A Week in A&E: Condition Critical? Panorama


A Week in A&E: Condition Critical?

Similar Content

Browse content similar to A Week in A&E: Condition Critical?. Check below for episodes and series from the same categories and more!

Transcript


LineFromTo

Accident & Emergency - the NHS's ever-open door.

0:00:030:00:07

-Who the

-BLEEP

-do you think you're talking to?

0:00:070:00:11

It's a more stressful place to work than it once was.

0:00:110:00:14

The pressure upon A&E just won't stop building.

0:00:140:00:17

-When the hospital's full, we cannot win.

-Ready, steady, slide.

0:00:170:00:21

-You need to wake up then, sweetheart.

-PHONE RINGS

0:00:230:00:26

Hello, A&E?

0:00:260:00:27

Not everyone is prepared to go on taking it.

0:00:280:00:31

A&E is a sinking ship and unless things change dramatically,

0:00:310:00:35

it will sink.

0:00:350:00:36

Tonight, the real emergency that's threatening A&E.

0:00:370:00:41

INDISTINCT TANNOY ANNOUNCEMENT

0:00:410:00:46

If we don't do something, you will turn up in an ambulance to

0:00:460:00:49

an emergency department and there will be no doctors there to see you.

0:00:490:00:52

SIREN WAILS

0:00:520:00:55

The University Hospital of North Tees in Stockton treated nearly

0:01:060:01:10

90,000 patients in its accident and emergency department last year.

0:01:100:01:14

Nothing special about that.

0:01:150:01:17

Yet they let us film for seven days in theirs...

0:01:190:01:22

But A&E's always politically sensitive.

0:01:230:01:26

You just lay still, mate.

0:01:260:01:28

More than 100 hospitals wouldn't.

0:01:280:01:30

Three initially said yes only to say no later.

0:01:300:01:33

It's 1.30am.

0:01:410:01:43

It's quiet in A&E when a 28-year-old man checks in,

0:01:430:01:48

escorted by police for his own safety.

0:01:480:01:52

Vodka and Lucozade.

0:01:520:01:54

He has deliberately cut himself - and badly.

0:01:550:01:58

Basically, I was having a quiet night in with my girlfriend

0:01:580:02:03

and she told me that she didn't want to continue the relationship.

0:02:030:02:08

Er, so I was upset.

0:02:090:02:11

And I couldn't find the words to tell her, so I got a knife and...

0:02:110:02:15

What we're going to do is take the dressings off

0:02:170:02:20

and have a look at your wounds.

0:02:200:02:21

SUCKS IN BREATH

0:02:230:02:24

-It takes a lot to surprise A&E staff.

-That's the deepest one.

0:02:300:02:34

Compared to all the others.

0:02:340:02:36

What we'll need to do is

0:02:360:02:38

we'll need to close it by using stitches, yeah?

0:02:380:02:41

The numbers turning up in A&E just go on rising nationally.

0:02:420:02:46

No pain, no gain, they say, though, don't they?

0:02:470:02:50

A million more patients in England since 2010.

0:02:510:02:55

We set out to discover why.

0:02:550:02:57

A&E staff say the initials really stand for "Anything and Everything".

0:03:010:03:05

All human life is here.

0:03:050:03:07

INDISTINCT

0:03:070:03:10

This morning I was in my van towards my job

0:03:100:03:14

and my left ear was itching like mad.

0:03:140:03:16

I always carry my pencil behind my lug.

0:03:160:03:19

I scratched it, realised there was no rubber on the end,

0:03:190:03:22

so it's gone in my ear.

0:03:220:03:23

Had to seek medical advice.

0:03:230:03:26

Certainly over the 25 years that

0:03:290:03:31

I've been in A&E things have changed.

0:03:310:03:35

It's higher volume, harder workload,

0:03:350:03:38

we get patients in who are possibly more demanding.

0:03:380:03:42

It's a more stressful place to work than it once was.

0:03:420:03:46

If I allowed my staff to behave like this,

0:03:460:03:49

they'd be out.

