Calis Beach and Fethiye Turkey Discussion Forum
General Topics => The Debating Chamber => Topic started by: Highlander on January 06, 2015, 21:36:08 PM
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Are the public more responsible than the Government for the current crisis in A&E Service delivery.
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Having used the Chester A & E dept twice in the last week they were absolutely chocker block on both occasions and on nightly visits to the hospital there have been 5 or 6 ambulances in the bays delivering people to the hospital. Waiting times were a joke, 3-4 hours on Friday for non life threatening patients.
I don't know if there is a connection but I would imagine A & E departments are busier now as you have little chance of getting in to see your GP these days, trying to get appointments is a joke. I waited on hold for 17 minutes yesterday to cancel an appointment my wife could not take, then they have signs up in the waiting room telling you how they have so many no shows. Not everyone would have the patience to wait 17 minutes to cancel. Its easier to just not turn up.
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I think uncontrolled immigration has put a huge strain on medical finances and resources, the whole system wasn't prepared.
Then you have binge drinking and anti-social behaviour, that puts a huge strain on A&E.
Then you have far too many managers, and a lot of them cant manage so they employ advisers.
And because they cant manage properly there is an over usage of agency staff. which costs a fortune.
That is my take on it.
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Listening to A&E staff they, almost without exception, say that the vast majority of the public turning up at A&E are in need of treatment and they would not be happy turning them away. Stories about people turning up with broken fingernails are scandalously amusing, and nurses like to tell such anecdotes for a laugh, but they represent only a tiny fraction of A&E attenders. Both GPs and A&E have witnessed a massive increase in patient numbers. This increase that has very little to do with immigrants although such claims will be made since immigration, together with the EU, are currently fashionable scapegoats. Indeed if it were not for the thousands of immigrant doctors and nurses in the NHS (e.g. the 40,000 doctors born overseas) things would be far worse, to the point total collapse.
I find one clear factor in the rise of patient numbers and few other possible factors. The clear one is the rise in numbers of elderly people in the UK (over 65s) who are also living longer (into their 70s. 80s and 90s). These are presenting a wide range of medical conditions that are often compounded into multiple problems (I sometimes feel that I am personally responsible for 5% of the increase of NHS usage). Other possible factors are increased susceptibility to illnesses due to modern lifestyle issues such as working stress, processed foodstuffs, sedentary pursuits; increased expectations and demands for the delivery “health” to the citizen; and increased diagnosis of illnesses that may have been dismissed as “growing pains” or “getting old” in the past.
Why is A&E unable to cope with this increase? The simple “vicious circle” explanation is that too few doctors and nurses in A&E create very poor working conditions that deter new doctors and nurses making a career in the service and so on, and so on. Actually there is no great shortage of young doctors entering the A&E service. But many (most?) of them have left after 2 to 3 years experience so there is a thin “middle tier” to go on to become A&E consultants. There are, however, structural issues that underlie the the A&E problem with increasing numbers. The GP service is also understaffed and overworked so they cannot take up many extra patients. The 111 service, as alternative to GP and A&E has been, largely, a failure; it does little more than forward patients to other services – especially GPs and A&E. In my experience the Walk-in Centres have been better but I don’t know how many of these there are and how much “traffic” they deal with. The largest problem, however, seems to be cutbacks in Social Care caused by financial cuts applied to local authorities. Even if there were more doctors and nurses in A&E they might not be able to treat to more patients because of the hospital bed logjam. Thousands of beds are filled with people – prominently the elderly – who don’t require hospital treatment, don’t want to be in hospital, have a home to go to, and could be there if only they had a little support from Social Care. That, of course, would be hell of a lot better and cheaper for all of us; but it isn’t there.
