Panorama S2014E10 A Week In A.E Condition Critical
Category
🦄
CreativityTranscript
00:00Accident and emergency, the NHS is ever open door.
00:07Who do you think you're in Portland to?
00:10It's a more stressful place to work than it once was.
00:14The pressure upon A&E just won't stop building.
00:17When the hospital's full, we cannot win.
00:19Ready, steady, slide.
00:25Hello, A&E.
00:28Not everyone's prepared to go on taking it.
00:31A&E is a sinking ship
00:33and unless things change dramatically, it will sink.
00:37Tonight, the real emergency that's threatening A&E.
00:46If we don't do something, you will turn up in an ambulance
00:49to an emergency department and there will be no doctors there to see you.
00:58The University Hospital of North Tees in Stockton
01:02treated nearly 90,000 patients
01:04in its accident and emergency department last year.
01:08Nothing special about that.
01:12Yet they let us film for seven days in theirs.
01:16But A&E is always politically sensitive.
01:19If you don't do something, you will turn up in an ambulance
01:22to an emergency department and there will be no doctors there to see you.
01:27More than 100 hospitals wouldn't.
01:30Three initially said yes, only to say no later.
01:42It's 1.30am.
01:44It's quiet in A&E when a 28-year-old man checks in,
01:48escorted by police for his own safety.
01:56He's deliberately cut himself, and badly.
01:59Basically, I was having quite a night in with my girlfriend
02:03and she told me that she didn't want to continue the relationship.
02:10So I was upset and I couldn't find the words to tell her.
02:15So I got a knife and...
02:18What we're going to do is take the dressings on and have a look if you want.
02:23Phew!
02:30It takes a lot to surprise A&E staff.
02:33That's the deepest one, compared to all the others.
02:37What we'll need to do is we'll need to close it by using stitches.
02:42The numbers turning up in A&E just go on rising nationally.
02:47No pain, no gain, they say, those on there.
02:51A million more patients in England since 2010.
02:55We set out to discover why.
03:00A&E staff say the initials really stand for anything and everything.
03:05All human life is here.
03:08How are you, Anthony?
03:10Oh, well, this morning, I was travelling with my bags towards my job
03:14and my left ear was itching like mad.
03:16I always carry my pencil behind my mug.
03:19I scratched it, realised there was no rubber on the end,
03:22so it's gone in my ear, so I'll have to seek medical advice.
03:28Certainly over the 25 years that I've been in Accenton Emergency,
03:32things have changed.
03:34It's higher volume, harder workload.
03:38We get patients in who are possibly more demanding.
03:41It's a more stressful place to work than it once was.
03:45If I allowed my staff to behave like this, they'd be out.
03:51A patient is brought in for some reason bitterly complaining about the NHS.
03:57You're getting on the bed, mate, right? Yes.
04:00But his medical diagnosis turns out to be quite simple.
04:05Diabetic. He's fallen.
04:07He's fallen. His sugar's probably been a bit low.
04:12He's laid on the floor till somebody's found him. Five, six hours.
04:16So, here we are.
04:19We'll psych you out, son. OK.
04:21Had anything to eat today? No.
04:24No. You know you should, shouldn't you?
04:27Well, I was on the floor.
04:31The hospital on Teeside in the north-east of England
04:35serves an area of once thriving heavy industry.
04:39The monuments to its past are all around.
04:44Its A&E is ruled by a government target.
04:48Patients must be seen and treated or admitted within four hours.
04:53So, I understand you've had high blood pressure because you take
04:56In England, Wales and Northern Ireland,
05:0095% have to be dealt with within this time limit.
05:04In Scotland, the figure is even higher, 98%.
05:08We've, um, he was pre-alerted through. Right, OK.
05:11Diverted him to the stroke team. So, they've got the stroke team.
05:15The nurses' station is the nerve centre of Stockton's A&E.
05:19Red on the computer screen warns staff that the patient is in critical condition.