0:03:490:03:51

A patient is brought in, for some reason bitterly complaining

0:03:520:03:55

about the NHS.

0:03:550:03:57

-We'll get you on the bed, mate, right?

-Yes.

0:03:570:03:59

But his medical diagnosis turns out to be quite simple.

0:04:010:04:04

Diabetic. He's fallen, his sugars might have been a bit low...

0:04:060:04:10

He's laid on the floor until somebody's found him,

0:04:110:04:14

five, six hours.

0:04:140:04:16

So, here we are.

0:04:160:04:19

-We'll sort you out, son.

-OK.

0:04:190:04:21

-Have you had anything to eat today?

-No.

-No?

0:04:210:04:23

You know you should do, don't you?

0:04:230:04:26

Well... I was on the floor!

0:04:260:04:29

The hospital on Teesside in the north-east of England

0:04:360:04:40

serves an area of once-thriving heavy industry.

0:04:400:04:43

The monuments to its past are all around.

0:04:430:04:46

Its A&E is ruled by a government target -

0:04:490:04:52

patients must be seen and treated or admitted within four hours.

0:04:520:04:57

So I understand you had high blood pressure because you take...

0:04:570:05:01

In England, Wales and Northern Ireland,

0:05:020:05:05

95% have to be dealt with within this time limit.

0:05:050:05:08

In Scotland, the figure is even higher - 98%.

0:05:080:05:12

-He was pre-alerted through... Diverted.

-So they've got the stroke team?

0:05:120:05:17

-Yeah.

-The nurses' station is the nerve station of Stockton's A&E.

0:05:170:05:23

Red on the computer screen warns staff that they may

0:05:230:05:26

be at risk in the jargon of breaching the four-hour limit.

0:05:260:05:30

Failure means fines and ultimately naming

0:05:300:05:33

and shaming for the hospital's management.

0:05:330:05:35

TANNOY: 'Anyone free for a handover in majors, please.'

0:05:350:05:38

Stockton's been meeting its targets.

0:05:380:05:40

It has a Patient Process Facilitator, dedicated to the task.

0:05:400:05:44

-Meet Pam Dove.

-Jack of all trades.

0:05:440:05:47

PHONE RINGS

0:05:510:05:53

Hello, can I help you?

0:05:530:05:54

There's a female patient who's getting close to breaching the limit.

0:05:540:05:58

The lady is on 220 minutes

0:05:580:06:00

and they have to be out the department in 239

0:06:000:06:02

otherwise it's classed as a breach.

0:06:020:06:04

She hasn't got long, now - she's got 15 minutes.

0:06:040:06:06

-So you've got about 15 minutes left...

-Yes.

-With the clock ticking...

0:06:100:06:13

-Yes.

-To avoid a breach.

-To avoid a breach.

0:06:130:06:16

Right, OK - how long will it be?

0:06:190:06:21

Right, five minutes and we can set off.

0:06:210:06:24

Lovely.

0:06:240:06:25

-This is like a Target Olympics.

-Yes.

0:06:280:06:30

-Like a race. It's a sprint.

-Definitely a sprint.

0:06:300:06:34

Throughout our seven days in A&E,

0:06:370:06:39

we saw the reality of working within this target culture.

0:06:390:06:44

Everyone we spoke to had something to say about trying to keep to

0:06:440:06:47

the targets in a department under continuous pressure.

0:06:470:06:50

PHONE RINGS

0:06:500:06:53

Hello, A&E, staff nurse.

0:06:530:06:54

I feel the breach thing is...

0:06:540:06:57

It's a bit of a mixed blessing.

0:06:580:07:01

We do need some pressure to make us work efficiently,

0:07:010:07:04

but at the same time, it can be infuriating

0:07:040:07:06

when all you want to do is look after your patient and you've got somebody

0:07:060:07:10

or multiple people telling you that this person is coming up to breach.

0:07:100:07:14

-Consultants were critical, too.

-We're working harder and harder

0:07:140:07:18

towards targets that are sometimes unachievable.

0:07:180:07:21

No matter how hard you try, you can't win?

