Treating A&E like a drop-in centre is risking lives

It was 5am. I was tired and stressed but felt a sense of pride and elation about what the team and I had achieved.

Two hours earlier, two teenagers had been brought to A&E after being hit by a car. 

Both were seriously injured — one had a fractured leg, a head injury and a broken shoulder; the other had a ruptured spleen and needed an urgent operation.

As the A&E consultant in charge, I had orchestrated the care of both patients and spent time with their families explaining what was happening. 

Despite the extent of their injuries, two hours after arriving they were both on the path to recovery.

Prior to that, the Saturday night shift had been busy, incredibly busy. 

I had dealt with many seriously ill patients: a woman who had broken her hip after falling in the bathroom, another with a painful and infected gallbladder, a man in his 80s with a large lung clot two months after recovering from Covid, a 25-year-old who had taken an overdose and many, many others.

And after speaking to the relatives of these two young men, all I wanted to do was have a coffee and sit quietly for five minutes before reviewing the next patient who needed our help.

But then I was told about the problem in ‘minors’, where self-presenting patients arrive. 

There was now a four-and-a-half-hour wait for treatment and it was my job to try to sort this out.

As I started to see those waiting, my elation at how well we had treated our earlier patients turned into despondence and bewilderment. 

These people had waited for more than four hours and, in so many of the cases, I was thinking, ‘Why are you even here?’

I saw a woman in her 20s who had a bruise. Yes, a bruise. 

She had fallen on her leg a week ago and had gone running since, but her mum had said she should get it checked and A&E was where she thought she should go.

Then there was the patient who had run out of blood pressure medications and said he couldn’t get a repeat prescription because he was on holiday. 

And a woman who had been in pain for three months, and another who was unhappy about how long it was taking to get an MRI scan after she had been referred for one a few weeks ago by her GP. 

Someone else had a cut which needed a clean and a plaster, but certainly not A&E attention.

Then there was a steady stream of post-lockdown partying complications. Two patients had drunk too much and, instead of going home to vomit, friends had brought them in. 

Another bloke had bought some ‘weird stuff’ . . . and now felt very ‘weird’.

The next ‘minor’ patient, however, was anything but. He was 38 and had a terrible, sudden-onset headache. 

It was a subarachnoid haemorrhage, a bleed in the brain which needs urgent surgery, and four hours was far longer than he should have waited.

But he had to, partly because staff were dealing with patients who could have been looked after elsewhere or who didn’t need medical attention at all.

This scene is now typical of A&E departments up and down the country. 

Figures from NHS England show that, in May, more than two million patients went to A&E, 65 per cent more than in the same month last year. 

And 16 per cent of those stayed for more than four hours. It’s the worst May performance on record.

The Royal College of Emergency Medicine is very worried about this. Dr Adrian Boyle, the vice president, said recently: ‘What’s been going on for the past six weeks, the levels of activity we are seeing, is creating a significant and sustained threat to patient safety.’ 

He added that research shows ‘excessive occupancy in emergency departments is inevitably associated with an increase’ in people dying.

All of us at the coal face are feeling the enormous pressure and many are worried about what will come next — when we fully reopen society and people party like they haven’t partied for two years; when Covid wave three hits; and when we face our normal winter challenges.

During the first wave of Covid, people were scared about coming to hospital for fear of catching the virus and because they knew hospitals were overwhelmed.

That anxiety has since diminished and people need help for ‘normal’ urgent medical problems. 

But it’s harder than usual to access this care, especially out of hours, and people who wouldn’t have needed A&E now do, because their issues have worsened without attention.

The woman who had an infected gallbladder should have had it removed weeks ago, but wait times have increased. 

The gallbladder and its stones were a ticking time-bomb for infection. 

What could have been treated with a routine operation developed into an acute problem requiring emergency admission.

As well as patients with severe Covid, we are seeing more and more complications of long Covid in A&E, such as lung clots. 

But the main increase in demand is from the rising numbers of frail elderly patients who have both medical and social needs and are not managing at home. 

These patients need to be in A&E, we are there for them, but they have complex needs which require a lot of time and resources.

Those of us on the front line are doing our best, but its harder in a Covid world. PPE slows us down, patients need Covid test results back before they can move to a ward, and infection control measures have reduced the number of available beds.

We have an exhausted workforce, with many off sick from stress and long Covid. 

There’s also been an increase in short-term time off because if a staff member has a cough they have to stay at home while they wait for their Covid test result.

But, despite these pressures, patients still come to us when they have not had an accident and it’s not an emergency. 

Sometimes it feels like A&E stands for ‘Anything & Everything’.

Patients come to A&E because our lights are always on. They know they can be treated here. 

But if you come with a minor ailment, it could make the wait for patients who truly need us much longer — it’s not just an inconvenience or waste of time, it’s a matter of life and death.

What we need is better access to GPs and specialist nurses out of hours, and when patients present with non-A&E problems, there should be nearby adequately resourced facilities to treat them. 

This is easier said than done, though, with the enormous pressures already faced by GPs.

But one thing everyone can do is take responsibility for their care. Use us when you need us: for chest pain, bleeding that won’t stop, stroke and such like.

But if you have a problem that is chronic or isn’t an accident or emergency, think about how else you could access help — pharmacists, your GP, walk-in centres, 111 or by taking two tablets of common sense twice a day.

Some details have been changed to protect identities.

Rob Galloway is an A&E consultant at a city hospital in the South East. His book (written under the name Dr Nick Edwards), In stitches: The Highs And Lows Of Life As An A&E Doctor, is published by Harper Collins.