05:23Red on the computer screen warns staff that they may be at risk
05:27in the jargon of breaching the four-hour limit.
05:30Failure means fines and ultimately naming and shaming
05:34for the hospital's management.
05:37Stockton's been meeting its targets.
05:40It has a patient process facilitator dedicated to the task.
05:44Meet Pam Dowden.
05:47Jack of all trades.
05:53Hello, A&E, can I help?
05:56There's a female patient who's getting close to breaching the limit.
05:59The lady's on two 20-minutes and they'll have to be out
06:02the department in two, three, nine, otherwise a cluster of breach.
06:05She hasn't got long now, that's all. She's got 15 minutes.
06:11So, you've got about 15 minutes left, with the clock ticking,
06:15to avoid a breach. To avoid a breach.
06:20Right, OK, how long will it be?
06:2315 minutes and then something can set off. Lovely.
06:28This is like a Target Olympics now.
06:31Oh, yeah. It's a sprint.
06:34Definitely a sprint.
06:37Throughout our seven days in A&E,
06:40we saw the reality of working within this Target culture.
06:44Everyone we spoke to had something to say
06:47about trying to keep the Targets in a department
06:50under continuous pressure.
06:53Hello, ladies.
06:56I feel the breach thing is kind of a bit of a mixed blessing.
07:01We do need some pressure to make us work efficiently,
07:04but at the same time it can be infuriating
07:07when all you want to do is look after your patients
07:10and you've got somebody or multiple people in your ear telling you
07:13that this patient's coming up to breach.
07:16Consultants were critical too.
07:19We're working harder and harder towards targets that are sometimes unachievable.
07:21No matter how hard you try, you can't win.
07:24We can't win when the hospital's full. We cannot win.
07:28But Pam, on this occasion, had a mini-victory.
07:32Did you win, Pam? Yes, we did.
07:35How many minutes did you have left? Four minutes.
07:38And Pam goes off shift and passes the baton over
07:41to the next competitor in the Target Olympics.
07:44You're about to hand all this over to Becky. Good luck.
07:47Thank you. She'll need it, won't she, this afternoon?
07:49I don't know.
07:51But the targets weren't designed to make life easier for the staff.
07:54They're meant to benefit patients.
07:57Patients come first. We need to do the best for patients.
08:00What you have to remember is behind every target is a patient.
08:04We don't want people to wait four hours in A&E.
08:07If you or I were going to the A&E department, we'd want to be seen quickly.
08:10So although we have that target, it's not the be-all and end-all.
08:14A&E is busy. There's a backlog of patients.
08:18Brought in by her daughter, 73-year-old Marion Naggs has bad stomach pain.
08:23She needs tests to find out what's wrong.
08:26But these take time.
08:30Eventually, the tests are completed and a bed is found for her in a ward.
08:35But there's a problem.
08:38When we got there, there was about four or five people
08:40waiting in front of her.
08:43And we waited there for about 10, 15 minutes.
08:46We were told we had to come back to the emergency unit because there were no beds.
08:50There's a traffic jam in the rest of the hospital.
08:54There's no beds. Everybody's trying to manage their own calls away.
08:58So it's just basically down-to-bed managers
09:01to help get some patients moved out onto the base ward.
09:04It's unfair to the patients. They're getting moved, getting shunted from pillar to post.
09:07And it's frustrating to us.
09:10And finally, second time round, Mrs Naggs is admitted.
09:14Do you want to sit in the chair?
09:17But having had a six-hour wait, she's breached the limit
09:21and become a negative statistic.
09:23I feel that the staff are trying their best to work with every single patient
09:27and treat them as an individual, not just a patient number.
09:30But they don't seem to have enough staff and enough resources
09:33to deal with the amount of people that are coming through the doors.
09:35And did you think that before today, or is that something you've learned today?
09:38That's something I've learned today, yeah.
09:43Peter Hawes, the diabetic, has had his blood sugar levels checked.