0:07:210:07:24

We can't win when the hospital is full. We cannot win.

0:07:240:07:27

'But Pam on this occasion had a mini victory.'

0:07:280:07:32

Did you win, Pam?

0:07:320:07:33

-Yes, we did.

-How many minutes did you have left?

-Four minutes.

0:07:330:07:36

And Pam goes off shift and passes the baton over to the next

0:07:380:07:41

competitor in the Target Olympics.

0:07:410:07:44

You're about to hand all this over to Becky - good luck!

0:07:440:07:46

-Thank you!

-She'll need it!

-I know!

0:07:460:07:49

But the targets weren't designed to make life easier for the staff -

0:07:490:07:53

they're meant to benefit patients.

0:07:530:07:56

Patients come first. We need to do the best for patients.

0:07:560:07:59

What you have to remember is behind every target is a patient.

0:07:590:08:03

We don't want people to wait four hours in the A&E.

0:08:030:08:06

If you and I were going to the A&E department,

0:08:060:08:08

we'd want to be seen quickly,

0:08:080:08:09

so although we have that target,

0:08:090:08:11

it's not the be-all and end-all.

0:08:110:08:12

A&E is busy. There's a backlog of patients.

0:08:160:08:20

Brought in by her daughter,

0:08:200:08:21

73-year-old Marion Knaggs has bad stomach pain.

0:08:210:08:25

She needs tests to find out what's wrong. But these take time.

0:08:250:08:29

Eventually, the tests are completed

0:08:320:08:34

and a bed is found for her in a ward. But there's a problem.

0:08:340:08:38

When we got up there, there was about four or five people waiting in

0:08:380:08:42

front of her and we waited there

0:08:420:08:43

for about 10 or 15 minutes

0:08:430:08:45

to be told we had to come back to the accident and emergency unit

0:08:450:08:48

cos there were no beds.

0:08:480:08:50

There's a traffic jam in the rest of the hospital.

0:08:510:08:55

There's no beds.

0:08:550:08:56

Everybody's trying. The manager on call is aware.

0:08:560:08:59

So it's just basically down to bed managers to help get some

0:08:590:09:02

patients moved out onto the base wards.

0:09:020:09:04

It's unfair to the patients - they're getting moved,

0:09:040:09:07

getting shunted from pillar to post. It's frustrating to us.

0:09:070:09:10

And finally, second time round, Mrs Knaggs is admitted.

0:09:100:09:14

Do you want to sit in the chair?

0:09:150:09:17

But having had a six-hour wait, she's breached the limit

0:09:170:09:21

and become a negative statistic.

0:09:210:09:23

I feel like the staff are trying their best to work with every

0:09:230:09:26

single patient and treat them as an individual, not just

0:09:260:09:29

a patient number, but they don't seem to have enough staff and enough

0:09:290:09:32

resources to deal with the amount of people coming through the doors.

0:09:320:09:36

Did you think that before today?

0:09:360:09:38

-Or is that something you've learned today?

-Something I've learned today.

0:09:380:09:42

Peter Hawes, the diabetic,

0:09:440:09:46

had had his blood sugar levels checked,

0:09:460:09:48

he's rested and now the hospital wants to get him out

0:09:480:09:50

before he breaches the four-hour rule as well.

0:09:500:09:54

I think I've been well looked after.

0:09:540:09:56

But I'm glad to be going home!

0:09:560:09:59

See ya!

0:10:030:10:04

And Peter goes off with 16 minutes to spare.

0:10:080:10:11

But in the rush to get him home,

0:10:110:10:13

no-one notices that he's being discharged with a cannula -

0:10:130:10:17

the tube for an intravenous drip - still in place,

0:10:170:10:21

which upsets the nurse who'd looked after him earlier.

0:10:210:10:24

It annoyed me, put it that way.

0:10:240:10:25

You try to have

0:10:250:10:27

that continuation of care.

0:10:270:10:30

The stresses and strains of the job are such that you're trying to

0:10:300:10:34

strive to meet those targets, you're pushed to the limits.

0:10:340:10:38

So, do the targets need reforming?

