Annals of government medicine

The Daily Mail delivers the news of another inspirational example of government medicine in England, much of it packed into the headline: “Doris, 95, was left on a hospital trolley for 28 hours – and when her son asked where she was, doctors didn’t have a clue…” The Daily Mail reporter raises the question whether Doris Miller’s case represents an aberration, a preview of coming attractions or an example of official policy. He argues that it is an extension of official policy:

An appalling but isolated case? If only it were.

Earlier this month, the College of Emergency Medicine (CEM), which represents A&E [Accident and Emergency] doctors, told NHS managers that they should routinely leave patients on hospital trolleys to alleviate overcrowding in casualty units.

The Daily Mail reporter pursues this point:

A&E departments have become a bottleneck in a NHS that is struggling to cope with reductions in staff and services caused by Government demands for £20 billion in efficiency savings by 2014. All this at a time when A&E attendances at English hospitals have exploded from 12.9 million in 2001 to 20.7 million in 2010.

Some of this is caused by population growth, but much of it is due to GPs radically cutting surgery opening hours and out-of-hours visits, leaving patients with nowhere else to turn.

Casualty units are also severely affected by the continued rise of Britain’s binge-drinking culture following the introduction in 2003 of licensing laws which permitted 24-hour drinking.

Around a third of all A&E attendance and ambulance costs are alcohol-related, according to a report on the impact of drink on the NHS, published in 2009 by the Institute of Alcohol Studies.

The CEM says the demands being placed on A&E units are so great that it has become an unfortunate necessity to ‘board’ patients on trolleys in corridors outside full wards, queuing for beds to become free.

The new guidelines state: ‘Boarding patients in the corridors of the wards where they will be admitted is controversial but supported by the college.’

The college is also recommending that hospitals cancel routine surgery to help clear beds and take the pressure off casualty units.

It warns that casualty staff are now under such great stress that they are at much greater risk of making errors such as failing to prescribe life- saving drugs or spotting early symptoms of crises such as heart attacks.

It also warns of the dangers of patients being left lying in ambulances for hours before space in A&E can be freed to receive them.

The college says that leaving patients on trolleys should be a stop-gap measure only until the NHS modifies its procedures to cope with the ever-growing pressures. But patients such as Mrs Miller are already suffering.

There is more to the story, all of it worth reading.

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