0:00:03 > 0:00:07Accident & Emergency - the NHS's ever-open door.
0:00:07 > 0:00:11- Who the- BLEEP- do you think you're talking to?
0:00:11 > 0:00:14It's a more stressful place to work than it once was.
0:00:14 > 0:00:17The pressure upon A&E just won't stop building.
0:00:17 > 0:00:21- When the hospital's full, we cannot win.- Ready, steady, slide.
0:00:23 > 0:00:26- You need to wake up then, sweetheart. - PHONE RINGS
0:00:26 > 0:00:27Hello, A&E?
0:00:28 > 0:00:31Not everyone is prepared to go on taking it.
0:00:31 > 0:00:35A&E is a sinking ship and unless things change dramatically,
0:00:35 > 0:00:36it will sink.
0:00:37 > 0:00:41Tonight, the real emergency that's threatening A&E.
0:00:41 > 0:00:46INDISTINCT TANNOY ANNOUNCEMENT
0:00:46 > 0:00:49If we don't do something, you will turn up in an ambulance to
0:00:49 > 0:00:52an emergency department and there will be no doctors there to see you.
0:00:52 > 0:00:55SIREN WAILS
0:01:06 > 0:01:10The University Hospital of North Tees in Stockton treated nearly
0:01:10 > 0:01:1490,000 patients in its accident and emergency department last year.
0:01:15 > 0:01:17Nothing special about that.
0:01:19 > 0:01:22Yet they let us film for seven days in theirs...
0:01:23 > 0:01:26But A&E's always politically sensitive.
0:01:26 > 0:01:28You just lay still, mate.
0:01:28 > 0:01:30More than 100 hospitals wouldn't.
0:01:30 > 0:01:33Three initially said yes only to say no later.
0:01:41 > 0:01:43It's 1.30am.
0:01:43 > 0:01:48It's quiet in A&E when a 28-year-old man checks in,
0:01:48 > 0:01:52escorted by police for his own safety.
0:01:52 > 0:01:54Vodka and Lucozade.
0:01:55 > 0:01:58He has deliberately cut himself - and badly.
0:01:58 > 0:02:03Basically, I was having a quiet night in with my girlfriend
0:02:03 > 0:02:08and she told me that she didn't want to continue the relationship.
0:02:09 > 0:02:11Er, so I was upset.
0:02:11 > 0:02:15And I couldn't find the words to tell her, so I got a knife and...
0:02:17 > 0:02:20What we're going to do is take the dressings off
0:02:20 > 0:02:21and have a look at your wounds.
0:02:23 > 0:02:24SUCKS IN BREATH
0:02:30 > 0:02:34- It takes a lot to surprise A&E staff.- That's the deepest one.
0:02:34 > 0:02:36Compared to all the others.
0:02:36 > 0:02:38What we'll need to do is
0:02:38 > 0:02:41we'll need to close it by using stitches, yeah?
0:02:42 > 0:02:46The numbers turning up in A&E just go on rising nationally.
0:02:47 > 0:02:50No pain, no gain, they say, though, don't they?
0:02:51 > 0:02:55A million more patients in England since 2010.
0:02:55 > 0:02:57We set out to discover why.
0:03:01 > 0:03:05A&E staff say the initials really stand for "Anything and Everything".
0:03:05 > 0:03:07All human life is here.
0:03:07 > 0:03:10INDISTINCT
0:03:10 > 0:03:14This morning I was in my van towards my job
0:03:14 > 0:03:16and my left ear was itching like mad.
0:03:16 > 0:03:19I always carry my pencil behind my lug.
0:03:19 > 0:03:22I scratched it, realised there was no rubber on the end,
0:03:22 > 0:03:23so it's gone in my ear.
0:03:23 > 0:03:26Had to seek medical advice.
0:03:29 > 0:03:31Certainly over the 25 years that
0:03:31 > 0:03:35I've been in A&E things have changed.
0:03:35 > 0:03:38It's higher volume, harder workload,
0:03:38 > 0:03:42we get patients in who are possibly more demanding.
0:03:42 > 0:03:46It's a more stressful place to work than it once was.
0:03:46 > 0:03:49If I allowed my staff to behave like this,
0:03:49 > 0:03:51they'd be out.
0:03:52 > 0:03:55A patient is brought in, for some reason bitterly complaining
0:03:55 > 0:03:57about the NHS.
0:03:57 > 0:03:59- We'll get you on the bed, mate, right?- Yes.
