I’m an A&E registrar, here is what is wrong with emergency departments at the moment:
• Too few alternatives. People can’t (or have the perception of being unable to) get a GP appointment in a timely manner to get a referral to a service, so they present to their local ED to get the referral. This splits them into 2 camps, one camp of patient genuinely does need an emergency referral to a specialty, which could have been prevented had they been seen by their GP earlier or had the referral pathway been an option. The other camp don’t need an emergency referral, which results in a difficult period of waiting for the patient where there is nothing I can do, but they continue to have their issue. How can this be fixed? More availability of GP appointments (both urgent and booked) in the community.
• I have no space to admit my patient - this is exit block, has been going on for years since we tried to reduce our hospital bed numbers much further than almost all other developed nations. How can this be fixed? Build more hospitals and have allow cottage hospitals and rehabilitation beds to take over the care of the relatively well but infirm elderly patients.
• I have too few staff. I can only see so many patients, my nurses can only do so many things at once. We need more doctors and we need more nurses. This can’t be a quick fix, and does require more training, more incentive to train, and more immigration into the country.
• the emergency department is the front door to the hospital. Causes a blockade of patients. This needs sorting at a local level but does need money and investment to set up new admissions pathways.
• less PFI restriction - I work at a large PFI hospital, the costs involved in the simplest of tasks are astronomical. We really need to cut and run from PFI deals and stop forcing competition. One example is every few years hospitals are forced to completely ditch all monitoring equipment and rerun the tender to supply.
• Too much demand. Yes, this is an issue. As a population we expect modern medicine to immediately fix any problem and have no patience for things to get better. This is difficult to fix, access to allied health professionals (Pharmacists, physios) will help a little and there has been some push towards this.
• mental health, this is a crisis, I can do little in the acute phase and it accounts for a large number of patients in my department (whether directly or indirectly). Most of which need counselling and CBT rather than medication, but there is so little access to this.
• Elderly patients are sicker and sicker - this is a by-product if simply living longer. More things to concurrently go wrong causes more complex emergency presentations leading to longer hospital stays. We need More beds, more GPs, more cottage hospitals.
Overall, we need more GP appointments, more psychiatry and mental health investments, more hospitals and rehab beds, more emergency department staff and less money going towards private finance initiatives. This is clearly not a quick fix. (I will await the response where people claim I missed immigration - I didn’t - it’s so far down the problem list that it is a distraction from the real issues facing emergency care, and I suspect this is deliberate).