You might like to read this, sent to the Times tonight:
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Sir
I am sure that I am not the only Consultant in Emergency Medicine dismayed by the superficial and inconclusive
report issued by the Audit Commission and infuriated by the Secretary of State for Health's ill-considered remarks in
response; he must be aware that it does little for staff confidence to be blamed for deteriorating performance.
There are three reasons for extended waiting times in Emergency Units. These are inadequate numbers of staff to see
patients (doctors or Emergency Nurse Practitioners), insufficient support staff (mostly nurses and receptionists) or
insufficient space. The audit commission drew only two conclusions; the total number of patients attending has
increased modestly in five years, and the number of staff has increased. They seem perplexed at the increased waits.
One plausible explanation is a changed case mix. More people attending hospital are admitted, arguably an excellent
proxy for a greater proportion being more ill. In my own Unit, the proportion being admitted between 1995 and 2001
has increased by up to 60.3%. These patients rarely spend less than 2 hours each in the department, often much
more, and as they are often acutely ill, tie up nursing and space resources.
Rarely does excessive waiting result from a dearth of doctors, but a dearth of nurses and space. If people cannot get
into a hospital bed they have to wait somewhere, and using our Emergency Units as this storage facility impinges
severely on the care we can give the next patient.
Should the Secretary of State facilitate timely discharge of the last patient and admission of the next by lobbying for
improved Social Services funding, he will find, doubtless to his equal bafflement, that the managers seem able to run
their emergency units once more.
Yours faithfully
Rowland Cottingham MB BS BSc DA FRCS(Ed) FFAEM.
Consultant in Emergency Medicine
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Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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