0:04:01 > 0:04:04But his medical diagnosis turns out to be quite simple.
0:04:06 > 0:04:10Diabetic. He's fallen, his sugars might have been a bit low...
0:04:11 > 0:04:14He's laid on the floor until somebody's found him,
0:04:14 > 0:04:16five, six hours.
0:04:16 > 0:04:19So, here we are.
0:04:19 > 0:04:21- We'll sort you out, son.- OK.
0:04:21 > 0:04:23- Have you had anything to eat today? - No.- No?
0:04:23 > 0:04:26You know you should do, don't you?
0:04:26 > 0:04:29Well... I was on the floor!
0:04:36 > 0:04:40The hospital on Teesside in the north-east of England
0:04:40 > 0:04:43serves an area of once-thriving heavy industry.
0:04:43 > 0:04:46The monuments to its past are all around.
0:04:49 > 0:04:52Its A&E is ruled by a government target -
0:04:52 > 0:04:57patients must be seen and treated or admitted within four hours.
0:04:57 > 0:05:01So I understand you had high blood pressure because you take...
0:05:02 > 0:05:05In England, Wales and Northern Ireland,
0:05:05 > 0:05:0895% have to be dealt with within this time limit.
0:05:08 > 0:05:12In Scotland, the figure is even higher - 98%.
0:05:12 > 0:05:17- He was pre-alerted through... Diverted.- So they've got the stroke team?
0:05:17 > 0:05:23- Yeah.- The nurses' station is the nerve station of Stockton's A&E.
0:05:23 > 0:05:26Red on the computer screen warns staff that they may
0:05:26 > 0:05:30be at risk in the jargon of breaching the four-hour limit.
0:05:30 > 0:05:33Failure means fines and ultimately naming
0:05:33 > 0:05:35and shaming for the hospital's management.
0:05:35 > 0:05:38TANNOY: 'Anyone free for a handover in majors, please.'
0:05:38 > 0:05:40Stockton's been meeting its targets.
0:05:40 > 0:05:44It has a Patient Process Facilitator, dedicated to the task.
0:05:44 > 0:05:47- Meet Pam Dove. - Jack of all trades.
0:05:51 > 0:05:53PHONE RINGS
0:05:53 > 0:05:54Hello, can I help you?
0:05:54 > 0:05:58There's a female patient who's getting close to breaching the limit.
0:05:58 > 0:06:00The lady is on 220 minutes
0:06:00 > 0:06:02and they have to be out the department in 239
0:06:02 > 0:06:04otherwise it's classed as a breach.
0:06:04 > 0:06:06She hasn't got long, now - she's got 15 minutes.
0:06:10 > 0:06:13- So you've got about 15 minutes left...- Yes. - With the clock ticking...
0:06:13 > 0:06:16- Yes.- To avoid a breach. - To avoid a breach.
0:06:19 > 0:06:21Right, OK - how long will it be?
0:06:21 > 0:06:24Right, five minutes and we can set off.
0:06:24 > 0:06:25Lovely.
0:06:28 > 0:06:30- This is like a Target Olympics.- Yes.
0:06:30 > 0:06:34- Like a race. It's a sprint. - Definitely a sprint.
0:06:37 > 0:06:39Throughout our seven days in A&E,
0:06:39 > 0:06:44we saw the reality of working within this target culture.
0:06:44 > 0:06:47Everyone we spoke to had something to say about trying to keep to
0:06:47 > 0:06:50the targets in a department under continuous pressure.
0:06:50 > 0:06:53PHONE RINGS
0:06:53 > 0:06:54Hello, A&E, staff nurse.
0:06:54 > 0:06:57I feel the breach thing is...
0:06:58 > 0:07:01It's a bit of a mixed blessing.
0:07:01 > 0:07:04We do need some pressure to make us work efficiently,
0:07:04 > 0:07:06but at the same time, it can be infuriating
0:07:06 > 0:07:10when all you want to do is look after your patient and you've got somebody
0:07:10 > 0:07:14or multiple people telling you that this person is coming up to breach.
0:07:14 > 0:07:18- Consultants were critical, too. - We're working harder and harder
0:07:18 > 0:07:21towards targets that are sometimes unachievable.
0:07:21 > 0:07:24No matter how hard you try, you can't win?
0:07:24 > 0:07:27We can't win when the hospital is full. We cannot win.
0:07:28 > 0:07:32'But Pam on this occasion had a mini victory.'
0:07:32 > 0:07:33Did you win, Pam?
