UK emergency departments increasingly failing

[Alfegos]

I don't particularly give a shit about waiting times.
I care a lot more about survival rates. If you want the express treatment, go private.

Yes, the two are connected to a degree, but not always.
I don't care if someone has to wait 8 hours for a nail in their hand. I'm sure it does suck for them.
But you know, there are other patients with more serious shit. The focus on waiting times misses this.

The funny thing about the private sector is that they don't have to meet targets on waiting times or survival rates, and they are not inspected by the CQC to any real degree - most figures are based on their "honesty". At the end of the day, most of the staff in private practice work in the NHS and do private work on the side. The wait may be a little shorter - the treatment is rarely any different, the real difference being you get cream cheese and salmon sandwiches, and there are more potted plants and ornaments.

[Quintium]

VOTE UKIP!

How do they plan on remedying the waits?

1. Stopping a large part of the inflow of migrants, which takes a bit of pressure off the kettle, while not stopping the inflow of useful staff if there should be a genuine lack of skilled staff in Britain (rather than, you know, a lack of people in the prime of their life who will clean floors and do plumbing for effectively less money than they need to pay their rent and buy food).
2. Taking on middle and higher management and all sorts of semi-public but for-profit organisations that are currently profiting from the NHS immensely, and investing more time and resources into nurses, doctors et cetera. A simpler NHS in terms of organisation is likely to cost less money, so that more money can be spent on actually helping people rather than keeping records here and there and hiring thousands of people just to 'motivate' and 'oversee' the people who do the actual work. Essentially, get rid of the man with the whip because he isn't getting any work done.

[Alfegos]

How do they plan on remedying the waits?

1. Stopping a large part of the inflow of migrants, which takes a bit of pressure off the kettle, while not stopping the inflow of useful staff if there should be a genuine lack of skilled staff in Britain (rather than, you know, a lack of people in the prime of their life who will clean floors and do plumbing for effectively less money than they need to pay their rent and buy food).
2. Taking on middle and higher management and all sorts of semi-public but for-profit organisations that are currently profiting from the NHS immensely, and investing more time and resources into nurses, doctors et cetera. A simpler NHS in terms of organisation is likely to cost less money, so that more money can be spent on actually helping people rather than keeping records here and there and hiring thousands of people just to 'motivate' and 'oversee' the people who do the actual work. Essentially, get rid of the man with the whip because he isn't getting any work done.

Last time I checked, UKIP were more for moving the UK towards a social insurance scheme, and selling off the NHS infrastructure to competing co-operatives and private companies. Libertarianism and all that.

Though if he's changed policy YET AGAIN, it wouldn't surprise me.

Sadly though, point 1) you make is a load of bollocks. Migrants put hardly any pressure on the health system - it's far more likely to be the elderly white natives who take up A&E resources. Hell, most migrants I see have rather easily curable conditions, or conditions that are actually curable - you can cure TB, you can't cure heart failure or COPD. Get rid of the elderly or the mental people if you want strain off the NHS!

[Marcurix]

Depends. There have been mutterings of people going to A&E for trivial things over the years, and some have given the impression its a growing problem. Such occurrences would extend wait times simply by the virtue of making the queue longer.

The most trivial thing I've seen in A&E was a man who came in with mouse bites on his feet, which he got after putting his boots on in the morning with a live mouse inside, before walking around for 2 hours in them. Safe to see that as soon as he took his boot off in the waiting room, the mouse fucked off pretty quickly, causing a nice ruckus.

Seriously though, a lot of the presenting complaints will be UTIs, bad coughs, and minor injuries (e.g. grazes, hammered thumb, penis in zipper), for whom most didn't want to wait for 2 weeks before being prescribed antibiotics or having somewhat definite treatment. They would be (on a typical day I suppose) 30% of people, with the other 70% with more serious illness. In our A&E at least (not being a trauma centre), only about 10% of people are SERIOUSLY ill (National Triage category 2 or 1), with only 3-4 people in a week being category 1 (I.e. Not breathing on arrival).

Hm, some interesting points there. I was hesitant to say it was an absolutely prevalent problem because I don't feel I've adequate experience or research in that particular area.

Though I'd like to dispute the penis in the zipper being a none emergency.

VOTE UKIP!

Why would I vote for the poster child of bad ideas and wishful thinking?

Hell, the party doesn't know it's own policy most the time.

[Colbert Super PAC]

Privatize the NHS. It's the only solution.

[Arlenton]

VOTE UKIP!

I prefer the Tories.

[Ostroeuropa]

I don't particularly give a shit about waiting times.
I care a lot more about survival rates. If you want the express treatment, go private.

Yes, the two are connected to a degree, but not always.
I don't care if someone has to wait 8 hours for a nail in their hand. I'm sure it does suck for them.
But you know, there are other patients with more serious shit. The focus on waiting times misses this.

