Doctors’ chief says A&E should be by appointment

APPOINTMENTS to be seen in accident and emergency departments could be introduced permanently in response to coronavirus, a senior doctor has said.

Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said it would cause “enormous harm” to patients if Britain returned to crowded casualty units with “elastic walls”.

Instead, patients should be given a “contact point” such as 111 to book a slot in an emergency department, or to be seen directly by a specialist, or diverted to the care they need, she said.

“The old way of doing things involved emergency departments having elastic walls. We were able to have an infinite number of patients. We were never able to say, we’re full, we’re at capacity. We now need to recognise that we can’t do that,” she told MPS.

Patients coming to A&E were some of the most vulnerable, and at risk if they picked up Covid, she said. “If we cannot have space to put those patients, we’re going to cause enormous problems and harm to patients. And so we need to be able to have some way of stopping those elastic walls and actually having some way of knowing who’s coming.”

“What we’re talking about is having a contact point before the emergency department – such as 111,” she said.

The A&E doctor said that during the pandemic, the amount of clinical input into 111 had increased, so that patients were being given a wider range of advice.

But, she said changes should go further, so that instead of going directly to A&E, patients should be offered “booked appointments” into emergency care and urgent treatment centres, while those who are known to have existing problems could be sent to specialists.

Such changes should be introduced permanently, she told the Commons health committee.

“We were becoming very, very crowded and we had people in corridors – and the idea that you could have a vulnerable 80-year-old with a hip fracture in a corridor or next to someone else who could have Covid is just impossible.”

At the same hearing, patients told how they had been “left in the lurch” when vital treatment was postponed.

Cancer patient Daloni Carlisle, from Sevenoaks in Kent, said that she was left “absolutely in limbo” when chemotherapy was delayed for months, despite scans showing a spread of the disease. She said: “For most of the lockdown I’ve been sitting here at home, knowing that all the cancers are growing.”

Prof Derek Alderson, president of the Royal College of Surgeons, urged the NHS to introduce “Covid-light sites” carrying out planned surgery, with regular testing of staff and patients to minimise infection risks.