I have just returned from holiday so forgive me for joining this
debate late.
The Audit Commission report was launched from my hospital at the
request of the DOH. We apparently had little say in this. We were
chosen because our figures are relatively ok for London. We had about
5 camera teams and I did serial interviews after Andrew Foster and
the modernisation man. The press were clearly only interested in
hearing bad news and wanted quotes critical of the government. I am
am obviously not a senior member of the A&E establishment but - and
here I am going to annoy some people:

Why are so many people so dispairing about A&E and still doing the
job? The waiting times in A&E are appalling - we all know that and
there is a good opportunity at the moment when we finally have a
target that relates to us - the 4 hour target. This focuses attention
and should be helpful. However it is not just about resources- how
you use them also matters- I want senior staff everytime now. Some
systems work better than others - local department management IS
important and we should try and learn from the good departments. Good
relations with the hospital management team is vital and I know I am
very fortunate in having a supportive management team and importantly
one who recognises that we are the first part of a patient journey so
what happens further down the line matters to us. We are having an
exciting challenging time at the moment thinking about new working
practices/ systems. The Audit Commission report adds to my power to
encourage system change and so I am happy to have it.

Quoting Adrian Fogarty <[log in to unmask]>:

> I am not convinced Francis that this report is really "A&E"
bashing. I
> heard
> Foster later that morning on Radio 2 (sorry!) and he basically said
that
> the
> doctors and nurses are working flat out, but Management - with a
capital
> M -
> was at fault. Take some of the summary paragraphs:
>
> 36    Not enough ENPs, hospital managers should address this.
> 37    Not enough RSCNs, not enough senior doctors [clearly a
> Management
> problem]
> 39    Hospital managers must now use information to improve patient
> care.
>
> Why should BAEM suddenly appear defensive about this? There was a
> clear
> message yesterday that the A&E service is crap and needs improving.
> Why
> argue with that? Surely we all agree with this sentiment? To turn
around
> and
> say, hmmm no it's OK actually, would be downright foolish, nay
> deluded,
> wouldn't it? And should we feel so guilty even if our micro-
management
> is
> suboptimal? None of us are professional managers, we're doctors
with a
> modicum of management skills, who haven't enough time to properly
> manage
> because we're too busy being doctors!
>
> Adrian Fogarty
> London Consultant - v. bad :(
>
> ----- Original Message -----
> From: "Francis Andrews" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, October 26, 2001 3:25 PM
> Subject: audit commission report
>
>
> > The list seems to have ben silent regarding the publication of the
> > latest audit commission report on A&E so here goes.
> >
> > Yet again, there seems to have been an absence of anyone
> 'influential'
> > from the A&E world defending our speciality in the media against
> some
> > of the inaccuracies of the audit commission report.  I listened to
> BBC
> > radio 4 on the morning of the report publication and it was left
to
> > the opposition spokesman on health to fight our corner and state
> that
> > departments were under pressure because there just simply are not
> > enough beds in the rest of the hospital, which jams up
departments.
> In
> > other news bulletins on the TV and on the web, I didn't see any
one
> > from BAEM or a senior (A&E, not gen. medicine) consultant etc
being
> > interviewed.  The Andrew Foster from the audit commission told
radio
> 4
> > that really, it was poor 'micro' management that was at fault, I
> think
> > implying the departments themselves-this is echoed throughout in
the
> > report.  Buried away in the report is the odd admission that
> actually
> > if all the cubicles in A&E are full, then it is very diifficult to
> > assess new patients.  The report feels that this is only a problem
> > occaisionally-more like everyday in most departments surely.
> >
> > The press statement on the BAEM website is watery and I think that
> yet
> > again, a major opportunity to publicly fight our corner from
within
> > the speciality has been lost.  Those in infuence within the
> speciality
> > must have known that this report was coming out and a vigorous and
> > very public defence should have been mounted.  If this wasn't
> thought
> > to be necessary given the report's highly critical main findings,
> then
> > perhaps the report is right and we as a speciality just cannot get
> our
> > act together, whether thrombolysing the right patients or
organising
> > staffing. Any one else feel mounting despair out there?
> >
> > Francis Andrews FFAEM
> > Liverpool
>