0:10:380:10:41

We asked the Department of Health for an interview,

0:10:410:10:44

but they declined and referred us to NHS England.

0:10:440:10:47

Their A&E chief admits they do.

0:10:470:10:51

What was intended to be something to ensure patient safety

0:10:510:10:54

and improve patient experience,

0:10:540:10:57

that has been translated down to something that feels like a target

0:10:570:11:01

culture and that's one very important reason why we need to review it.

0:11:010:11:05

And do you accept that the four-hour 95% target as it currently applies

0:11:050:11:10

-is too crude a measure?

-It's too crude.

0:11:100:11:12

I think now things have moved on.

0:11:120:11:14

When it came in, it was highly effective. Now, it's too blunt.

0:11:140:11:17

It's really been a powerful weapon for change within A&E

0:11:170:11:21

departments, so it's not going to be got rid of without there

0:11:210:11:24

being something that is better.

0:11:240:11:26

It's the end of the day.

0:11:330:11:34

There are fewer staff, but difficult new patients.

0:11:340:11:37

Drug abuse happens around the clock -

0:11:380:11:40

this hospital deals with three to four overdoses a day.

0:11:400:11:43

This woman is admitted unconscious.

0:11:520:11:55

The first priority, to bring her round.

0:11:550:11:58

All right. All right.

0:11:580:12:00

Can you speak to us, how are you doing?

0:12:000:12:03

You need to wake up then, sweetheart.

0:12:030:12:06

-Sharp scratch.

-My name's Jenny.

-Try your very best.

0:12:060:12:11

Just about to do a sharp blood test, OK?

0:12:110:12:13

A test reveals a long list of drugs in her system.

0:12:140:12:18

Diazapines, opiates...

0:12:180:12:22

Well, it's got methadone and morphine have tested positive,

0:12:220:12:26

so that's basically heroin or sort of heroin replacement medication.

0:12:260:12:31

Cocaine, obviously.

0:12:310:12:33

For a while, this patient consumed resources -

0:12:330:12:37

everything else had to wait.

0:12:370:12:39

Later, she was admitted to a ward, but by morning,

0:12:390:12:42

she'd discharged herself.

0:12:420:12:44

Are you all right there, darling?

0:12:440:12:46

The constant pressure upon A&E means that it's always

0:12:470:12:50

in the political front line.

0:12:500:12:53

Before this winter, a crisis was predicted and the government

0:12:530:12:56

announced that £400 million more was going into A&E in England.

0:12:560:13:01

But Stockton Hospital didn't qualify for any of this

0:13:010:13:03

because of its above-average performance.

0:13:030:13:06

Last couple of months it's been horrendous.

0:13:060:13:08

Beds are emptied and then straightaway,

0:13:080:13:10

patients go back in again, so...

0:13:100:13:12

We're constantly chasing our tails.

0:13:120:13:15

And that day, the hospital simply ran out of beds.

0:13:150:13:18

So at one of their twice-daily bed management meetings,

0:13:180:13:22

they responded.

0:13:220:13:23

Because we have trigger points, we have an escalation policy

0:13:280:13:32

and a programme of trigger points that we look at.

0:13:320:13:35

BLEEPER

0:13:350:13:36

Sorry. That's a call to say that they're escalating another bed meeting because of pressures.

0:13:360:13:42

So it's likely to be that either A&E or the emergency assessment unit

0:13:420:13:46

are under pressure.

0:13:460:13:47

Anyway, I want to knock myself clean off. BLEEP!

0:13:470:13:52

-Just relax.

-Otherwise, I'll BLEEP.

0:13:530:13:56

Listen, Michael...

0:13:560:13:57

Staff in A&E are attending to Michael Alfwaite.

0:13:570:14:01

He's had far too much to drink and he's threatened suicide.

0:14:010:14:05

The paramedics said you wanted to kill yourself, slit your wrists?

0:14:060:14:09

-You going to do it?

-I suppose so.

0:14:090:14:12

The most common drug of abuse arriving in the department

0:14:120:14:15

is alcohol, which comes on a daily basis.

