Slugger O'Toole

Conversation, politics and stray insights

The solution to the A+E problems lies outside A+E

Thu 22 March 2012, 8:20pm

The travails of the NI NHS are back in the news and specifically the problem of A+E: except it is not actually all an A+E problem. The main problem is the long waits in A+E of 12 hours or more.

It must be understood that these people are not a waiting initial assessment and treatment but rather are awaiting admission to a ward: their A+E stay and treatment should have already finished. These people are entirely inappropriately being treated in A+E on trolleys, in assorted side rooms etc.

The A+E department is not the appropriate place for them to be treated and the staff there are too busy with the latest admissions (and the need to keep to the four hour initial treatment standard) to give the trolley waits the time they need.

The solution is to move the patients to beds in appropriate wards but ironically the solution is not necessarily to have more beds. The problem is that the beds in the wards are frequently full of patients awaiting further investigations, tests and treatments which need to be performed on that admission though not necessarily immediately.

The easiest way would be to use an example. If a patient is admitted with a bad angina attack / mild heart attack most of them will need an angiogram (the dye test). Some need this immediately as a life and death emergency but most do not. Frequently people in Northern Ireland wait for days for such an investigation: they come to no harm from this wait but they do occupy a bed.

However, if they had the angiogram within the first day or two they could be home by day three: preferable for the patient but of most relevance for this discussion freeing a bed for someone else. Exactly the same issue pertains for all sorts of other aliments. Getting patients their investigations and treatments earlier allows them to be discharged sooner and creates a bed for someone otherwise waiting on a trolley in A+E.

Sue Ramsey of Sinn Fein gets this point right at the very end of this piece though I am unsure if she draws the correct conclusions from it – to be fair she does not get the time to draw conculsions:

The problem then is not increasing the size of A+E or the numbers of A+Es (that latter option might well be actively counterproductive though minor injuries units have great value). It is not even increasing the number of beds. Rather it is addressing the bottle necks in the system.

These bottle necks waste patients’ time and keep them inappropriately in hospital which can actually be dangerous for older, frailer patients who more easily catch potentially life threatening illnesses in hospital.

Increasing access to these investigations, however, takes money to buy the equipment and most importantly to staff the relevant theatres etc. It would also be potentially sensible to contemplate semi routine work beyond normal office hours.

The BMA have been considering this regarding hospital consultants but consultants alone are not the solution. Most decisions a consultant makes or procedures a consultant does require a team that means consultants, junior doctors, nurses, radiographers etc. etc.

Thus far Poots has made sensible suggestions of allowing senior nurses to discharge patients at weekends and trying to ensure patients can be discharged in the morning. Currently it is remarkably difficult to discharge a patient in the morning for assorted reasons which usually look fairly spurious.

The other issues around increasing procedures etc are potentially more problematic. Larger centres can more easily run later and at weekends as they have a larger pool of staff. Yet again it comes back to the fact that we need a smaller number of hospitals performing more state of the art procedures, more frequently, at times outside normal office hours.

This is safer and better use of resources and provides patients with what they want: namely more chance of getting better and getting better more quickly. All health ministers both direct rule and local have repeatedly shied away from admitting to the need to close hospitals.

To be fair in GB the battle to rationalise the hospital estate has been almost as long and hard with assorted daft appeals to historic names and places of the past. There has also been the inevitable shroud waving that people will die unless there is a hospital less than 30 minutes away; not worrying about the facilities of the unit nor the frequency with which procedures are performed by it.

Poots seems to be willing to contemplate changes to hospital numbers though thus far he has slightly hidden behind Compton which itself did a bit of a fudge by not stating which hospitals should lose their acute status. On this issue a clear steer is required from ministerial level.

Almost everyone within health knows what needs to happen but petty rivalries, ensuring one’s own position and systemic inertia all hamper the needed changes. Poots will hopefully be willing to drive through all the needed changes and to be fair to him one of his first actions was to reduce Lagan Valley’s A+E opening hours (in his own constituency).

