Her temperature was not coming down, and for the past 3 days, it was an average of 39°C. The usual quick fix of Calpol, water and rest was just not working, and my 6 year old niece was becoming weaker and weaker. We became increasingly worried, and having visited and called the GP, we were advised to go to the paediatric A&E department at Croydon University Hospital.
We picked up the sweaty achy child, packed her bag with the essentials (water, Lucozade, colouring books etc) and braced ourselves for the cold night. We all anticipated that long dreaded A&E wait, but convinced ourselves that given it was a Monday night, we had a sickly child and it was only 9pm, the wait would be short. A doctor would see us straight away, and he/she would examine the child, give her a remedy and off we go back home. Unfortunately, and stereotypically, we didn’t leave until 2am, a whole 5 hours later. This got me thinking- the NHS have such a push on meeting a national target of seeing patients in A&E within 4 hours, but this target still appears to be unrealistic. Why?
Firstly, what is the target? The national target to treat and admit, transfer or discharge a patient is within 4 hours of arrival. All Trusts’ are expected to achieve this in 95% of cases, with a goal of eventually getting this to 98%.
The results make a difficult read.
According to figures up to September 2018, on average, 88.9% of patients were seen and treated within 4 hours of arrival, meaning the target was missed by 6.1%. In theory, this doesn’t sound too bad, but with any medical condition, life and death can be determined by a matter of seconds or minutes, and timings in A&E can be this difference.
Of the 131 Trusts, only 18 were able to meet this target, with Barnsley Hospital NHS Trust leading the way at 98.6% of patients in A&E seen and treated within 4 hours. This means a shocking 113 Trusts’ were below this target, with the lowest coming from United Lincolnshire Hospitals NHS Trust at just 69.5% of people being seen and treated within 4 hours. Most worryingly is England last hit this target in July 2015.
The results are overwhelmingly scary, with very little sign of improvement. But my thoughts in this blog aren’t to jump on the band wagon of criticising our healthcare, but to rather understand why we aren’t reaching this target.
From what I saw in my time waiting, it is clear that there is a huge disproportion of patients to medical staff. Nurses, doctors and medical students were running (yes, literally running) from patient to patient, bed to bed and ward to ward whilst the waiting room continued to fill with patients. They were worked off their feet and looked tired and exhausted, yet they still powered on to help people. Their lack of capacity resulted in patient frustration, and the atmosphere felt very hostile.
With the lack of staff and this looming target in their minds, is it fair to expect a doctor/nurse to stick to this deadline just to comply with a set of statistics? Is it in turn actually forcing them to go through a conveyor belt of patients without actually treating them properly just to make sure they are out the door within 4 hours? It just seems unfair to set a target without considering the people who are expected to meet it. This is completely evident following the conviction of Dr Hadiza Bawa-Garba 2015 for manslaughter by gross negligence following the death of 6 year old Jack Adcock in 2011. Dr Hadiza Bawa-Garba was a junior doctor who faced a day (probably one of many) where she was dealing with many wards and patients on her own, with no senior help, little training and with an IT system which had crashed. The overwhelming impossibility of her task led to the death of 6 year old Jack Adcock. For more reading on this, please refer to Terrence Donovan’s blog, “Medical Mistakes”.
If the A&E target is to be met, you need enough staff members to meet the high demand and, more importantly, to understand the urgency or otherwise of every patient.
Another important aspect of A&E which needs to be considered is the front line, mainly the receptionists. They have such an important job as front of house to make sure they take the correct detail and convey the right messages. Following the recent judgement in the case Darnley v Croydon Health Services NHS Trust, receptionists must now advise on the triage system. Terrence Donovan has discussed this in greater detail in his blog “Should the NHS pay damages for incorrect advice about waiting times?”.
What I saw in A&E was staff members going beyond their level of expertise to make sure they comply with this deadline, which is very dangerous. Timing is crucial, but mixed with staff members who aren’t adequately trained and expected to give life or death advice is undeniably going to affect patient care. If we are to expect A&E to run smoothly and safely, you need people to understand their job, and this will only come with training. But are the understaffed nurses/doctors/receptionist receiving this or are they just expected to get on with things and hope for the best? I think I know how Dr Hadiza Bawa-Garba would answer this….
I completely understand why a national target has been set, but looking at the figures and having seen it first hand, it is clear why these targets aren’t being met. Maybe it seems too simple but surely getting more staff and training them adequately will not only allow this target to be met, but also improve patient care?
Silly me though, I forgot funding our healthcare is not a priority…
About the author
Satvir Sokhi specialises in clinical negligence and has experience of working with clients who have sustained a range of injuries, including brain injuries, injuries arising from birth, orthopaedic injuries and gastrointestinal injuries.