At an early stage of their training, senior house officers are also left routinely in sole charge of departments at night with only telephone access to consultants when they need help, according to a National Audit Office report.
Less experienced doctors hesitate to seek assistance at night for fear of disturbing senior colleagues too often, NAO researchers found during inspections of six A & E departments in England. 'All the departments had issued guidance on when to call in more senior staff, but many senior house officers still found this decision difficult, especially when they were obliged to call out the same individual on each occasion.'
In five of the hospitals, medical staffing levels 'fell well short' of those recommended by the British Association of Accident and Emergency Medicine. There were staff shortages at University College Hospital, London; Taunton and Somerset Hospital; St James's University Hospital, Leeds; the Leeds General Infirmary; and the Worcester Royal Infirmary.
At half of the A & E departments studied, consultants pursued other clinical interests, limiting the time available for supervising junior medical staff and managing the department. 'These other activities took up staff time and space in the department, by bringing more patients in at busy times,' the report said.
It singles out Worcester Royal Infirmary for special criticism for failing to meet standards advocated by professional bodies and specialists in A & E medicine. Patient care at Worcester was hampered by the location of key specialities and services on a separate site 2.5 miles away. As the Independent reported last February, two consultants at Worcester resigned from the hospital citing the 'dangerous' lack of emergency cover and the 'patently unsafe' service offered to patients. However, health authorities told the NAO that all services may not be on one site until the end of the decade.
Poor computing and information systems were key features of many of the hospitals visited. Although nurse managers complained of under-staffing in each of the three larger departments, none appeared to have efficient systems for assessing the level of staffing needed. About 11 million people attend an accident and emergency department each year but there was no common policy on departments' access to registers of children at risk to help detect cases of physical abuse more readily and accurately.
NHS Accident and Emergency Departments in England, National Audit Office, House of Commons Paper 159; HMSO, pounds 7.15. NHS Accident and Emergency Departments in Scotland, NAO, House of Commons Paper 158; HMSO, pounds 7.15.Reuse content