One sign/symptom that the Health Service is cracked beyond redemption will be patients demanding private A&E care, private ambulances etc.
More than half of the A&E departments in England are substandard, according to the NHS regulator, putting patient’s lives at risk.
An analysis by the Care Quality Commission (CQC) found that 57% of the 176 A&E units inspected under a new rating system were either performing badly or not as well as they should have.
The figures came as the president of the Royal College of Emergency Medicine, which represents A&E doctors, warned that patients were dying unnecessarily because of overcrowding in hospitals.
Dr Clifford Mann said: “Quite a lot of people are having worse care because of overcrowding and some people, undoubtedly, will not recover from their illness, whereas had they been seen in a properly resourced department and seen as promptly as possible, they would have survived.”
Dr Adrian Boyle, an A&E consultant and spokesman for the college, said: “Emergency departments across the UK are under significant pressure with a toxic mix of increased attendances and lack of beds.
“This has resulted in increased work for emergency departments and increased pressure has reduced our ability to look after seriously ill and injured people.”
The college estimates that 500 patients die unnecessarily every year because of overcrowding in A&E departments.
Mann believes that 15 new A&E units should have opened in the past five years to cope with rising demand. Instead, some closed.
Of the A&E departments inspected by the CQC, 16 were rated as “inadequate”. This means that they were performing so badly that the regulator was forced to take action against the trust that ran them.
Reports into those units reveal a catalogue of failings, which include:
•Inspectors had to intervene personally at one department to ensure that 11 patients at risk of deteriorating were made safe
•Patients had to wait outside hospitals in large multi- occupancy ambulances known as “jumbulances”
•An A&E unit became so overcrowded that a third of an entire ambulance service fleet was held up outside the hospital, leaving a shortage of ambulances to attend other emergencies
•A quarter of patients with blood poisoning at one A&E unit failed to receive safe and timely treatment
•Medical staff inserted cannulas and examined patients on trolleys in corridors
•Patients were either “stacked” in the middle of the department because of a shortage of bays or forced to share cubicles
•An A&E department which considered being in a state of crisis as normal
•Staff failed to report unsafe overcrowding to management because it happened daily
•A failure to dispose safely of clinical waste, such as needles
•Unqualified A&E staff telling patients to go elsewhere when there were long delays.
In one report about the A&E department at William Harvey Hospital in Ashford, which is part of the East Kent Hospitals University NHS Foundation Trust, inspectors wrote: “We saw patients left on trolleys rather than beds consequently not receiving relief for pressure areas. We saw patients on trolleys and chairs in the corridor and patients stacked in the middle of the department as there were no bays available.
“Patients were having cannulas inserted in the corridors . . . We saw patients being examined in the main corridor.”
Another report — into Birmingham Heartlands Hospital A&E unit, run by the Heart of England NHS Foundation Trust, said: “High risk and high stress from overcrowding and poor patient flow had become accepted as standard practice by nursing and medical staff and their leaders. Crisis was normalised within the emergency department.”
Both hospitals have said they are addressing the problems raised by the CQC.
Whipps Cross University Hospital in east London, which was given an “inadequate” rating in its latest inspection, apologised this year to Leanne Kenward who suffered a miscarriage after A&E staff ignored her requests for help for six hours.
“Compassion should be the first thing you receive on the NHS, especially when you turn up at A&E,” Kenward said. “But no one thought about me or how I felt.”
Barts Health NHS Trust, which runs the hospital, said: “We sincerely apologise for the distress caused to Miss Kenward and her partner during this difficult time.”
More evidence of problems facing some A&E departments is provided this weekend by a photograph of an elderly woman on a trolley in a corridor. It was taken at 10pm on April 4 after the patient had been waiting for 4½ hours and has been released by Karl Deitch, president of the Hands off HRI (Huddersfield Royal Infirmary) campaign.
The Calderdale and Huddersfield NHS Foundation Trust plans to downgrade the hospital’s A&E unit to an urgent care centre and Deitch says that it is being left to deteriorate.
David Birkenhead, the trust’s medical director, said: “That night was one of our busiest of the year with many patients requiring admission and out-of-hospital care.
“All patients arriving in A&E were clinically assessed and prioritised and, for some less urgent cases, this meant there were, that night, regrettably, some delays.”