It has also been suggested at a very senior level within the health trusts that the current health minister has made a decent beginning and should stay in post after the rerunning of d’Hondt and for the whole of this Stormont term as the time frame for these changes is years and not weeks or months. A clear indication of this from Peter Robinson would be highly useful.

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Comments (23)

  1. hfmccloy (profile) says:

    Utter non-sense:

    fact minor injury provision did not solve problems when Omagh and Dungannon lost actue status.

    Fact minor injury provision did not solve problems when Mid Ulster and Whiteabbey lost acute status.

    Patient pathways like it or not still direct patients into the same crowed house.

    All this is going to lead to is nicely named waiting rooms that wont be classed as waiting times although patients will still be laying in wait ot be treated

    Shocking that this propaganda gets airtime

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  2. iluvni (profile) says:

    Not too convinced ‘senior nurses’ should be releasing anyone.

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  3. Turgon (profile) says:

    hfmccloy,
    How many people are alive today or still have full use of their limbs etc. because they got the specialised treatment available in proper large A+E departments rather than the treatment in the tiny old fashioned causalty departments of yesteryear?

    Minor injuries departments help deal with minor problems. The serious illnesses and accidents need to go to fully fledged A+E departments: one cannot have such departments in every medium sized town in Northern Ireland. If one did they would very rapidly deskill and become a liability to their patients.

    As to propoganda: no this is what is happening. Change is always frightening especially for those who do not understand the changes; even more so when some for cynical reasons whip up public anxieties. The simple fact is that every professional organisation to do with health world wide recognises the need for change and consolidation in health care. It is about better outcomes which simply put means you and your relatives surviving.

    ilunvi,
    The point is that they would discharge people already identified by the consultant as “fit for home on Saturday”. What currently happens is that such people sit about waiting for a very busy on call junior doctor to see them on the day of discharge and then they often end up staying in unnecessarily because the doctor was too busy to get to them in a timely fashion.

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  4. iluvni (profile) says:

    I appreciate that is often the case Turgon.
    Still, I dont like the solution proposed.

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  5. We should really be doing more to stop admissions to A & E in the first place. I recently had the experience of being in A&E with an injured child while priority seemed to be given to a bunch of drunks and druggies…as the Hospital seemed to be anxious to get them out of the hospital more quickly than their condition seemed to deserve.
    Being drunk, high, loud and aggressive seems to guarantee speedy treatment.
    Maybe we should try Prohibition.
    It also has to be said that when asked….many of those reporting to Reception did not actually have a GP.
    There may well be problems in relation to “beds” but we should be doing a lot more to keep people out of A & E in the first place.

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  6. Turgon (profile) says:

    FJH1745,
    I agree entirely though bizarrely the excess numbers of inappropriate people coming to A+E are a largely separate problem to that of the long trolley waits.

    On the issue of inappropriate attendances it is a real problem. The police do not want these people (the drunk and high) lest they take sick whilst in their custody. Also to be fair some inappropraie attendances may not seem inappropriate to the patient themselves. The suggestion of colocation of A+E and GP out of hours may help in this scenario.

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  7. hfmccloy (profile) says:

    Turgon you have bought into the Smoke scReen , I submitted one of the largest documents to the Compton review that proves these changes are based on money not clinical reasons, how many drunks clog the system up can you answer that lol

    How many people who get injured go to a and e as they are not doctors ?

    How many parents takes their child to a ande to be sure because if they don’t they can be done for neglect?

    How many people living miles away from a and e make a mouthy knowing they will wait for hours for no reason?

    Fact mortality and morbidity have risen due to health and safety closures if hospital sites, butnits ok as were going to make more pathways into the same crowded rooms, catch yourself on

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  8. Turgon (profile) says:

    hfmccloy,
    You are correct only in that people sometimes cannot tell how serious their injury is. That is, however, an argument against having either minor injuries units or small casualty departments.

    I have spent years seeing how the old small casualty departments staffed by a doctor only a year from qualifying had to deal with things beyond the capabilities of the staff through no fault of their own. Then people were admitted to wards with the doctor there again only a year out of medical school.