0:14:150:14:18

-How much have you had to drink today?

-Well...quite a lot.

0:14:180:14:22

There are more than a million alcohol-related hospital admissions

0:14:220:14:27

in England each year.

0:14:270:14:29

-I'm

-BLEEP

-sick to

-BLEEP

-death of these

-BLEEP.

0:14:290:14:34

He is fighting. He has not really got the strength to actually...

0:14:340:14:37

Do you know what I mean?

0:14:370:14:39

They're managing to hold him fine and I think he's just all bravado.

0:14:390:14:43

In the cubicle just opposite, they've had quite enough of him.

0:14:440:14:49

The nurses and doctors shouldn't have to put up with him swearing

0:14:490:14:53

and threatening to bite and kill them.

0:14:530:14:56

It's scandalous. Something should be done.

0:14:560:14:58

If they get in that state, they should be chucked out

0:14:580:15:00

and let themselves get sorted.

0:15:000:15:02

Now he's briefly become violent and fallen over.

0:15:060:15:09

-Who the

-BLEEP

-do you think you're talking to?

0:15:090:15:14

Michael, what are you doing, sweetheart?

0:15:140:15:16

Many A&E staff seem to have the patience of saints.

0:15:210:15:24

If you all just understand what...

0:15:240:15:27

It's becoming less attractive as a career.

0:15:270:15:30

The job is stressful and it is hard work.

0:15:340:15:37

My work/life balance hasn't been good in recent weeks.

0:15:370:15:40

Myself, I'm sure many of my colleagues,

0:15:400:15:43

we all take work home with us.

0:15:430:15:44

It isn't a balance?

0:15:440:15:46

-I have a lot of work on my plate.

-Not life?

0:15:460:15:49

No.

0:15:490:15:51

Recruiting enough A&E staff and keeping them in their jobs

0:15:540:15:57

is now a national problem.

0:15:570:16:00

Their champion says accident and emergency departments

0:16:000:16:03

won't work properly at this rate.

0:16:030:16:05

For the last three years, we have recruited only 50%

0:16:050:16:08

of the registrars into emergency medicine.

0:16:080:16:10

This means there is a lack of about 350-375 registrars

0:16:100:16:14

around the country.

0:16:140:16:16

That equates to three quarters of a million patient consultations

0:16:160:16:19

per year that can't happen because those doctors don't exist.

0:16:190:16:24

They're one consultant, a registrar and two nurses short

0:16:240:16:28

in Stockton's A&E, and fill up some gaps in staffing with hired temps.

0:16:280:16:32

They're called locums in the trade.

0:16:340:16:36

The one on shift admits it's not quite the same

0:16:360:16:38

as having someone permanent.

0:16:380:16:41

You can have good locums and you can have bad locums.

0:16:410:16:44

Quite a lot at the moment are perceived as being bad,

0:16:440:16:50

they sort of come in, don't care about the job.

0:16:500:16:52

They come in to do the work, get paid and go.

0:16:520:16:55

So stressed out A&E doctors have been voting with their feet.

0:16:580:17:03

That's the house we often stay in when we go down there.

0:17:030:17:06

-You rent this place?

-Yeah, rent it down there for very little.

0:17:060:17:09

John Thompson trained in Stockton

0:17:110:17:13

and he's worked as an A&E consultant there too.

0:17:130:17:16

But he has left the NHS behind to live and work in Fremantle,

0:17:160:17:21

in Australia.

0:17:210:17:22

We met him when he was here visiting relations and old friends.

0:17:220:17:26

-There are kangaroos, there you go. Stalking kangaroos.

-Oh, my word!

0:17:260:17:30

The pressures are less in Australia

0:17:320:17:36

and the emphasis primarily for my working day

0:17:360:17:39

is on patient care.

0:17:390:17:41

The pressures from the four-hour rule and from up above

0:17:410:17:45

have taken so much away from the job in the NHS in the UK

0:17:450:17:49

that it's just...

0:17:490:17:51

It's too hard.