0:07:33 > 0:07:36- Yes, we did.- How many minutes did you have left?- Four minutes.
0:07:38 > 0:07:41And Pam goes off shift and passes the baton over to the next
0:07:41 > 0:07:44competitor in the Target Olympics.
0:07:44 > 0:07:46You're about to hand all this over to Becky - good luck!
0:07:46 > 0:07:49- Thank you!- She'll need it! - I know!
0:07:49 > 0:07:53But the targets weren't designed to make life easier for the staff -
0:07:53 > 0:07:56they're meant to benefit patients.
0:07:56 > 0:07:59Patients come first. We need to do the best for patients.
0:07:59 > 0:08:03What you have to remember is behind every target is a patient.
0:08:03 > 0:08:06We don't want people to wait four hours in the A&E.
0:08:06 > 0:08:08If you and I were going to the A&E department,
0:08:08 > 0:08:09we'd want to be seen quickly,
0:08:09 > 0:08:11so although we have that target,
0:08:11 > 0:08:12it's not the be-all and end-all.
0:08:16 > 0:08:20A&E is busy. There's a backlog of patients.
0:08:20 > 0:08:21Brought in by her daughter,
0:08:21 > 0:08:2573-year-old Marion Knaggs has bad stomach pain.
0:08:25 > 0:08:29She needs tests to find out what's wrong. But these take time.
0:08:32 > 0:08:34Eventually, the tests are completed
0:08:34 > 0:08:38and a bed is found for her in a ward. But there's a problem.
0:08:38 > 0:08:42When we got up there, there was about four or five people waiting in
0:08:42 > 0:08:43front of her and we waited there
0:08:43 > 0:08:45for about 10 or 15 minutes
0:08:45 > 0:08:48to be told we had to come back to the accident and emergency unit
0:08:48 > 0:08:50cos there were no beds.
0:08:51 > 0:08:55There's a traffic jam in the rest of the hospital.
0:08:55 > 0:08:56There's no beds.
0:08:56 > 0:08:59Everybody's trying. The manager on call is aware.
0:08:59 > 0:09:02So it's just basically down to bed managers to help get some
0:09:02 > 0:09:04patients moved out onto the base wards.
0:09:04 > 0:09:07It's unfair to the patients - they're getting moved,
0:09:07 > 0:09:10getting shunted from pillar to post. It's frustrating to us.
0:09:10 > 0:09:14And finally, second time round, Mrs Knaggs is admitted.
0:09:15 > 0:09:17Do you want to sit in the chair?
0:09:17 > 0:09:21But having had a six-hour wait, she's breached the limit
0:09:21 > 0:09:23and become a negative statistic.
0:09:23 > 0:09:26I feel like the staff are trying their best to work with every
0:09:26 > 0:09:29single patient and treat them as an individual, not just
0:09:29 > 0:09:32a patient number, but they don't seem to have enough staff and enough
0:09:32 > 0:09:36resources to deal with the amount of people coming through the doors.
0:09:36 > 0:09:38Did you think that before today?
0:09:38 > 0:09:42- Or is that something you've learned today?- Something I've learned today.
0:09:44 > 0:09:46Peter Hawes, the diabetic,
0:09:46 > 0:09:48had had his blood sugar levels checked,
0:09:48 > 0:09:50he's rested and now the hospital wants to get him out
0:09:50 > 0:09:54before he breaches the four-hour rule as well.
0:09:54 > 0:09:56I think I've been well looked after.
0:09:56 > 0:09:59But I'm glad to be going home!
0:10:03 > 0:10:04See ya!
0:10:08 > 0:10:11And Peter goes off with 16 minutes to spare.
0:10:11 > 0:10:13But in the rush to get him home,
0:10:13 > 0:10:17no-one notices that he's being discharged with a cannula -
0:10:17 > 0:10:21the tube for an intravenous drip - still in place,
0:10:21 > 0:10:24which upsets the nurse who'd looked after him earlier.
0:10:24 > 0:10:25It annoyed me, put it that way.
0:10:25 > 0:10:27You try to have
0:10:27 > 0:10:30that continuation of care.
0:10:30 > 0:10:34The stresses and strains of the job are such that you're trying to
0:10:34 > 0:10:38strive to meet those targets, you're pushed to the limits.
0:10:38 > 0:10:41So, do the targets need reforming?
0:10:41 > 0:10:44We asked the Department of Health for an interview,
0:10:44 > 0:10:47but they declined and referred us to NHS England.
