A&E pressure is ‘demoralising’ but social care investment is the answer, says doctor
PUBLISHED: 13:51 21 February 2019 | UPDATED: 14:02 21 February 2019
A Norfolk A&E consultant has spoken out about the ‘demoralising’ pressure on staff on the frontline and suggested more money for social care was the way to help.
Dr Jim Crawfurd, regional chairman for the Royal College of Emergency Medicine in the East of England, gave his view after it was revealed the number of patients waiting more than four hours in A&E departments reached its highest level in five years.
Dr Crawfurd said he was not surprised by the figures, as the situation was the same up and down the country.
In January 60pc of patients at the Norfolk and Norwich University Hospital (NNUH) were admitted, transferred, or discharged with four hours in January - the national target is 95pc.
While at the Queen Elizabeth Hospital (QEH) in King’s Lynn 74.9pc were seen within that time, and the number was 83.4pc at the James Paget University Hospital (JPUH) in Gorleston.
At the same time, the number of people turning up at A&E had risen, as had the number of people who needed an emergency admission to hospital.
Dr Crawfurd said: “What we’re hearing is it’s been bad the last few weeks. It feels like all the planning that went in was holding things up for longer than we thought it might do up to the last few weeks.
“It’s demoralising for ED (emergency department) staff and it’s not just ED staff, it’s everyone across the whole system. For all that the focus is on the front door - because that’s where the headlines are - in other areas they try and relieve the pressure at the front door, every ward will be as stretched as it possibly can safely be to try and relieve some of that pressure.”
“None of us want to walk past patients in the corridor and it’s not every day, but it’s not what any of us want or what we would want for our patients. Corridors are bad for patients, bad for staff, we know patients in corridors results in bad care for patients and that’s not what we want.
“It’s the people who are waiting on trolleys and the corridors, that’s the sad side of it.”
Dr Crawfurd said when the targets were first introduced - although there was some scepticism - it did help to ensure patients were seen in a timely manner.
He said: “I think the overwhelming feeling of my generation, and I qualified in 1999, was when we qualified in the late 90s seeing patients on trolleys in the ED was completely normal and when the four-hour target came in that rapidly changed.
“And it was a driver to get people out of the ED and into wards. Things got a lot better in emergency medicine as a result of the target.”
Dr Crawfurd said there were debates to be had around defining the targets and whether things could be recorded differently, but that the RCEM had said scrapping it altogether would not be helpful.
And he also said it was not necessarily those going to A&E with minor problems that were causing the issues.
He said: “The problem we are concerned about it there are situations where that person books in as for example indigestion and it turns out they have a heart attack, and unless we’ve got senior people at the front door checking these people over, it might be missed.”
He said those who seemed to have minor conditions would always wait longer, but the main issue - and the cheapest to solve - was for more investment to be put into social care to help people get out of hospital quicker.
He said: “We don’t have enough nurses or doctors, we don’t train enough, but that’s expensive stuff.”
But he said while more money was needed it was about “putting the money where it’s going to have an effect”.
“If you look at the NHS budget they would not have to put a large amount of that into social care to make a difference,” he said.
“It’s about making social care an attractive market again.
“It’s a national problem, it needs national attention. Every trust and every department is doing what it can to provide safe care.”