09:47He's rested, and now the hospital wants to get him out
09:50before he breaches the four-hour rule as well.
09:53I think I've been well looked after, but I'm glad to be going home.
10:02See you.
10:03See you.
10:08And Peter goes off with 16 minutes to spare.
10:12But in the rush to get him home, no-one notices that he's being discharged
10:17with a cannula, the tube for an intravenous drip, still in place,
10:21which upsets the nurse who looked after him earlier.
10:24Don't annoy me, put it that way.
10:26You try to have that continuation of care.
10:29The stresses and the strains of the job are such that
10:33you are trying to strive to meet those targets, you are pushed to the limits.
10:38So, do the targets need reforming?
10:41We asked the Department of Health for an interview, but they declined
10:45and referred us to NHS England.
10:47Their A&E chief admits they do.
10:50What was intended to be something to ensure patient safety
10:55and improve patient experience, that has been translated
10:59down to something that feels like a target culture.
11:02And that's one very important reason why we need to review it.
11:05And do you accept that the four-hour, 95% target as it currently applies
11:10is too crude a measure?
11:12It's too crude. I think things have moved on.
11:15When it came in, it was highly effective. Now it's too blunt.
11:18It's really been a powerful weapon for change within A&E departments.
11:22So it's not going to be got rid of without there being something that is better.
11:30It's the end of the day.
11:32There are fewer staff, but difficult new patients.
11:36Drug abuse happens around the clock.
11:39This hospital deals with three to four overdoses a day.
11:51This woman is admitted unconscious.
11:54The first priority to bring her round.
11:57Can you speak to us? Speak to us. How are you doing?
12:07Try your very best.
12:09Just about to do a sharp blood test, OK?
12:12A test reveals a long list of drugs in her system.
12:16Benzodiazepines, opiates.
12:20Well, it's got methadone and morphine of test positive.
12:23So that's basically heroin or sort of heroin replacement medication.
12:29Cocaine, obviously.
12:31For a while, this patient consumed resources.
12:35Everything else had to wait.
12:37Later, she was admitted to a ward.
12:39But by morning, she discharged herself.
12:45The constant pressure upon A&E means that it's always in the political front line.
12:49Before this winter, a crisis was predicted,
12:52and the government announced that £400 million more was going into A&E in England.
12:57But Stockton Hospital didn't qualify for any of this
13:00because of its above-average performance.
13:02The last couple of months has been horrendous.
13:05The beds are emptied and then straightaway patients go back to England again.
13:09So we're constantly chasing our tails.
13:12And that day, the hospital simply ran out of beds.
13:15And that day, the hospital simply ran out of beds.
13:18So at one of their twice-daily bed management meetings, they responded.
13:27Because we have trigger points, we have an escalation policy
13:32and a programme of trigger points that we look at.
13:35That's a call to say that they're escalating another bed meeting because of pressures.
13:40So it's likely to be that either A&E or the emergency assessment unit are under pressure.
13:56Staff in A&E are attending to Michael Althwaite.
13:59He's had far too much to drink and he's threatened suicide.
14:11The most common drug of abuse arriving in the department is alcohol,
14:16which comes on a daily basis.
14:23There are more than a million alcohol-related hospital admissions in England each year.
14:33He is fighting. He's not really got the strength, I think, to actually do it.
14:37They're managing to hold him fine and I think he's all bravado.
14:43But in the cubicle just opposite, they've had quite enough of him.
14:49The nurses and doctors shouldn't have to put up with him swearing
14:52and threatening to bite him and kill him.
14:54It's scandalous. Something should be done.
14:57If they get in that state, they should be chucked out and let themselves get sawed.
15:01Now he's briefly become violent and fallen over.
15:14Many A&E staff seem to have the patience of saints.
15:20It's becoming less attractive as a career.
15:23The job is stressful and it is hard work.
15:26My work-life balance hasn't been very good in recent weeks.
15:30Myself, I'm sure many of my colleagues, we all take work home with us.