0:10:47 > 0:10:51Their A&E chief admits they do.
0:10:51 > 0:10:54What was intended to be something to ensure patient safety
0:10:54 > 0:10:57and improve patient experience,
0:10:57 > 0:11:01that has been translated down to something that feels like a target
0:11:01 > 0:11:05culture and that's one very important reason why we need to review it.
0:11:05 > 0:11:10And do you accept that the four-hour 95% target as it currently applies
0:11:10 > 0:11:12- is too crude a measure? - It's too crude.
0:11:12 > 0:11:14I think now things have moved on.
0:11:14 > 0:11:17When it came in, it was highly effective. Now, it's too blunt.
0:11:17 > 0:11:21It's really been a powerful weapon for change within A&E
0:11:21 > 0:11:24departments, so it's not going to be got rid of without there
0:11:24 > 0:11:26being something that is better.
0:11:33 > 0:11:34It's the end of the day.
0:11:34 > 0:11:37There are fewer staff, but difficult new patients.
0:11:38 > 0:11:40Drug abuse happens around the clock -
0:11:40 > 0:11:43this hospital deals with three to four overdoses a day.
0:11:52 > 0:11:55This woman is admitted unconscious.
0:11:55 > 0:11:58The first priority, to bring her round.
0:11:58 > 0:12:00All right. All right.
0:12:00 > 0:12:03Can you speak to us, how are you doing?
0:12:03 > 0:12:06You need to wake up then, sweetheart.
0:12:06 > 0:12:11- Sharp scratch.- My name's Jenny. - Try your very best.
0:12:11 > 0:12:13Just about to do a sharp blood test, OK?
0:12:14 > 0:12:18A test reveals a long list of drugs in her system.
0:12:18 > 0:12:22Diazapines, opiates...
0:12:22 > 0:12:26Well, it's got methadone and morphine have tested positive,
0:12:26 > 0:12:31so that's basically heroin or sort of heroin replacement medication.
0:12:31 > 0:12:33Cocaine, obviously.
0:12:33 > 0:12:37For a while, this patient consumed resources -
0:12:37 > 0:12:39everything else had to wait.
0:12:39 > 0:12:42Later, she was admitted to a ward, but by morning,
0:12:42 > 0:12:44she'd discharged herself.
0:12:44 > 0:12:46Are you all right there, darling?
0:12:47 > 0:12:50The constant pressure upon A&E means that it's always
0:12:50 > 0:12:53in the political front line.
0:12:53 > 0:12:56Before this winter, a crisis was predicted and the government
0:12:56 > 0:13:01announced that £400 million more was going into A&E in England.
0:13:01 > 0:13:03But Stockton Hospital didn't qualify for any of this
0:13:03 > 0:13:06because of its above-average performance.
0:13:06 > 0:13:08Last couple of months it's been horrendous.
0:13:08 > 0:13:10Beds are emptied and then straightaway,
0:13:10 > 0:13:12patients go back in again, so...
0:13:12 > 0:13:15We're constantly chasing our tails.
0:13:15 > 0:13:18And that day, the hospital simply ran out of beds.
0:13:18 > 0:13:22So at one of their twice-daily bed management meetings,
0:13:22 > 0:13:23they responded.
0:13:28 > 0:13:32Because we have trigger points, we have an escalation policy
0:13:32 > 0:13:35and a programme of trigger points that we look at.
0:13:35 > 0:13:36BLEEPER
0:13:36 > 0:13:42Sorry. That's a call to say that they're escalating another bed meeting because of pressures.
0:13:42 > 0:13:46So it's likely to be that either A&E or the emergency assessment unit
0:13:46 > 0:13:47are under pressure.
0:13:47 > 0:13:52Anyway, I want to knock myself clean off. BLEEP!
0:13:53 > 0:13:56- Just relax.- Otherwise, I'll BLEEP.
0:13:56 > 0:13:57Listen, Michael...
0:13:57 > 0:14:01Staff in A&E are attending to Michael Alfwaite.
0:14:01 > 0:14:05He's had far too much to drink and he's threatened suicide.
0:14:06 > 0:14:09The paramedics said you wanted to kill yourself, slit your wrists?
0:14:09 > 0:14:12- You going to do it? - I suppose so.
0:14:12 > 0:14:15The most common drug of abuse arriving in the department
0:14:15 > 0:14:18is alcohol, which comes on a daily basis.
0:14:18 > 0:14:22- How much have you had to drink today? - Well...quite a lot.
