Week 3 – How to solve the A&E Crisis

Firstly, I just got quite a shock when I clicked on my stats page… whoever has been reading all of my posts in the last 2 hours, you’ve managed to significantly inflate my ego. Thanks.

So, today I’m going to dip my toe into the A&E “crisis” in the NHS. For those of you who aren’t aware of it; the UK Emergency departments are currently overrun, understaffed and most are failing to meet their target of admitting or discharging 95% of patients within 4 hours of arrival.

Ambulance Drivers have targets too! 8 minutes is shorter than 4 hours.

Paramedics have targets too! 8 minutes is a lot shorter than 4 hours.

Yesterday I saw this on the BBC website. Click on it and have a look; it’s a series of “inside-out” videos. Basically, a couple of BBC reporters spent a shift (they say they did the full 13 hours, but I don’t believe them, they look far too awake at the end) getting in everyones way in a number of A&E departments across England.

I think this was a really good thing; I think it is the first time in a long time that I have agreed with anything that the BBC have done in relation to healthcare.. personally I think that their “coverage” of the privatisation of the NHS has been disgraceful, for a “neutral” agency, they aren’t half showing their blue colours.. sorry, that was meant to say true.

The clips are each 2-5 minutes long and just give you a very small glimpse into what a Sunday (they would choose the quietest day of the week) in these A&E departments looks like. They have interviews with senior staff about how they think the current NHS crisis could be solved and a few come up with some good ideas. What I think would have been really interesting would have been to interview some of the more junior staff. After all, it is these staff that are the future of Emergency Medicine (fingers crossed I will be one of them). I think it would have been really interesting to see what they think about the current situation, where A&E doctors seem to bearing the brunt of the media and governments criticism of the NHS despite being grossly understaffed.

A couple of weeks ago now I wrote (here) about how just throwing money at A&E isn’t going to solve the problem, it might paper over the cracks for a few days, but come winter and another season of flu and norovirus then A&E is going to very quickly become very overstretched, with all the potential problems for patients that this brings.

The answer doesn’t lie in throwing a bit of money at the departments, it requires funding going into emergency medicine in general. Another BBC post here shows how understaffed A&E departments across the country are. It also points out that A&E doctors can pretty much choose their job, there are not many specialties that have this luxury. This is obviously a huge plus point for someone thinking of doing emergency medicine as their speciality. However the fact that there are so many free jobs is the reason for the big negative of being an A&E doctor.

The hours are brutal. An F2 friend of mine worked 98 hours in his first week on the department in August. What about the European Working Time directive I hear you say? I’m pretty sure the people in charge of rotoring A&E haven’t even heard of it. These punishing hours are a direct result of there being too few doctors to fill positions. More doctors means more flexibility on the rota, more cover, shorter shifts and fewer nights. My mate is currently doing 1 week of nights followed by 3 days off before a stretch of 12 day shifts (07.00-20.00) without a day off. No fucking wonder people don’t want to go into emergency medicine. My buddy jokingly said that his kids (3, and 6) won’t even remember his face by the end of his current rotation.

Of course, all these extra hours bring in a fair chunk of money, however comparatively (especially considering the hours that you put in) it is not as well paid as other.. easier.. specialties. What GPs do to earn their astronomical salaries working 30 hour weeks I will never know.

The supply gap in ED doctors does allow a certain type of person to profit quite handsomely.. this person is the locum doctor. These people take on extra (exceptionally well paid- we’re talking £50+/hour) shifts through an agency (which takes a cut) at the hospital. I don’t have anything against locums at all, all they are doing is looking out for themselves and their families by earning as much money in the quickest way possible. I just think that if some of them took EM as a specialty then the problem would begin to ease slightly, not to mention costs would come down dramatically.

My final gripe with A&E departments currently is a big one. I was lucky enough to be taught by a very senior member of the college of emergency medicine last week and I spoke with him after the lecture as he was shocked to find out that we have so little exposure to ED (most of our class have had none at all, the 3 days I did here, here and here were of my own accord).  He said that a really common story he heard from medical students was that they were “chased” out of the ED by stressed nurses, doctors and consultants. This was the case for me in the last of those three links. He has very kindly agreed to let me shadow him in his ED in a couple of weeks, which will be fascinating as he runs one of the largest trauma centers in the UK.

The A&E crisis is not going away. Until someone in the government actually listens to the college of emergency medicine and does something to ease the pressure on A&E it isn’t going to either. I just hope that no-one that I know suffers because of it.

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