15:34It isn't a balance. It's work.
15:36It's not a balance. I have a lot of work on my plate, yeah.
15:39Not life? Yeah.
15:41No.
15:43No.
15:45No.
15:47No.
15:49No.
15:50No.
15:54Recruiting enough A&E staff and keeping them in their jobs
15:58is now a national problem.
16:00Their champion says accident and emergency departments
16:03won't work properly at this rate.
16:05For the last three years, we've recruited only 50% of the registrars
16:09into emergency medicine.
16:11This means that there's a lack of about 350, 375 registrars
16:15around the country.
16:16That equates to three quarters of a million patient consultations
16:20per year that can't happen because those doctors don't exist.
16:24They're one consultant, a registrar and two nurses short
16:28in Stockton's A&E and fill up some gaps in staffing with hired temps.
16:34They're called locums in the trade.
16:36The one on shift admits it's not quite the same
16:39as having someone permanent.
16:41You can have good locums and you can have bad locums.
16:43Quite a lot at the moment are perceived as being bad locums.
16:48They sort of come in, they don't care about the job,
16:51they just come in to do the work, get the pay packet and go.
16:57So stressed out A&E doctors have been voting with their feet.
17:02That's the house we often stay in when we go down there.
17:05Oh, you rent this place down there?
17:07Yeah, I just rent that down there for very little.
17:10John Thompson trained in Stockton
17:13and he's worked as an A&E consultant there too.
17:16But he's left the NHS behind to live and work in Fremantle in Australia.
17:22We met him when he was over here visiting relations and old friends.
17:26They'd be kangaroos, there you go, stalking kangaroos.
17:29Oh, my word.
17:31The pressures are less in Australia
17:33and the emphasis primarily for my working day is on patient care.
17:39The pressures from the four-hour rule and from up above
17:43have taken so much away from the job in the NHS in the UK
17:48that it's just too hard.
17:52The number of UK medical graduates working in Australian emergency departments
17:57has gone up by over 60% in the last four years.
18:00Oh, yes, so that looks a lot better, doesn't it?
18:03Yes.
18:05Still quite dry, isn't it?
18:07Alex Muirhead quit as well.
18:09She didn't leave the country,
18:11but she left the specialisms she'd originally chosen for good.
18:15She was an A&E consultant at Stockton Hospital until last December.
18:19Any questions?
18:21Now she's a local GP instead.
18:23Brilliant.
18:25It's quite sad, really, because I used to love working in A&E,
18:28but it got to the stage where I just didn't enjoy my job
18:32and I didn't want to spend another 20 years working as an A&E consultant.
18:37As an A&E department, I don't think you get an awful lot of respect
18:41from the rest of the hospital.
18:43To some extent, A&E is now seen as everyone's dumping ground.
18:48SIREN BLARES
18:52All medics and staff from Wardrobe,
18:54all medics and staff from Wardrobe, please, thank you.
19:00It would help if far fewer of us turned up in A&E in the first place.
19:05According to official figures,
19:0740% of patients don't need to go to accident and emergency at all.
19:12For some, it's a safe haven.
19:15I come here every week. I get admitted every week.
19:18You come here every week?
19:20Every week, yes.
19:21Are they good and kind to you here when you come here?
19:24You say you come here a lot?
19:26Some of them are. The ones who know me personally, they're all right.
19:29People just think, he's in and out, he's an idiot.
19:32In the last month, I think he's attended six times.
19:35Is he the only one, or is this...?
19:37No, no, no, we have quite a few what we class as regulars.
19:43Peter's admitted to a ward.
19:46There are plenty of others who shouldn't be here at all,
19:48but they turn up in A&E all the same.
19:51We had a gentleman who came in and he had a splinter in his finger.
19:55And at that point, we were in a three-and-a-half-hour wait.
20:01A lot of sore throats come in.
20:04And coughs.
20:07I'm talking just little coughs.
