Doctors 'shun' casualty posts

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The Independent Online


Fierce criticism of hospital accident and emergency departments, in the face of mounting pressures and growing staff shortages, is on the way from the Audit Commission.

A leak to the Health Service Journal of the commission's draft report on NHS casualty departments shows that most are having difficulty in attracting enough doctors of all ranks, from consultants to juniors.

Meanwhile, swift emergency admission is proving more difficult to achieve at many hospitals. An increasing proportion of patients in many A & E departments are acutely ill, but many are treated by unsupervised and inexperienced doctors.

If the number of emergency admissions continues to rise, log-jams of patients blocking cubicles and spilling into corridors will become an increasing problem, affecting not only the speed with which patients are seen, but their quality of care, the draft report says.

It recommends a complex series of measures, including training nurses to handle less serious cases and using a wider range of skills, from suturing wounds and applying plaster of Paris to defibrillating patients after heart attacks.

The study also criticises the Patient's Charter standard that patients must be assessed within five minutes of arrival. With few exceptions, the commission found, those units that had the best rating for assessing patients quickly were in fact the slowest for actually treating and discharging them.

The draft, due for revision and publication next year, says that the charter has forced changes in the way the departments operate which have not always been to the patient's advantage.

Widespread variations were found in the time it took for patients to be treated in the 220 A & E departments in England and Wales. At one, 95 per cent of patients were seen by a doctor within one hour, at another, only 32 per cent.

The number of consultant accident specialists has doubled in the past 15 years, but while some hospitals have three consultants others have one. Shorter junior doctor hours, more telescoped training, the removal of the requirement that all trainee surgeons must do a spell in casualty, and competition from other specialities meant that half of hospitals had too few doctors.

A rise of a quarter in junior grades and 43 per cent in middle grade doctors is needed to meet staffing needs. That is unlikely to happen, the commission believes.