0:14:22 > 0:14:27There are more than a million alcohol-related hospital admissions
0:14:27 > 0:14:29in England each year.
0:14:29 > 0:14:34- I'm- BLEEP- sick to- BLEEP- death of these- BLEEP.
0:14:34 > 0:14:37He is fighting. He has not really got the strength to actually...
0:14:37 > 0:14:39Do you know what I mean?
0:14:39 > 0:14:43They're managing to hold him fine and I think he's just all bravado.
0:14:44 > 0:14:49In the cubicle just opposite, they've had quite enough of him.
0:14:49 > 0:14:53The nurses and doctors shouldn't have to put up with him swearing
0:14:53 > 0:14:56and threatening to bite and kill them.
0:14:56 > 0:14:58It's scandalous. Something should be done.
0:14:58 > 0:15:00If they get in that state, they should be chucked out
0:15:00 > 0:15:02and let themselves get sorted.
0:15:06 > 0:15:09Now he's briefly become violent and fallen over.
0:15:09 > 0:15:14- Who the- BLEEP- do you think you're talking to?
0:15:14 > 0:15:16Michael, what are you doing, sweetheart?
0:15:21 > 0:15:24Many A&E staff seem to have the patience of saints.
0:15:24 > 0:15:27If you all just understand what...
0:15:27 > 0:15:30It's becoming less attractive as a career.
0:15:34 > 0:15:37The job is stressful and it is hard work.
0:15:37 > 0:15:40My work/life balance hasn't been good in recent weeks.
0:15:40 > 0:15:43Myself, I'm sure many of my colleagues,
0:15:43 > 0:15:44we all take work home with us.
0:15:44 > 0:15:46It isn't a balance?
0:15:46 > 0:15:49- I have a lot of work on my plate. - Not life?
0:15:49 > 0:15:51No.
0:15:54 > 0:15:57Recruiting enough A&E staff and keeping them in their jobs
0:15:57 > 0:16:00is now a national problem.
0:16:00 > 0:16:03Their champion says accident and emergency departments
0:16:03 > 0:16:05won't work properly at this rate.
0:16:05 > 0:16:08For the last three years, we have recruited only 50%
0:16:08 > 0:16:10of the registrars into emergency medicine.
0:16:10 > 0:16:14This means there is a lack of about 350-375 registrars
0:16:14 > 0:16:16around the country.
0:16:16 > 0:16:19That equates to three quarters of a million patient consultations
0:16:19 > 0:16:24per year that can't happen because those doctors don't exist.
0:16:24 > 0:16:28They're one consultant, a registrar and two nurses short
0:16:28 > 0:16:32in Stockton's A&E, and fill up some gaps in staffing with hired temps.
0:16:34 > 0:16:36They're called locums in the trade.
0:16:36 > 0:16:38The one on shift admits it's not quite the same
0:16:38 > 0:16:41as having someone permanent.
0:16:41 > 0:16:44You can have good locums and you can have bad locums.
0:16:44 > 0:16:50Quite a lot at the moment are perceived as being bad,
0:16:50 > 0:16:52they sort of come in, don't care about the job.
0:16:52 > 0:16:55They come in to do the work, get paid and go.
0:16:58 > 0:17:03So stressed out A&E doctors have been voting with their feet.
0:17:03 > 0:17:06That's the house we often stay in when we go down there.
0:17:06 > 0:17:09- You rent this place?- Yeah, rent it down there for very little.
0:17:11 > 0:17:13John Thompson trained in Stockton
0:17:13 > 0:17:16and he's worked as an A&E consultant there too.
0:17:16 > 0:17:21But he has left the NHS behind to live and work in Fremantle,
0:17:21 > 0:17:22in Australia.
0:17:22 > 0:17:26We met him when he was here visiting relations and old friends.
0:17:26 > 0:17:30- There are kangaroos, there you go. Stalking kangaroos.- Oh, my word!
0:17:32 > 0:17:36The pressures are less in Australia
0:17:36 > 0:17:39and the emphasis primarily for my working day
0:17:39 > 0:17:41is on patient care.
0:17:41 > 0:17:45The pressures from the four-hour rule and from up above
0:17:45 > 0:17:49have taken so much away from the job in the NHS in the UK
0:17:49 > 0:17:51that it's just...
0:17:51 > 0:17:53It's too hard.
0:17:54 > 0:17:56The number of UK medical graduates
0:17:56 > 0:18:00working in Australian emergency departments has gone up
0:18:00 > 0:18:03by over 60% in the last four years.