20:12One reason we heard for coming to A&E is
20:14because it's difficult to get an appointment with a GP.
20:18I was involved in a road traffic accident last night.
20:21I woke up this morning with a pain across my shoulders.
20:24I went to a local doctor's, but they couldn't book me in,
20:27so I couldn't really wait till Monday.
20:29I don't want to waste these people's time, you know what I mean?
20:32Because there's more deserving people than me.
20:37Besides GPs, the NHS offers a whole host of alternatives
20:41to accident and emergency care.
20:43But lots of us still say,
20:45thanks, but no thanks, I'll stick to A&E.
20:49We've been in a nightclub, me and my partner.
20:52A guy has been trying to, like, parodically dancing with me.
20:57He's obviously had too much to drink, went for him,
21:01and I've got caught in the middle of it and been punched in the face.
21:05Had you any doubt about whether to come here?
21:07No. I think I'm just being a bit vain, that's all.
21:09I'm just panicking in case I have broke my nose.
21:12Even the professionals admit,
21:14part of the reason some patients still go to A&E
21:18is that the alternatives are a bit of a maze.
21:21Yeah, I think it's very difficult to understand.
21:23You know, we've had lots of different things.
21:25You know, NHS Direct, the 111 system,
21:28they don't really know what all that means.
21:30Minor injuries unit. Minor injury.
21:32Urgent care. Urgent care centre.
21:34No, I agree entirely.
21:36I think there's a confusion around all the names.
21:37You want me to know where to go? Yes.
21:40And I can't... I can only just make head or tail of these titles
21:43and I've been working hard at it. Yes.
21:45Did you lose consciousness when you fell?
21:47No.
21:49But quite a lot of patients in Stockton
21:51wish they were being treated in a hospital near a home.
21:53I was walking my dog and she was on her leg
21:59and then another dog came chasing up to her
22:02and I fell flat on my face.
22:04I was in shock.
22:05Because I knew my face was all bleeding.
22:08And you know what women are like.
22:10We like to have our pretty faces.
22:16And on top of that,
22:18Christine Johnson had to travel to be treated.
22:21In 2011, the A&E department in Hartlepool,
22:2415 miles away, was shut
22:26and services were concentrated in Stockton Hospital instead.
22:30And here, as in other places,
22:32the closure of a local A&E still hurts.
22:34Where would you like to have been taken then?
22:36Hartlepool.
22:38So for you and your husband,
22:40getting here to Stockton is a bit of a palaver.
22:42It is, yes.
22:44Have you told anybody that?
22:46No. It was to open our door.
22:48I'm just a little person, aren't I?
22:53Bye.
22:55Well, I think right across the country
22:57people want all the services that they can
22:59as local as possible.
23:01And whilst we try to achieve that,
23:03if you go in for a local service,
23:05it's got to be of the highest quality.
23:07And bringing the two services together
23:09was the right thing to do.
23:11Can I have a look at you, sir?
23:13Is that OK?
23:15What was striking about our time in A&E
23:17was the number of elderly, frail patients
23:19they dealt with day and night.
23:21The number of over 65s
23:23attending major A&E departments in England
23:25has gone up by around 190.
23:27in the last year alone.
23:29Admitted in the small hours of the morning,
23:31it was Bill Galloway's 100th birthday.
23:34Happy birthday to you.
23:37Happy birthday to you.
23:41What is the most challenging in the middle of the night
23:43is complex medical patients.
23:45So your elderly patient,
23:47you know, just doing simple things
23:49at four o'clock in the morning,
23:51interpreting a chest X-ray,
23:53trying to get clear information
23:55off people at that time in the morning.
23:57And when you've got a department
23:59full of those type of patients,
24:01it is absolutely exhausting.
24:03And if they're admitted onto a ward,
24:05the elderly may affect
24:07A&E departments in a different way.
24:09It's Sunday.
24:1178-year-old Dot Bromelow
24:13has been medically fit
24:15to be discharged for two days.
