ACCIDENT and Emergency departments are reported to be under more pressure than ever before. Gazette health reporter Helen Morton spent 12 hours with Basingstoke hospital's A and E team to get a taste of what is happening on the frontline.
WITH an increasing number of admissions, a rapidly ageing population and patient confusion about where to go for urgent medical help, accident and emergency departments across the country are under strain.
The Emergency Department (ED) at Basingstoke hospital has seen a 20 per cent rise in admissions in the last year and, as reported in The Gazette, staff have been struggling to hit Government-imposed targets for waiting times in recent months.
This year, 50,000 patients will visit the ED at Basingstoke hospital – 80 per cent walking in and 20 per cent being brought in by ambulance.
Dr John Kitching, clinical director of unscheduled care at Hamp-shire Hospitals NHS Foundation Trust, said the department is facing a number of challenges, including the recent closure of the drop-in centre at the hospital, the impact from the introduction of the controversial NHS 111 helpline referral system, and an ever-ageing population.
Drop-in service Hampshire Healthcare Centre, which was based in hospital grounds, was closed at the end of March by NHS Hampshire – a decision which has had an impact on the numbers through the doors of the ED.
The introduction of NHS helpline 111, which replaced NHS Direct, has also had an impact, with more patients being referred to ED by call handlers at the service, many of whom have not had medical training.
Dr Kitching said the ageing population also presents a big challenge, explaining: “It is a massive problem. People are living longer and older people need more health care. “It’s a problem which is putting a strain on hospitals across the country.
“You could say it all adds up to a perfect storm. But we are taking steps to make things better.”
North Hampshire Clinical Commissioning Group is working with the hospital to put GPs into ED to deal with the more minor complaints, and Dr Kitching explained the department has also had a recruitment drive to help with vital staffing levels.
A national review into urgent or unplanned care, led by NHS medical director Sir Bruce Keogh, concluded this week, and states that a much simpler and more co-ordinated system of round-the-clock care needs to be introduced.
The review found that there is pressure throughout the system because of “fragmentation and variation in services”, which leads to confusion among patients who then “default” to A&E.
Professor Keith Willett, who chaired the review's steering group, said: "We know that A&E is the pinchpoint of the health and care system and that staff are working very hard to provide the care they know the public need.
"To relieve the pressure and design a system that is sustainable and fit to meet future challenges, we need as many patients, doctors, nurses and NHS colleagues as possible to get involved."
'Nowhere else for patients to turn'
WITH well-publicised problems in Accident and Emergency departments across the country, I had no idea what to expect when I spent 12 hours with staff and patients in Basingstoke hospital’s Emergency Department (ED) on Saturday, June 15.
Patients with conditions ranging from cut fingers to heart attacks all crossed the threshold of ED between midday and midnight, and I saw the staff having to juggle jobs as they treated the most serious cases while managing the queues of people in the waiting room.
Some of those attending ED seemed almost embarrassed to be there, feeling that their medical complaint wasn’t serious enough to warrant a visit – but the clear message I heard from patients and staff was: “There’s nowhere else to go”.
I spent much of my time in the ‘see and treat’ room, where I was able to observe dozens of patient consultations.
Most of those coming through the doors needed treatment for cuts, broken bones, pains and sprains.
Some of the injuries I saw were as a direct result of the patients’ behaviour.
Michael Benwell, 16, from Bordon, was treated for burns on his arm, which he sustained after lighting the spray from an aerosol deodorant on the Friday night, and Arran Birrell, 30, of Quilter Road, Basing-stoke, had broken his hand punching a wardrobe.
Other patients seemed apologetic, including Tracey Jeram, who had cut her finger on a gazebo at Sherborne St John fete, and Maria Amatt, whose daughter Lydia, a university student, who had injured a finger when a taxi door slammed on it the week before.
She said: “There’s really nowhere else for us to go at the weekend. This is the only place which is open.”
It was fortunate that Lydia did attend ED – she had, in fact, broken the tip of her middle finger and could need an operation in the future.
An elderly woman, from Basingstoke, was given painkillers by Paul Barton, lead emergency nurse practitioner, after complaining of severe aches and pains in her neck.
Her husband said he refused to call the 111 number as he had a terrible experience with the service previously.
Paul said: “That was an inappropriate admission but they had no-where else to go at the weekend. What else are they supposed to do? They obviously won’t be calling 111 again.”
I also visited the resuscitation room where patients with the most serious problems are treated. In the few hours I was at the hospital, there were heart attack cases, children suffering seizures and a death.
Erin Jarvis, senior sister, was in resus all day with a team of hard-working nurses.
She said: “They are absolutely fantastic. Some of them haven’t eaten since 7.30am because it’s been so busy. When patients are sitting in the waiting room, they don’t see all of this going on. “They just think there are too few staff working, but they don’t realise that when something major happens, we need more nurses in resus.”
Despite recent problems with the length of waiting times in Basingstoke hospital ED, the people I spoke to seemed happy with the length of the queues. Most waited between an hour and 90 minutes to be treated.
The only complaint I witnessed was around noon, when a man who had hurt his fingers seemed to be in a lot of pain and was complaining to the receptionists.
After he was seen, he left and came back with a box of chocolates for them to apologise for his behaviour.
Paul Barton said: “If you’re nice to patients, they tend to be nice to you. Pain can do funny things to people but we don’t have too many problems.
“It will be interesting to see what happens in the future, but we all just work as hard as we can to help the patients who come in.”