The funny thing about the private sector is that they don't have to meet targets on waiting times or survival rates, and they are not inspected by the CQC to any real degree - most figures are based on their "honesty". At the end of the day, most of the staff in private practice work in the NHS and do private work on the side. The wait may be a little shorter - the treatment is rarely any different, the real difference being you get cream cheese and salmon sandwiches, and there are more potted plants and ornaments.

Ya, i'm aware, but an express service is something private could probably do well in without much fuss from the public.
I don't think NHS targets on waiting lists are a bad idea per say, just that it shouldn't be the point of as much focus as it currently is.
I care far more about survival rates.

As is, the government would be tooting it's horn if the NHS managed to check another 5% of people in, then completely fucked the treatment and killed them, and declaring it met it's target for waiting lists.
That's a little stupid.


If you instead only take the survival rates stat, then that will also, naturally, involve reducing waiting times, but keeps an eye on the actual goal.

[Fionnuala_Saoirse]

They could be waiting in the corridor to be transferred to another ward for 2 hours, but that doesn;'t count as the transfer request has already been made. They could be sent to the "Clinical Decisions Unit" (ISIS, hurhur), which is essentially a cupboard with some beds in, at which point the clock stops, and they still haven't gone to a ward or been fully sorted out. I suspect that if these things were taken into account, you'd find 50%+ of patients have to wait for 4 or more hours.

I don't see much wrong with stopping the clock at the final point of ED decision making and management. If your ED is worth anything at all the patient should have been stabilised with an initial management plan and treatment instated to carry them through until the next senior review. In the interim any old FY1 or 2 should be able to monitor them and flag up any concerns to triage up patients for this senior review.

[Dread Lady Nathicana]

The main contributing factors are an ageing population, increased patient expectations, and insufficient funding.

Oh it's this rude betch

Says the guy hiding behind internet anonymity. *** Warned for flaming ***

[Alfegos]

They could be waiting in the corridor to be transferred to another ward for 2 hours, but that doesn;'t count as the transfer request has already been made. They could be sent to the "Clinical Decisions Unit" (ISIS, hurhur), which is essentially a cupboard with some beds in, at which point the clock stops, and they still haven't gone to a ward or been fully sorted out. I suspect that if these things were taken into account, you'd find 50%+ of patients have to wait for 4 or more hours.

I don't see much wrong with stopping the clock at the final point of ED decision making and management. If your ED is worth anything at all the patient should have been stabilised with an initial management plan and treatment instated to carry them through until the next senior review. In the interim any old FY1 or 2 should be able to monitor them and flag up any concerns to triage up patients for this senior review.

I don't argue with that in the slightest - to be honest in the interim, the nurses should be monitoring them through taking basic observations (at least that's how it is here), and the stabilisation should have happened as necessitated by the state the patient came in.

My main irk is that the 4 hour target is portrayed by the government as entirely based around patient convenience, and defines it as being time from arrival to leaving the ED, rather than as a true measure of time taken to see the patient initially (which would be rather useful), the time taken to see the on take medical or surgical teams, and the time taken to a management plan being formulated, or where necessary for a senior review to be conducted. It's a very poorly fitting target that doesn't address hundreds of minutiae, and is rigidly enforced at the cost of medical treatment. And really, it has little value, as you noted - but is mindlessly enforced nonetheless!

The backlog comes, and thus the lack of spaces in ED arises, when you have patients who you can't transfer. Medically stabilising someone is one thing which in most cases can be done rather quickly and simply. I have yet to see a protocol that addresses mentally stabilising someone. And similarly, you have a number of patients with no safe place to go to when discharged - either because they are suicidal, chronically very unwell, or have no fixed abode.

[Fionnuala_Saoirse]

My main irk is that the 4 hour target is portrayed by the government as entirely based around patient convenience, and defines it as being time from arrival to leaving the ED, rather than as a true measure of time taken to see the patient initially (which would be rather useful), the time taken to see the on take medical or surgical teams, and the time taken to a management plan being formulated, or where necessary for a senior review to be conducted. It's a very poorly fitting target that doesn't address hundreds of minutiae, and is rigidly enforced at the cost of medical treatment.

If that truly is the case in your emergency department then I would argue the problem lies less with a blunt target and more with the more subjective (and therefore more difficult to study and address) bad leadership of senior members of the team. You are going to be a doctor one day and you would be benefitted by recognising early the power you have. If you want to prevent a patient moving from your department you put your foot down and simply state that this is the case. No manager type can overrule you on this without going to a more senior member in your own chain of command and more often than not they will side with you.

And really, it has little value, as you noted - but is mindlessly enforced nonetheless!