24:17But she's still taking up
24:19an acute hospital bed.
24:21Why are you still up here in the ward?
24:23Well, bureaucracy.
24:25She relies on home help,
24:27which is organised by her council's
24:29social services department.
24:31It was stopped as soon as
24:33she was admitted into hospital.
24:35That's standard practice,
24:37but it can't be rearranged
24:39until after the weekend.
24:41But for the moment,
24:43until your care package is sorted...
24:45I'm stuck.
24:47Today, as we speak,
24:49we have eight of those patients
24:51that are sitting in a hospital bed
24:53that are waiting for a process
24:55to be completed.
24:57So you can't get them out?
24:59No.
25:01Using official figures,
25:03we've calculated that in total,
25:05delays involving social care packages
25:07are costing the NHS in England
25:09about £100 million a year,
25:11and cuts in local authority budgets
25:13are making things worse.
25:15There's bound to be a consequence.
25:17Social care and local authorities
25:19have taken a significant reduction.
25:21We need to join the services up,
25:23and one of the key things we have to do
25:25is to bring the doctors,
25:27the nurses,
25:29the social workers back together.
25:31Because it's expensive for the NHS
25:33and embarrassing for the government.
25:35It's expensive for the NHS,
25:37and it's wrong for patients
25:39to keep them in high-acuity
25:41healthcare environments
25:43when they would be much better off
25:45at home being supported
25:47in their own environments.
25:49We spent seven days in A&E.
25:51Alex Muirhead, now a GP,
25:53originally looked forward
25:55to many more years there,
25:57and now he's gone.
25:59There's a tiny part of me
26:01that feels guilty from jumping
26:03from a sinking ship,
26:05but for me,
26:07I don't have a single regret about leaving.
26:09A sinking ship?
26:11Yeah, A&E is a sinking ship,
26:13and unless things change dramatically,
26:15it will sink,
26:17because it's not a popular place
26:19to work now.
26:21I don't think we're going to go down
26:23like the Titanic in a matter of hours.
26:25We're going to slowly sink,
26:27and that's the reality of emergency medicine.
26:31Stockton remains
26:33a good and safe hospital,
26:35but the man who represents
26:37A&E doctors nationally
26:39warns of the risks
26:41unless action is taken.
26:43This is about a call to arms
26:45to address the real problems
26:47that we have in accident and emergency departments
26:49up and down the country.
26:51You feel it really pushing?
26:53Yeah.
26:55My real fear,
26:57is that you end up in an ambulance
26:59to an emergency department
27:01and there will be no doctors there to see you.
27:03There will never be no doctor there to treat you.
27:05That won't happen.
27:07We may have a situation
27:09where emergency medicine doctors
27:11are insufficient.
27:13What we will have to do in the short term
27:15is to look at how we use
27:17the wider skills that are available
27:19in the hospital,
27:21to look at the extended role of nurses,
27:23of paramedics,
27:25of physician's assistants.
27:27There are serious shortages of staff,
27:29treating patients who shouldn't be there at all.
27:36Remember what the initials A&E are short for.
27:40They can stand for anything and everything
27:42or always and everyone.
27:44Stand for that because we're always open.
27:47We're open 24 hours a day,
27:49seven days a week,
27:51and anyone can drop in at any time.
27:53There certainly is an expectation from the public
27:55that they come to A&E
27:57to get things sorted.
27:59It's a bit of a difficult thing.
28:01If we provide a good service,
28:03you almost make a rod for your own back.
28:05Some people working in this environment
28:07is what draws them,
28:09but for some people
28:11who don't want to be struggling with difficulties
28:13like having no beds,
28:15trying to maintain the safety
28:17and comfort of your patients.
28:19We didn't just see flashing blue lights
28:21of accident and emergency.
28:23There are political warning lights as well.
28:25This most visible part of the NHS
28:27is under heavy stress
28:29and in need of urgent treatment.
28:57.