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Accidents, emergencies... and crises

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A&E is becoming a 'catch-all' A&E is becoming a 'catch-all'

Last year I spent an interesting few days interviewing hospital nurses for another project, and heard exactly where the NHS was going wrong. One ICU nurse told me the story of an elderly couple brought into emergency the previous winter when the wife became ill, and the husband (who had dementia) simply had nowhere else to go. It wasn’t the right place for them, and the pressure was on to treat other patients. But… ‘If I’d sent them away, they’d have died,’ she shrugged. ‘So they stayed.’ Another one was more succinct: ‘You want the story of the NHS in a sentence? Sooner or later everything goes through A&E.’

And so just as the advertising for Christmas seems to start earlier every year, so warnings of the winter A&E crisis do too. This year the CQC has fired the starting gun with a report that claims that over half the A&E departments in the UK are not good enough, and that even with the Government’s much-feted promise of £20 billion extra for the NHS, they were unlikely to improve. Units are struggling because there’s an increase of up to 10% every year from people turning up seeking care.

The 1.4 million older folks currently locked out to some extent of the social care system, are part of this queue. But so too are young people with mental health problems. If A&E is not fit for purpose, it’s because its purpose was never intended to be this. A&E is there to deal with emergencies, not crises.

So how to fix it? Politicians finally grasping the nettle of social care reform would be a good start, as would a period of proper focus on CAMHS. But it also needs a change in thinking, away from the primacy of big hospitals. A mindset where we intervene earlier and closer to home, will save lives and money.

What do you think? Leave a comment below or tweet your views to @IndyNurseMag

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Centralised emergency departments play a critically important role in the management of true emergencies, eg cardiac cath labs for AMIs, reception of major trauma, stroke, burns and neuro emergencies. The clinical outcomes for these patients with life threatening conditions is getting better year on year.

Less well managed by centralised emergency departments is the care and reception of older patients with minor injury and minor illness - patients in this group need prompt and efficient local care. Ideally this care and treatment is provided in community hospitals which are equipped and staffed to comprehensively provide a care package which avoids referral to Acute Hospitals. There are outstandingly good examples of this type of care being delivered in our minor injury units and urgent care centres, where these services are combined with inpatient beds and rehabilitation teams the turnaround time can be increased resulting in earlier discharge and avoiding the often referred to 'bounce back' of these patients to Acute Hospitals.

Appropriately located and resourced minor injury and urgent care facilities supported by community hospital inpatient and rehab teams will do much to improve the outcomes of non emergency patients and also alleviate the pressure on emergency departments, which is now acknowledged to be a 'year round' pressure and not limited to a 'winter pressure'.

Mike Paynter
Consultant Nurse
Somerset
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