0:18:03 > 0:18:08That looks a lot better, doesn't it? It's still quite dry.
0:18:08 > 0:18:11Alex Muirhead quit, as well.
0:18:11 > 0:18:12She didn't leave the country
0:18:12 > 0:18:16but she left the specialism she had originally chosen for good.
0:18:16 > 0:18:20She was an A&E consultant at Stockton Hospital until last December.
0:18:22 > 0:18:24Now she is a local GP instead.
0:18:24 > 0:18:28It was quite sad, really, because I used to love working in A&E
0:18:28 > 0:18:32but it got to the stage where I just didn't enjoy my job
0:18:32 > 0:18:37and I didn't want to spend another 20 years working as an A&E consultant.
0:18:37 > 0:18:39As an A&E department I don't think you get
0:18:39 > 0:18:43an awful lot of respect from the rest of the hospital.
0:18:43 > 0:18:48To some extent, A&E's now seen as everyone's dumping ground.
0:18:52 > 0:18:55All medical staff for the boardroom.
0:19:01 > 0:19:05It would help if far fewer of us turned up in A&E in the first place.
0:19:05 > 0:19:07According to official figures,
0:19:07 > 0:19:1140% of patients don't need to go to accident and emergency at all.
0:19:11 > 0:19:15For some, it's a safe haven.
0:19:16 > 0:19:18Every week. I get admitted every week.
0:19:18 > 0:19:21- You come here every week? - Every week, mate.
0:19:21 > 0:19:24- Are they good and kind to you when you come here?- Some of them are.
0:19:24 > 0:19:27The ones who know me personally, they're all right,
0:19:27 > 0:19:31but other people think he is in and out, he is an idiot.
0:19:31 > 0:19:34In the last month, I think he's attended six times.
0:19:34 > 0:19:36Is he the only one or is there...?
0:19:36 > 0:19:39No, no, we have quite a few, what we class as regulars.
0:19:41 > 0:19:44Peter is admitted to a ward.
0:19:44 > 0:19:47There are plenty of others who shouldn't be here at all
0:19:47 > 0:19:50but they turn up in A&E all the same.
0:19:51 > 0:19:55We had a gentleman who came in and he had a splinter in his finger.
0:19:55 > 0:19:58At that point we were on a three-and-a-half hour wait.
0:20:01 > 0:20:06A lot of sore throats come in, and coughs.
0:20:06 > 0:20:09I am talking just little coughs.
0:20:12 > 0:20:15One reason we heard for coming to A&E
0:20:15 > 0:20:19is because it's difficult to get an appointment with a GP.
0:20:20 > 0:20:23I was involved in a road traffic accident last night.
0:20:23 > 0:20:25Woke up this morning with pain across my shoulders.
0:20:25 > 0:20:28Went to the local doctor's but they couldn't book me in
0:20:28 > 0:20:29so I couldn't really wait until Monday.
0:20:29 > 0:20:32I don't want to waste these people's time,
0:20:32 > 0:20:34I am sure there's more deserving people than me.
0:20:39 > 0:20:43Besides GPs, the NHS offers a whole host of alternatives
0:20:43 > 0:20:44to accident and emergency.
0:20:46 > 0:20:51But lots of us still say "Thanks, but no thanks, I'll stick to A&E."
0:20:51 > 0:20:55We have been in a nightclub, me and my partner.
0:20:55 > 0:20:59A guy has tried to provocatively dance with me.
0:20:59 > 0:21:03He has obviously had too much to drink, went for him
0:21:03 > 0:21:06and I've got caught in the middle of it and been punched in the face.
0:21:06 > 0:21:09- Had you any doubt about whether to come here?- No.
0:21:09 > 0:21:14I think I'm just being a bit vain, I am panicking in case I broke my nose.
0:21:14 > 0:21:19Even the professionals admit part of the reason some patients still go
0:21:19 > 0:21:23to A&E is that the alternatives are a bit of a maze.
0:21:23 > 0:21:25It's very difficult to understand.
0:21:25 > 0:21:29We've had lots of different things, NHS Direct, the 111 system.
0:21:29 > 0:21:32They don't really know what all that means.
0:21:32 > 0:21:35Minor injuries unit, urgent care centre...
0:21:35 > 0:21:38I agree entirely. I think there is a confusion around the names.
0:21:38 > 0:21:42You want me to know where to go and I can only just make head or tail
0:21:42 > 0:21:44of these titles and I've been working hard at it.
