A and E images 2

Ambulances  waiting outside A and Es which are full of patients waiting to be found beds on already full wards

It has not been a month since Jeremy Hunt and Theresa May rejected comments by the British Red cross that the UK was facing a ‘Humanitarian Crisis’ in health and social care. The Government cut back funds to councils who pay for social care for elderly/frail patients discharged from hospital.  As a result there are delays in discharging patients who are sometimes disparagingly referred to as bed blockers. Bed occupancy is now about 90% on average. A safe level is thought to be 85% .

A nursing home bed costs  between £800 – £1100 a week; an acute hospital bed three times that amount but it comes from the NHS budget.  Hunt and May announced that foreigners should be charged for using the NHS and GPs should open 7 days a week. However scapegoating GPs and foreigners will not make ‘beds appear’. Seriously ill patients still need to be admitted.

 

Extract taken from ‘The Secret Doctor’ Blog  BMA

There were no beds.

I was in resus at 9pm with a young person who had been intubated and ventilated to keep him alive following an overdose. We’d been told the closest bed was forty miles away, but the sister on critical care phoned around the local units and eventually negotiated a bed somewhat closer.

The parents waited anxiously to be told where our NHS could manage to fit their son in, their son who had almost lost his life completely in the last hour. I watched the relief on their faces when they were finally told we only had to move him ten miles away.

Meanwhile, we had been alerted to another critical patient less than ten minutes out, so the daytime registrar, who had already finished his shift, stayed to do the transfer. Nobody else would be free.

I scanned down the line of resus bays and they were all full. I shot the A&E consultant a concerned look and he assured me they were moving one out. The health care assistant was just packing them up, so I helped her push the trolley around to major injuries.

We negotiated past the row of patients in the corridor. ‘Cubicle 10,’ the coordinator shouted, but when we got there is was already occupied. They were all occupied.

‘I’ll sort it out’ the coordinator assured me, so I hurried back around to resus.

The next patient was post cardiac arrest, but he had been shocked and stabilised, so we intubated him and got him ready for an urgent coronary angioplasty. That angioplasty would save his life, but when I handed him over to the anaesthetist I knew I would still have no bed for him when he came out the other side.

I moved on to the next resus bay; an elderly man was on 100 per cent oxygen and hypoxic. His family sat around him and he struggled still to breathe despite non-invasive ventilation assistance that had been started as a temporary holding measure. I was there to assess whether he stood to benefit from admission to intensive care. They tell you this assessment is always done independently, that it should not be tainted by capacity problems.

Question 1: Do they need admission?

Question 2: How can I facilitate it?

I believed that entirely, but the reality… there were no beds.

The consultant came and it was decided the patient would not benefit from escalation to intensive care.

I agreed it was the right decision for the patient but I was also genuinely relieved this was the decision, that he didn’t also need a bed I didn’t have.

The second patient returned from angioplasty and stayed in the theatre recovery area all night. An on-call anaesthetist took herself away from emergency theatres to stay with him.

Morning time came and there was still no bed, so we transferred him to another hospital too.

Pass the parcel… pass the patient, but this was not a game and I didn’t enjoy it.

The next evening I arrived for night shift number two. ‘I’m sorry,’ the charge nurse said, ‘the day SpR is in resus with an intubated patient and I just have no bed for him, I think you’re going to be there all night’.

And so it continued.

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