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There may have been a time when a trolley was just another piece of hospital equipment. Now it’s a word synonymous with failure and delay.
The number of patients waiting more than 12 hours for admission increased a hundred-fold, according to new analysis from the Royal College of Emergency Medicine.
For the patients on those trolleys, they are often lonely, frightened and in pain. And it takes its toll on the doctors working in emergency medicine too.
Simon Walsh is an emergency medicine consultant from London. He says it is one of the factors that cause such a high turnover of staff in the specialty, and he has noticed a marked increase in the times patients have to wait during his time in the job.
He says: ‘One of the most frustrating aspects of working in emergency medicine is that I’m surrounded by a group of doctors and nurses who are really passionate about delivering high-quality care – but despite your best intentions patients are waiting on trolleys, often for over 12 hours and there’s very little you can do.’
The RCEM found that despite a relatively mild winter, 1,597 patients waited more than 12 hours for admission between January and March of this year. For the same period five years ago, this figure was 15.
If a twelve-hour wait sounds bad, Dr Walsh points out that in reality patients are waiting even longer.
‘The patient may have been waiting for three or four hours already – the clock only starts ticking after the decision to admit them is taken.’
This has an emotional impact on the staff treating them.
He says: ‘When you see elderly and vulnerable patients lying on a trolley it’s frustrating and upsetting and you go home at the end of a 12-hour shift having done the best you can but knowing patients had a bad experience.’
‘It’s one of the big factors that means there’s such a high turnover of staff – people find it difficult.
‘We do all the things that we can do for patients – we tell them we care, offer cups of tea and food and make sure they’ve had painkillers offered to them and generally show we are a caring face and that we are doing our best to get their needs met.’
Dr Walsh has been a consultant since 2004 – and says life in emergency medicine is very different to how it was back then.
‘A&E has always been a busy place to work in, and at times throughout my career there have been long waiting times for patients but certainly over the last five years or so, patients who are clearly unwell enough to need emergency admission to hospital seem to be waiting longer and longer on trolleys in our departments. There just isn’t anywhere to admit them, despite no-one being in any doubt that they need admitting.’
With a harsh winter expected frontline staff like Dr Walsh needs the government to find the political will to grapple with the problem – and free up the resource to allow dedicated doctors and nurses to do their jobs properly.
‘People are genuinely worried about the coming winter with risk of significantly more patients. Last year was supposed to be a good winter – it wasn’t particularly cold and there wasn’t a large outbreak but all of us working felt it was the worst year any of us have experienced in terms of the stress and demand and the effect it has grinding staff down day by day.’
When confronted by the inevitable headlines, it has become something of a tradition that governments will find short-term cash settlements to paper over the cracks in emergency care. Dr Walsh says this is not enough.
‘The approach in recent years has been to apply a sticking plaster to the problem which is a major recurring and growing problem – putting short term cash for extra locum doctors or nursing staff doesn’t really deal with the underlying problem. The problem is there aren’t enough acute beds in hospitals in general particularly in the winter months.
‘The short-term emergency solution is to provide more beds but in the long term there really needs to be an open and honest debate about the costs of providing the level of emergency care that people expect and have a right to. Ultimately that comes down to investment, particularly in the acute and emergency part of the service – and also social care.’
Peter Blackburn is a senior staff writer at the BMA
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