On the contrary, I think it has been of incredible value to the emergency medical teams across the UK and allows them to leverage much needed funding and push through protocols and access to diagnostics, etc that they previously simply would never have had. It may even finally drive forward adoption of technological advances of which the UK is way behind the curve and will allow EM trainees to push for increased education and speciality advancement.

The backlog comes, and thus the lack of spaces in ED arises, when you have patients who you can't transfer. Medically stabilising someone is one thing which in most cases can be done rather quickly and simply. I have yet to see a protocol that addresses mentally stabilising someone.

Haloperidol 5mg and lorazepam 2mg IM stat are great at it

And similarly, you have a number of patients with no safe place to go to when discharged - either because they are suicidal, chronically very unwell, or have no fixed abode.

Have you personal examples of such failed patients in whom admission would have been worth the 400-500 pound a night fee? I'm not doubting that there are some that exist but i do highly doubt it is as great as the public perception. The vast majority of patients reporting suicidality are, in my experience, at no acute risk which would require admission and can be followed up by outpatient services. Those of no fixed abode are not, and should not, be the concern of the medical and nursing teams unless admission is absolutely necessary on those grounds.

[Fionnuala_Saoirse]

If you instead only take the survival rates stat, then that will also, naturally, involve reducing waiting times, but keeps an eye on the actual goal.

If you're taking mortality rates in EDs only then it certainly won't reduce waiting times as a consequence. It will simply result in increases in funding going into pre-hospital emergency teams and unnecessarily fancy as fuck resuscitation rooms.

[Southern Hampshire]

Good.

It's time to wrap up NHS.

Y'know what? run for office, make that a main point of your manifesto, see how far you get. Even "Man of the people" Nigel Farage had to back away from that when pressed if he supported it. If he doesn't think he can get away with openly coming out and saying it how do you think anyone will?

Unfortunately in this flawed constitutional monarchy I cannot run for office anywhere else than my local constituency.

[New Chalcedon]

http://www.bbc.co.uk/news/health-30433575

*snips linked article*

I'm ashamed to see Northern Ireland falling so far below the national targets and ultimately I think the five million being allocated to improve things is pitifully low. It would also be interesting to try and pin down exactly what Scotland is doing that means they can hit such a better marker (although not quite high enough). In the end though statistical markers such as these don't reflect the suffering and ongoing harm being caused by these shoddy services and we need to be more forceful in addressing them.

Any thoughts?

Wow, it's almost like four years of rule by a Government that hates the NHS has harmed the NHS' ability to do its job.

Golly gee, who'da thought it?

Yes, the last line was sarcasm. You had to ask?

[New Chalcedon]

Why you gotta be so rude

Detailing contributory factors to the NHS' woes is rude these days eh. Well fuck me times have changed.

Noting any part of reality that upsets the right-wing applecart (And there are many) is "rude". And as we're told by the media constantly, it's incumbent upon all of us Lefties to be polite and civil. The Right are exempt from that requirement, of course. They're allowed to say what they please, and it's "bold", "daring" and "challenging". When a leftie challenges the RW conventional wisdom, it's "shrill", "questioning" or "confrontational". Sometimes "argumentative", if the media outlet in question is feeling particularly generous.

[Rhursbourg]

people need stop ordering prescriptions that they do not need thus freeing a bit more cash for the NHS

[Fartsniffage]

people need stop ordering prescriptions that they do not need thus freeing a bit more cash for the NHS

How does a layman know what they do or do not need? It's the job of the doctors to tell them that and remove the item from their prescription.

[Rhursbourg]

people need stop ordering prescriptions that they do not need thus freeing a bit more cash for the NHS

How does a layman know what they do or do not need? It's the job of the doctors to tell them that and remove the item from their prescription.

just case of people ordering them for the sake of ordering the medicine and they are not even taking them, it should be the Doctor that says whether they should be on it or not , but if the the persons not going to take its it is up to them to tell the doctor or the Pharmacist they want to stop the repeat prescription when the review comes up or before the review

[Atlanticatia]

What's the average wait time?

[Cerbergo]

Well, this would explain why I've been seeing at least 5 ambulances a day on my journey to and from school.

[The Nihilistic view]

The other thing to wonder is what was wrong with the people that waited so long? A&E prioritise more serious cases so those who wait longest should in theory not have anything serious. We often hear of people going to A&E without a serious enough problem so if these are the people that are failing to be seen within the 4 hour target then I don't have a problem with it.

[Fionnuala_Saoirse]

The other thing to wonder is what was wrong with the people that waited so long? A&E prioritise more serious cases so those who wait longest should in theory not have anything serious. We often hear of people going to A&E without a serious enough problem so if these are the people that are failing to be seen within the 4 hour target then I don't have a problem with it.

Every emergency department i've been in has tended to have longer times to disposal for the more unwell patients by virtue of their cases requiring more management.