What about the responsibility of individual patients? Of course it is easy to point a finger at the drunks (which I do even though I once went to A&E for stitches in my scalp caused by a drunken fall when I was 20) and perhaps town centre medical tents could help some of the demand from this quarter. Or, they could stop getting drunk. But a broken arm from a drunken fall is just as much a broken arm from a rugby match – and, arguably, both are self-inflicted – and both need treatment. We could direct people away from A&E when they don’t need to access it. The 111 service appears to use non-medical staff to lead people through a simple flow chart based on YES/NO before directing on to another service. Perhaps every home in the UK should have one of these to help decide where to go when you are ill or injured – stick it on the onside of one of your kitchen cabinet doors. With a bit of imagination we could think of all sorts of ways to mould the individual into the sort of patient (GP, A&E, Walk-in, Pharmacy, etc) with which the system can deal. Maybe. What I am damned sure about is that politicians, or anyone else, jumping up and saying “People should be more responsible!” will make no bloody difference at all. If “irresponsible” individuals are the "problem" they need to be assisted in becoming a "solution" – not harangued.
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Good post Colwyn - fine diagnosis!
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As I picked Mrs B up from hospital last night she was told there were 7 available beds and 51 patients waiting for them.
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The whole NHS including A&E is being deliberately underfunded and under resourced so that unfounded claims that it isn't working can be made to justify privatisation. Large swathes to the tune of billions of pounds have already been privatized. It may not appear any different because the services that have been sold off operate from the same premises but the fact is that the health service we paid for with tax payers money, that we own is being given away for profit and gain.
In actual fact the NHS is one of the most cost effective and efficient health services on the world recent research has shown but we don't hear this, just the failings of a system that is being deliberately undermined for political and financial gain.
It's an absolute disgrace.
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Tax Reaserach UKS - includes chart - 20111
http://www.taxresearch.org.uk/Blog/2011/06/06/the-nhs-a-stunningly-cost-effective-supplier-of-high-quality-healthcare/
Best in the world - 2014
http://www.ehi.co.uk/news/EHI/9474/commonwealth-fund-says-nhs-world-%27best%27
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Never been able to cope for years and strangely enough the situation always worsens in election year
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Actually at the time of the last election research found that more than 70% of actual users of the NHS were happy with the service, waiting times were radically reduced and models of good practice were being shared around the country.
Anyone who can remember the state of the NHS by the end of the last Conservative government and probably one of the main reasons apart from all the sleaze stories they were booted out of office will know what a huge improvement that was.
I doubt very much now after 5 years of underfunding and selling off what is not theirs to sell anyone can say the same now.
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I mean the political rhetoric worsens,the Tory press scream 3rd world headlines,the Labour muppets pick up and run with the ball while the Tory fat cats sit back and think how much easier it will be to sell off an apparently ailing service
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Make it like driving, if they turn up worse for wear at A&E, breathalyse them and if they fail, charge them for their treatment :)
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OMG - I was just about to post exactly that :o
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You'd be bankrupt for starters! ;)
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I can see the headlines now.
"Tarmac Terror Tested "
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I can see the point Keith is making where the injuries/illness is drink related chargeable, but I see it as a supply rather than a demand issue. Make the brewers/pub/club owners pay. They are the ones selling, or rather overselling the booze, and allowing the problem back out on the street for either the police or NHS to sort out.
I speak as a former licensee, when if you allowed people to drink to the excesses you get these days, you were under threat of losing your license, from the court.. not as today some old bureaucrat in the local authority. These days where you have a pub/club or even an area where there is excessive drinking it is seen as a business success, rather than a social problem. Put the responsibilities back on the supply side.
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A&E in the headlines again today.
a) Waiting times have worsened over the holiday period with fewer that 87% of patients being seen within 4 hours. The target is 95% which was itself reduced from 98% when Con-Lib came to power.
http://www.bbc.co.uk/news/health-30742817 (http://www.bbc.co.uk/news/health-30742817)
b) The first private company to take over a hospital when it won a ten year contract to manage Hinchinbrooke Hospital says it can no longer make a profit and intends to renege on the contract with seven years to run. In particular, the company cites increasing A&E pressure as a prime cause of lack of viability.
http://www.bbc.co.uk/news/uk-england-cambridgeshire-30740956 (http://www.bbc.co.uk/news/uk-england-cambridgeshire-30740956)
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As an SIA Licenced Door Supervisor I know that the Licensing Act 2003 makes it illegal to sell alcohol to someone who is drunk, or even to try and buy it on their behalf.
I wonder how many licensees or their staff HAVE actually been prosecuted for selling alcohol to a person who is already obviously intoxicated ?
