Starting the week in A&E: Taking the temperature of our stretched Accident and Emergency services

The start of the working week is the busiest time for England's stretched accident and emergency services. Jonathan Brown drops in on one to take its temperature

Jonathan Brown
Tuesday 04 February 2014 01:00

Monday, 10am: statistically, this, rather than closing time on a Saturday night after an alcohol-fuelled day of self-inflicted injury, violence and mishap, is the moment of peak demand for the National Health Service's under-pressure accident and emergency services. At Leeds' St James's University Hospital, the hard blue chairs in the casualty reception area are starting to fill up with the walking wounded. Among them is Danielle Cobbold, 28, who has been suffering from a bad back since October.

Last night, the pain became so severe she was crying in agony. "I think I have a slipped disc. I have been going backwards and forwards to the doctors for months and he has had me on painkillers," she says. "I've been thinking about this decision for weeks. I just can't cope with the pain – it's shooting through my whole body. I want a scan – I want a solution today."

Cobbold is one of 2.9 million people each year likely to visit their casualty departments on a Monday, accounting for 16 per cent of all emergency attendances in England in 2012-13, according to data published by the Health and Social Care Information Centre last week.

Demand to see an emergency hospital doctor was up 4 per cent last year. Growth is being driven by booming numbers of short-term residents in inner-city areas who are not registered with a local GP, and an ageing population with often complex health needs. The issue is now one of the most urgent facing the NHS.

Consultant Dr Anin Dasgupta has been on duty for an hour, during which he has seen patients complaining of chest pains and shortness of breath and some suffering from abdominal pain. "The challenge for us is to work out the people who are really sick and need to be sorted out quickly," he says.

"If someone feels unwell, and they can't get an appointment with their GP, then they need to be seen. Different people behave differently when they are sick. There are those with a minor illness that come straight to A&E. Other people can be really sick and have delayed presentation. But a lot don't appreciate the services that are out there," he adds.

St James's and Leeds General Infirmary, along with two walk-in clinics, provide accident and emergency cover for 750,000 people. The city faces some of the greatest pressures on its emergency services anywhere in England.

Last year, there were between 360 and 450 visits to A&E per 1,000 head of population in Leeds.But figures such as these can be misleading, explains senior sister Julie Groves, who has 21 years' experience in the casualty department.

"It is not so much the number of patients but the dependency issues they have, how sick they are. We only have so many cubicles. If you add an extra five patients an hour and they all have complex problems, it becomes a whole different ball game," she says.

During the day, patient numbers build up, their conditions deteriorate and beds become unavailable elsewhere in the hospital –all factors that can threaten the target waiting time of four hours.

Since midnight on Sunday, staff at St James's A&E have seen 63 patients, of whom only 12 have been admitted for treatment. After a hectic weekend in which 500 people were seen (215 of whom were later admitted), Monday is proving an unusually quiet day. But each patient needs painstaking evaluation and appropriate care. Tanya Cullen, 27, from Leeds, suffered a serious oil burn while cooking in a ski resort in the French Alps and is now waiting to be transferred to the specialist burns unit at Pinderfields in Wakefield.

"I feel a lot more comfortable being here. There was a communication barrier. They didn't speak much English and I don't speak a lot of French," she says.

Geoff Sutton, 72, suffered a fall five days a go at his home. He has Type 2 diabetes and underwent two knee replacements eight years ago. He saw his GP last Thursday and was asked to come back the following Friday for a blood test and an ECG heart check. But in the meantime he had become dizzy and was losing his balance.

"I'm a bit of a stubborn old stick. My wife and daughter said I had had enough and they called an ambulance," he says. Mr Sutton has now had all the necessary tests, had his medication tweaked and was hoping to be discharged. "I'm glad I came. I couldn't have been better treated," he adds.

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