THE National Health Service lurches from one crisis to another. The latest is the unprecedented demand currently placed on the A and E departments of hospitals during the evenings and in particular at the weekends. This has culminated in a warning from the College of Emergency Medicine that it will soon no longer be able to cope.
There are several reasons for this crisis having developed. The first is the change to the out-of-hours service provided by GPs as a result of the “new” GP contracts that came into play in 2004. This gave GPs the opportunity to opt out of providing out-of-hours care and, surprise surprise, some 90% of them decided to do just that.
The relevant Health Trusts were required to take up the slack and they largely responded by providing GP staffed out-of-hours clinics based at the local hospital A and E department.
As a result, patients requiring medical assistance contacted NHS direct and, if it were deemed necessary by the nurse at the other end of the phone for them to see a doctor, an appointment would be made for them at the A and Ebased clinic.
Take a chance
As time went on, patients came to realise that they could circumvent the hassle of calling NHS direct and instead just take their chance by turning up in Casualty unannounced. Sure it might mean a long wait but what else was there to do on a Saturday night if your favourite football team had lost that day?
The result was that A and E waiting rooms began to become crowded with anything from persons with suspected appendicitis to those with nothing more than a moderate dose of the common cold.
Another factor that has led to the current crisis is that for some time now, working in A and E has been something of the Cinderella of the medical specialities with relatively few medics having a “burning desire” to make this area of medicine their life’s work. This has led to serious A and E staff shortages especially in the middleranking tiers of the medical profession. The reasons for this are numerous and I will suggest but a few.
Unpredictable caseload
The first is likely to be the unpredictable nature of the caseload. In veterinary practice we are all too familiar with how a quiet Saturday afternoon on call can turn, literally in an instant, into a hugely stressful Saturday evening with the competing demands of a serious RTA, a potential caesarean section, and the hospitalised dog with acute gastroenteritis that has suddenly taken a turn for the worse.
Most people like to know how much work they have to do at the start of each day so that they can best plan how to get it done.
The second point is that with the best will in the world, the NHS, like most veterinary practices, runs on much reduced staffing levels overnight and particularly during the weekend.
This in itself can bring about feelings of isolation, especially amongst junior medical staff who may be left to deal with situations and cases they feel inadequately prepared for.
Modicum of control
Working in highly stressful situations for prolonged periods of time suits relatively few people. Humans are generally creatures who like to have some pattern to their lives and to feel that they have a modicum of control over it.
The third point is that dealing with patients in A and E can be extremely challenging on the basic level of human to human interaction, particularly on a Friday and Saturday night.
The percentage of visits at these times that are alcohol-related is obscenely high and many of the people so affected are not able to moderate their behaviour. Who would want to have to deal civilly with people who are behaving brutishly and whose ailment is entirely self-inflicted?
If all this were not enough, then consider the impact of the recent changes to how out-of-hours services are to be accessed. The new 111 nonemergency phone line that was to replace NHS direct has had more than its fair share of teething problems.
Inappropriate advice
Patients unable to get through on the phone have simply gone to A and E and many others have been advised inappropriately by the service to do the same thing. The result is overcrowded hospital waiting rooms and increased waiting times to be seen.
The veterinary profession has so far avoided any such problems but I suspect that it will not be long before, at dinner parties, I hear people complaining not only about the “exorbitant” fees that vets are charging but also about how far they had to travel in order to access the only emergency clinic that was open.
When faced with such comments I have one of two strategies, depending on how much wine I have consumed when the moaning comes to light.
No more than two glasses and I simply grin and bear it and move to another circle of people who hopefully have something more interesting to say. More than four glasses and I am likely to get sucked into some heated debate which usually ends with my wife apologising on my behalf and one less Christmas card needing to be sent.
Getting away with murder
What really galls me in all this is that the medical profession appears at times to get away with murder (literally in the case of some of the recent scandals that have come to light for which no individuals have been considered culpable), whereas the veterinary profession is sometimes vilified for providing easily accessible high quality out-of-hours care because it is considered by the public to be too expensive.
We really need to improve our PR at grassroots level so at the least I can socialise without feeling I have to justify my new Skoda as it nestles in amongst the Mercs and Range Rovers of those doing the complaining.
What we probably need, I dare to suggest, is a high-profile celebrity much loved by the public who can champion the profession on our behalf. Hmm … seems like that option, for the time being at least, has been well and truly wrested from our grasp.