0:21:44 > 0:21:48- Did you lose consciousness when you fell?- No.
0:21:48 > 0:21:51Bu quite a lot of patients in Stockton wish they were being
0:21:51 > 0:21:54treated in a hospital nearer home.
0:21:54 > 0:21:59I was walking my dog and she was on a lead
0:21:59 > 0:22:02and then another dog come chasing up to her
0:22:02 > 0:22:04and I fell flat on my face.
0:22:04 > 0:22:06I was in shock.
0:22:06 > 0:22:09I knew my face was all bleeding
0:22:09 > 0:22:11and you know what women are like,
0:22:11 > 0:22:14we like to have our pretty faces.
0:22:18 > 0:22:22On top of that, Christine Johnson had to travel to be treated.
0:22:22 > 0:22:26In 2011, the A&E department in Hartlepool, 15 miles away,
0:22:26 > 0:22:31was shut and services were concentrated in Stockton Hospital instead.
0:22:31 > 0:22:37And here, as in other places, the closure of a local A&E still hurts.
0:22:37 > 0:22:40- Where would you like to have been taken?- Hartlepool.
0:22:40 > 0:22:44For you and your husband, getting here to Stockton is a palaver?
0:22:44 > 0:22:47- It is.- Have you told anybody that? - No, it was... Who can I tell?
0:22:50 > 0:22:52I'm just a little person, aren't I?
0:22:57 > 0:22:59I think right across the country,
0:22:59 > 0:23:02people want all the services that they can as local as possible,
0:23:02 > 0:23:05and whilst we try to achieve that,
0:23:05 > 0:23:06if you go in for a local service,
0:23:06 > 0:23:09it's got to be of the highest quality.
0:23:09 > 0:23:12And bringing the two services together was the right thing to do.
0:23:12 > 0:23:15Can I have a look at you, sir, is that OK?
0:23:15 > 0:23:19What was striking about our time in A&E was the number of elderly,
0:23:19 > 0:23:23frail patients they dealt with day and night.
0:23:23 > 0:23:26The number of over-65s attending major A&E departments
0:23:26 > 0:23:31in England has gone up by around 190,000 in the last year alone.
0:23:31 > 0:23:33Admitted in the small hours of the morning,
0:23:33 > 0:23:37it was Bill Galloway's 100th birthday.
0:23:37 > 0:23:41# Happy birthday to you Happy birthday to you... #
0:23:41 > 0:23:45What is the most challenging in the middle of the night
0:23:45 > 0:23:47is complex medical patients.
0:23:47 > 0:23:52Elderly patients, just doing simple things at 4am,
0:23:52 > 0:23:54interpreting a chest X-ray,
0:23:54 > 0:23:57trying to get clear information at that time of the morning
0:23:57 > 0:24:00and when you have a department full of those type of patients,
0:24:00 > 0:24:01it's absolutely exhausting.
0:24:03 > 0:24:05If they're admitted on to a ward,
0:24:05 > 0:24:08the elderly may affect A&E departments in a different way.
0:24:08 > 0:24:10It's Sunday.
0:24:10 > 0:24:1478-year-old Dot Bromilow has been medically fit to be discharged
0:24:14 > 0:24:18for two days, but she's still taking up an acute hospital bed.
0:24:18 > 0:24:21Why are you still up here in the ward?
0:24:21 > 0:24:24Well, bureaucracy.
0:24:24 > 0:24:25She relies on home help
0:24:25 > 0:24:30which is organised by her council's social services department.
0:24:30 > 0:24:33It was stopped as soon as she was admitted into hospital.
0:24:33 > 0:24:35That's standard practice.
0:24:35 > 0:24:38But it can't be rearranged until after the weekend.
0:24:38 > 0:24:41For the moment, until your care package is sorted...
0:24:41 > 0:24:42I'm stuck.
0:24:43 > 0:24:47Today as we speak, we have eight of those patients
0:24:47 > 0:24:49that are sitting in a hospital bed
0:24:49 > 0:24:51that are waiting for a process to be completed.
0:24:51 > 0:24:54If they don't leave the hospital it clogs up the system
0:24:54 > 0:24:57and causes problems back in A&E and you can't get them out?
0:24:57 > 0:24:58No.
0:24:58 > 0:25:02Using official figures, we have calculated that in total,
0:25:02 > 0:25:05delays involving social care packages are costing
0:25:05 > 0:25:09the NHS in England about £100 million a year.
