I would never blame patients for coming to emergency departments. You will never hear me saying they should be going somewhere else but it might be nice if they did.”
Health Secretary Jeane Freeman said: “NHS Scotland funding is at a record high, supporting a historically high number of staff.
“Despite substantially increased attendances at our A&Es, around nine in 10 people are still being seen, treated, or discharged within four hours.”
Freeman said Scotland’s A&Es have outperformed the rest of the UK in the last four years.
She added: “We want to go further. I brought forward the £850million waiting times improvement plan to help increase capacity and efficiency and introduce new models of care.”