0:17:510:17:53

The number of UK medical graduates

0:17:540:17:56

working in Australian emergency departments has gone up

0:17:560:18:00

by over 60% in the last four years.

0:18:000:18:03

That looks a lot better, doesn't it? It's still quite dry.

0:18:030:18:08

Alex Muirhead quit, as well.

0:18:080:18:11

She didn't leave the country

0:18:110:18:12

but she left the specialism she had originally chosen for good.

0:18:120:18:16

She was an A&E consultant at Stockton Hospital until last December.

0:18:160:18:20

Now she is a local GP instead.

0:18:220:18:24

It was quite sad, really, because I used to love working in A&E

0:18:240:18:28

but it got to the stage where I just didn't enjoy my job

0:18:280:18:32

and I didn't want to spend another 20 years working as an A&E consultant.

0:18:320:18:37

As an A&E department I don't think you get

0:18:370:18:39

an awful lot of respect from the rest of the hospital.

0:18:390:18:43

To some extent, A&E's now seen as everyone's dumping ground.

0:18:430:18:48

All medical staff for the boardroom.

0:18:520:18:55

It would help if far fewer of us turned up in A&E in the first place.

0:19:010:19:05

According to official figures,

0:19:050:19:07

40% of patients don't need to go to accident and emergency at all.

0:19:070:19:11

For some, it's a safe haven.

0:19:110:19:15

Every week. I get admitted every week.

0:19:160:19:18

-You come here every week?

-Every week, mate.

0:19:180:19:21

-Are they good and kind to you when you come here?

-Some of them are.

0:19:210:19:24

The ones who know me personally, they're all right,

0:19:240:19:27

but other people think he is in and out, he is an idiot.

0:19:270:19:31

In the last month, I think he's attended six times.

0:19:310:19:34

Is he the only one or is there...?

0:19:340:19:36

No, no, we have quite a few, what we class as regulars.

0:19:360:19:39

Peter is admitted to a ward.

0:19:410:19:44

There are plenty of others who shouldn't be here at all

0:19:440:19:47

but they turn up in A&E all the same.

0:19:470:19:50

We had a gentleman who came in and he had a splinter in his finger.

0:19:510:19:55

At that point we were on a three-and-a-half hour wait.

0:19:550:19:58

A lot of sore throats come in, and coughs.

0:20:010:20:06

I am talking just little coughs.

0:20:060:20:09

One reason we heard for coming to A&E

0:20:120:20:15

is because it's difficult to get an appointment with a GP.

0:20:150:20:19

I was involved in a road traffic accident last night.

0:20:200:20:23

Woke up this morning with pain across my shoulders.

0:20:230:20:25

Went to the local doctor's but they couldn't book me in

0:20:250:20:28

so I couldn't really wait until Monday.

0:20:280:20:29

I don't want to waste these people's time,

0:20:290:20:32

I am sure there's more deserving people than me.

0:20:320:20:34

Besides GPs, the NHS offers a whole host of alternatives

0:20:390:20:43

to accident and emergency.

0:20:430:20:44

But lots of us still say "Thanks, but no thanks, I'll stick to A&E."

0:20:460:20:51

We have been in a nightclub, me and my partner.

0:20:510:20:55

A guy has tried to provocatively dance with me.

0:20:550:20:59

He has obviously had too much to drink, went for him

0:20:590:21:03

and I've got caught in the middle of it and been punched in the face.

0:21:030:21:06

-Had you any doubt about whether to come here?

-No.

0:21:060:21:09

I think I'm just being a bit vain, I am panicking in case I broke my nose.

0:21:090:21:14

Even the professionals admit part of the reason some patients still go

0:21:140:21:19

to A&E is that the alternatives are a bit of a maze.

0:21:190:21:23

It's very difficult to understand.

0:21:230:21:25

We've had lots of different things, NHS Direct, the 111 system.

0:21:250:21:29

They don't really know what all that means.

0:21:290:21:32

Minor injuries unit, urgent care centre...

0:21:320:21:35

I agree entirely. I think there is a confusion around the names.

0:21:350:21:38

You want me to know where to go and I can only just make head or tail

0:21:380:21:42

of these titles and I've been working hard at it.