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Not enough would be a fair guess. I'm with UBT on this one. These pubs and clubs
are churning out drunks on a daily basis. One eye on the profit margins and a
blind eye to the customers. They have a responsibility towards their safety.
They should be made to keep them on the premises until it's safe to let them out.
That would result in a reduction in drunks and some very smelly licensed premises.
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My Local A & E is instigating some sort of advanced Triage system which will start in late Summer.
From what I can make out there will be medical staff directing people to the right department. In other words if there is no need for immediate treatment they will be either told to go to a pharmacy, make an appointment with outpatients or go to their GP. This tells me there is a vast majority of people who don't think before they present themselves for treatment.
On a further note...I recently had major Cancer surgery... my experience can only be described as a nightmare. No bed for me to settle into on arrival. I was directed to a public toilet to change into theatre Gown and then had to walk to theatre. After 2 days in the High Dependency Unit and one day on the ward I was then told to go home as they didn't want me to catch the infection which was present. Later found out it was MRSA. Must admit I was happy to get home despite being still very poorly. Even care at home was poor with the District Nurse arriving to remove staples but no implement to do so !!
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Not enough would be a fair guess. I'm with UBT on this one. These pubs and clubs
are churning out drunks on a daily basis. One eye on the profit margins and a
blind eye to the customers. They have a responsibility towards their safety.
They should be made to keep them on the premises until it's safe to let them out.
That would result in a reduction in drunks and some very smelly licensed premises.
What about personal responsibility? Nobody makes the customers drink. I don't need or want pubs, restaurants, supermarkets to take responsibility for my health or well-being in that way. Nanny state springs to mind. Someone gets drunk, makes an arse of themselves and looks to blame someone else!
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Pussinboots That all sounds a bit of a nightmare a friend of mine had a similar experience and in recent years I have had little faith in the NHS .
I hope you have now recovered
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Bluewise.
If the Licensing Laws were enacted as effectively as the Motoring Laws by the Police and the Courts
maybe the A&E staff would enjoy a safer and more pleasant work environment and City dwellers
could live in far better surroundings.Or do you condone one section of society being able to ignore
the Laws that don't suit their commercial interests.?.
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No, I’m with you both on that. I definitely don’t condone the law being ignored by a section of society for profit but I don’t think the drunk and disorderly law should be ignored by individuals either.
I agree about wanting a more pleasant and safe environment for people at work/living in towns etc. I also agree there is a responsibility to uphold the law inside and outside licensed premises. I would welcome fall-down drunks being arrested and punished instead of being told to "move along mate” by officers but as it’s considered a minor offence it’s a wrist slapping or at worst a fine. The way things are these days, the Police couldn’t cope with the sheer volume of offenders on a typical Saturday night in town!
My point is that there is some personal responsibly here. Yes, the licensee is wrong to serve someone more booze but the person drinking to oblivion is the problem. If the law was upheld in the pubs the problem would probably just shift to drinking even more before they go out. Unless of course, they were not even allowed into the pubs/clubs when drunk and had a real risk of punishment if found drunk on the streets.
I do agree with most of your points Kevin, it’s just the “responsibility toward their safety” that tends to get me a bit rattled as I feel it’s our own responsibility to manage our behaviour.
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I had to go to A & E last night at 11.30 pm after doing the right thing and calling NHS 111.
I had to wait 2 and a half hours to be seen. In that time I counted 4 lots of people who had been brought in for treatment by the Police. 3 Drunks and One with fighting wounds. At one point there were 12 Police milling in reception. Additional to that spotted 3 different private security guards employed by NHS. One person who I think was looking for a bed for the night complete with bicycle kept having to be removed each time he returned. Out of approximately 20 others waiting for treatment only 1 appeared to be from outside the UK (Iraqi as I did speak to him). The Waiting area was absolutely filthy with rubbish and spilt drinks etc.
All in all not a very reassuring situation for those waiting for treatment.
Once I was called I was in and out in just over an hour and was treated extremely well by staff who were obviously working under very difficult conditions.
Just a typical Friday night in a medium sized UK hospital... dread to think what its like in a Big City hospital.
Happy to report I am ok ! Have a small blood clot in my leg.
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Glad you are OK PiB - were you at DRI?
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Yes Blu.. Good old DRI !!! Am getting used to injecting myself 8)