0:25:09 > 0:25:13And cuts in local authority budgets are making things worse.
0:25:13 > 0:25:15There's bound to be a consequence.
0:25:15 > 0:25:19Social care and local authorities have taken a significant reduction.
0:25:19 > 0:25:24We need to join the services up and one of the key things we have to do
0:25:24 > 0:25:29is to bring the doctors, the nurses, the social workers back together.
0:25:29 > 0:25:33Because it's expensive for the NHS and embarrassing for the Government?
0:25:33 > 0:25:35It's expensive for the NHS.
0:25:35 > 0:25:38It's wrong for patients to keep them in high acuity health care
0:25:38 > 0:25:42environments when they would be much better off at home
0:25:42 > 0:25:44being supported in their own environments.
0:25:46 > 0:25:49We spent seven days in A&E.
0:25:49 > 0:25:53Alex Muirhead, now a GP, originally looked forward to many more
0:25:53 > 0:25:56years there, but decided enough was enough.
0:25:56 > 0:25:59There's a tiny part of me that feels guilty for jumping
0:25:59 > 0:26:01from a sinking ship, but for me,
0:26:01 > 0:26:04I don't haven't a single regret about leaving.
0:26:04 > 0:26:06- A sinking ship?- Yeah.
0:26:06 > 0:26:11The A&E is a sinking ship and unless things change dramatically,
0:26:11 > 0:26:16it will sink because it's not a popular place to work now.
0:26:16 > 0:26:19I don't think we're going to go down like the Titanic
0:26:19 > 0:26:21in a matter of hours, we're going to slowly sink.
0:26:21 > 0:26:25It will be on a daily, weekly, monthly basis, there will be
0:26:25 > 0:26:29an imperceptible reduction in the capacity of emergency medicine.
0:26:31 > 0:26:34Stockton remains a good and safe hospital
0:26:34 > 0:26:38but the man who represents A&E doctors nationally
0:26:38 > 0:26:41warns of the risks unless action is taken.
0:26:41 > 0:26:44This is about a call to arms to address the real problems that
0:26:44 > 0:26:47we have in accident and emergency departments up and down the country.
0:26:47 > 0:26:51- You feel it pushing?- Yeah.
0:26:51 > 0:26:53My real fear if we don't do something about recruitment
0:26:53 > 0:26:55and retention in emergency medicine,
0:26:55 > 0:26:58is that you will turn up in an ambulance to an emergency department
0:26:58 > 0:27:00and there will be no doctors there to see you.
0:27:00 > 0:27:04There will never be no doctor, that won't happen.
0:27:04 > 0:27:08We may have a situation where emergency medicine
0:27:08 > 0:27:10doctors are insufficient.
0:27:10 > 0:27:13What we will have to do in the short-term is to look
0:27:13 > 0:27:16at how we use the wider skills that are available
0:27:16 > 0:27:20in the hospital, to look at the extended role of nurses,
0:27:20 > 0:27:24of paramedics, of physician's assistants.
0:27:24 > 0:27:28Working to crude and blunt targets with serious shortages of staff,
0:27:28 > 0:27:31treating patients who shouldn't be there at all.
0:27:31 > 0:27:34111 can give you medical advice...
0:27:36 > 0:27:39Remember what the initials A&E are short for?
0:27:39 > 0:27:42They can stand for "Anything and Everything",
0:27:42 > 0:27:43or "Always and Everyone".
0:27:43 > 0:27:46They stand for that because we are always open,
0:27:46 > 0:27:49we are open 24 hours a day, seven days a week.
0:27:49 > 0:27:51Anyone can drop in at any time.
0:27:51 > 0:27:55There certainly is an expectation from the public they come to A&E
0:27:55 > 0:27:58and they get seen and sorted.
0:27:58 > 0:28:01It's a difficult thing, if we provide a good service,
0:28:01 > 0:28:04you almost make a rod for your own back.
0:28:04 > 0:28:07Some people, working in this environment is what draws them.
0:28:07 > 0:28:10Bu for some people, they don't want to be struggling with difficulties
0:28:10 > 0:28:14like having no beds and trying to maintain the safety
0:28:14 > 0:28:16and comfort of your patients.
0:28:18 > 0:28:21We didn't just see flashing blue lights at accident and emergency,
0:28:21 > 0:28:24there are political warning lights, as well.
0:28:24 > 0:28:28This most visible part of the NHS is under heavy stress
0:28:28 > 0:28:30and in need of urgent treatment.