0:21:420:21:44

-Did you lose consciousness when you fell?

-No.

0:21:440:21:48

Bu quite a lot of patients in Stockton wish they were being

0:21:480:21:51

treated in a hospital nearer home.

0:21:510:21:54

I was walking my dog and she was on a lead

0:21:540:21:59

and then another dog come chasing up to her

0:21:590:22:02

and I fell flat on my face.

0:22:020:22:04

I was in shock.

0:22:040:22:06

I knew my face was all bleeding

0:22:060:22:09

and you know what women are like,

0:22:090:22:11

we like to have our pretty faces.

0:22:110:22:14

On top of that, Christine Johnson had to travel to be treated.

0:22:180:22:22

In 2011, the A&E department in Hartlepool, 15 miles away,

0:22:220:22:26

was shut and services were concentrated in Stockton Hospital instead.

0:22:260:22:31

And here, as in other places, the closure of a local A&E still hurts.

0:22:310:22:37

-Where would you like to have been taken?

-Hartlepool.

0:22:370:22:40

For you and your husband, getting here to Stockton is a palaver?

0:22:400:22:44

-It is.

-Have you told anybody that?

-No, it was... Who can I tell?

0:22:440:22:47

I'm just a little person, aren't I?

0:22:500:22:52

I think right across the country,

0:22:570:22:59

people want all the services that they can as local as possible,

0:22:590:23:02

and whilst we try to achieve that,

0:23:020:23:05

if you go in for a local service,

0:23:050:23:06

it's got to be of the highest quality.

0:23:060:23:09

And bringing the two services together was the right thing to do.

0:23:090:23:12

Can I have a look at you, sir, is that OK?

0:23:120:23:15

What was striking about our time in A&E was the number of elderly,

0:23:150:23:19

frail patients they dealt with day and night.

0:23:190:23:23

The number of over-65s attending major A&E departments

0:23:230:23:26

in England has gone up by around 190,000 in the last year alone.

0:23:260:23:31

Admitted in the small hours of the morning,

0:23:310:23:33

it was Bill Galloway's 100th birthday.

0:23:330:23:37

# Happy birthday to you Happy birthday to you... #

0:23:370:23:41

What is the most challenging in the middle of the night

0:23:410:23:45

is complex medical patients.

0:23:450:23:47

Elderly patients, just doing simple things at 4am,

0:23:470:23:52

interpreting a chest X-ray,

0:23:520:23:54

trying to get clear information at that time of the morning

0:23:540:23:57

and when you have a department full of those type of patients,

0:23:570:24:00

it's absolutely exhausting.

0:24:000:24:01

If they're admitted on to a ward,

0:24:030:24:05

the elderly may affect A&E departments in a different way.

0:24:050:24:08

It's Sunday.

0:24:080:24:10

78-year-old Dot Bromilow has been medically fit to be discharged

0:24:100:24:14

for two days, but she's still taking up an acute hospital bed.

0:24:140:24:18

Why are you still up here in the ward?

0:24:180:24:21

Well, bureaucracy.

0:24:210:24:24

She relies on home help

0:24:240:24:25

which is organised by her council's social services department.

0:24:250:24:30

It was stopped as soon as she was admitted into hospital.

0:24:300:24:33

That's standard practice.

0:24:330:24:35

But it can't be rearranged until after the weekend.

0:24:350:24:38

For the moment, until your care package is sorted...

0:24:380:24:41

I'm stuck.

0:24:410:24:42

Today as we speak, we have eight of those patients

0:24:430:24:47

that are sitting in a hospital bed

0:24:470:24:49

that are waiting for a process to be completed.

0:24:490:24:51

If they don't leave the hospital it clogs up the system

0:24:510:24:54

and causes problems back in A&E and you can't get them out?

0:24:540:24:57

No.

0:24:570:24:58

Using official figures, we have calculated that in total,

0:24:580:25:02

delays involving social care packages are costing

0:25:020:25:05

the NHS in England about £100 million a year.

0:25:050:25:09

And cuts in local authority budgets are making things worse.

0:25:090:25:13

There's bound to be a consequence.

0:25:130:25:15

Social care and local authorities have taken a significant reduction.

0:25:150:25:19

We need to join the services up and one of the key things we have to do

0:25:190:25:24

is to bring the doctors, the nurses, the social workers back together.

0:25:240:25:29

Because it's expensive for the NHS and embarrassing for the Government?

0:25:290:25:33

It's expensive for the NHS.

0:25:330:25:35

It's wrong for patients to keep them in high acuity health care

0:25:350:25:38

environments when they would be much better off at home

0:25:380:25:42

being supported in their own environments.

0:25:420:25:44

We spent seven days in A&E.

0:25:460:25:49

Alex Muirhead, now a GP, originally looked forward to many more

0:25:490:25:53

years there, but decided enough was enough.

0:25:530:25:56

There's a tiny part of me that feels guilty for jumping

0:25:560:25:59

from a sinking ship, but for me,

0:25:590:26:01

I don't haven't a single regret about leaving.

0:26:010:26:04

-A sinking ship?

-Yeah.

0:26:040:26:06

The A&E is a sinking ship and unless things change dramatically,

0:26:060:26:11

it will sink because it's not a popular place to work now.

0:26:110:26:16

I don't think we're going to go down like the Titanic

0:26:160:26:19

in a matter of hours, we're going to slowly sink.

0:26:190:26:21

It will be on a daily, weekly, monthly basis, there will be

0:26:210:26:25

an imperceptible reduction in the capacity of emergency medicine.

0:26:250:26:29

Stockton remains a good and safe hospital

0:26:310:26:34

but the man who represents A&E doctors nationally

0:26:340:26:38

warns of the risks unless action is taken.

0:26:380:26:41

This is about a call to arms to address the real problems that

0:26:410:26:44

we have in accident and emergency departments up and down the country.

0:26:440:26:47

-You feel it pushing?

-Yeah.

0:26:470:26:51

My real fear if we don't do something about recruitment

0:26:510:26:53

and retention in emergency medicine,

0:26:530:26:55

is that you will turn up in an ambulance to an emergency department

0:26:550:26:58

and there will be no doctors there to see you.

0:26:580:27:00

There will never be no doctor, that won't happen.

0:27:000:27:04

We may have a situation where emergency medicine

0:27:040:27:08

doctors are insufficient.

0:27:080:27:10

What we will have to do in the short-term is to look

0:27:100:27:13

at how we use the wider skills that are available

0:27:130:27:16

in the hospital, to look at the extended role of nurses,

0:27:160:27:20

of paramedics, of physician's assistants.

0:27:200:27:24

Working to crude and blunt targets with serious shortages of staff,

0:27:240:27:28

treating patients who shouldn't be there at all.

0:27:280:27:31

111 can give you medical advice...

0:27:310:27:34

Remember what the initials A&E are short for?

0:27:360:27:39

They can stand for "Anything and Everything",

0:27:390:27:42

or "Always and Everyone".

0:27:420:27:43

They stand for that because we are always open,

0:27:430:27:46

we are open 24 hours a day, seven days a week.

0:27:460:27:49

Anyone can drop in at any time.

0:27:490:27:51

There certainly is an expectation from the public they come to A&E

0:27:510:27:55

and they get seen and sorted.

0:27:550:27:58

It's a difficult thing, if we provide a good service,

0:27:580:28:01

you almost make a rod for your own back.

0:28:010:28:04

Some people, working in this environment is what draws them.

0:28:040:28:07

Bu for some people, they don't want to be struggling with difficulties

0:28:070:28:10

like having no beds and trying to maintain the safety

0:28:100:28:14

and comfort of your patients.

0:28:140:28:16

We didn't just see flashing blue lights at accident and emergency,

0:28:180:28:21

there are political warning lights, as well.

0:28:210:28:24

This most visible part of the NHS is under heavy stress

0:28:240:28:28

and in need of urgent treatment.

0:28:280:28:30

Download Subtitles

SRT

ASS