    Now in most hospitals much more senior people and many more of them are available. Tell me what do you think should happen to a person having a heart attack, a stroke or after a major accident: go to a big modern A+E even if it is some miles away or go to the local small casualty supposedly for stabilisation and onward transport but in actual fact to die. Time to definitive care is what matters and only the largest of our hospitals can now or will ever be able to offer that. This is fundamentally a debate about living and dying; getting better or being permanently disabled.

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  9. hfmccloy (profile) says:

    Alright it’s obvious a history and up to date lesson is needed here, not that I have the time but I will give you the finer points:

    Minor Injury units do not save lives, can prove a clinical risk in terms of what it provides as people are not doctors, nurses are not doctors and time is wasted going to minor injury when they should of went to A&E. Ring out of hours and speak to a nurse, that nurse will direct an ambulance to you, its not rocket science. Doctors from the health commission also are against minor injury units as they are not working.
    Centralised services leaving huge rural area devoid of acute care, leaves ambulances and rapid response vehicles to fill the gap, ambulances are tied up in urban areas due to trackers being fitted in ambulances, leaving rapid response vehicles who cannot deliver clot busters or meningitis vaccine and more to spin around rural areas to stabilise patients on the road and in their beds to die where as a small unit could of stabilised them.
    Staffing and services at the A&E’s and acute hospitals outside of the greater urban areas were immense, for example, the Mid Ulster hospital developed the first intensive care unit in the UK, the first ambulatory care in Ireland, pioneered surgery that is word recognised, had and has some of the top consultants and doctors in Ireland, trained many of the remaining ones that went elsewhere in Northern Ireland. And was at its time the only fully Acute Hospital in the history of Ireland in terms of medical inpatient beds
    The larger units do not exist, nor will they ever exist in any form in this country, clinical risk identified in the past showed that removing hospitals without development was the highest risk, that is what happened, that is the long and short of it, and while the smoke screen developers and people wonder how a man died while waiting to be admitted maybe you should ask the question Why Was He Laying There in the first place? Why in rural areas where maternities are removed for health and safety are there high still births and infant deaths? Why are there increased morbidity levels? Increase deaths from heart associated and respiratory disease?

    How far do you live from an acute A&E?

    If what is happening is acceptable then why not shut down every acute hospital outsode of Belafst and line the country up therough different doors into the Royal? quote from a docotor

    You can wait that long inside hospitals now you are at risk from picking up a hospital aquired infection! quote from a docotor

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  10. Turgon (profile) says:

    hfmcloy,
    There we go as usual. Appeals to places and names of yesteryear. What a hospital did or did not do is history: interesting but not how we organise health care today. Incidentally the ICU in the Mid Ulster was not an ICU by the normal modern definition of an ICU. Yet again the names and designations of the past have no relevance to now.

    The comment about minor injuries may have some validity.

    That on ambulances is incorrect. There are ambulance stations in rural areas: one can have an ambulance depot in the rural area which will then bring the patient rapidly to a specialist centre.

    Your comment about meningitis is incorrect: it is not a vaccine one is given if one has meningitis it is benzyl penicillin or a third generation cephalosporin (or possibly a carbapenem if fear of anaphylaxis to penicillins – chloramphenicol is the final option if really worried re anaphylaxis). These drugs can and should be given by the GP or ambulance and then the patient taken to a specialist centre.

    The clot busting drugs argument is even simplier. The rest of the UK is moving away from such drugs (thrombolytics) and to primary angioplasty (also called primary percutaneous coronary intervetion). Most studies suggest that drive times of 2 hours or less (certainly one hour or less) result in better outcomes for patients with this strategy than with thrombolytics.

    The fundamental flaw in your argument is not, however, medical it is practical. No one is suggesting only one hospital. The ideal would be 5. Northern Ireland is very small and contrary to popular belief does not have especially poor transport links. In the rest of the UK, in Europe let alone in North America and Australia people are transported much greater distances to specialist centres and hence, get better outcomes.

    The suggestions about still births etc. are simply incorrect. Also small units without all the necessary services are indeed the best way to ensure higher neonatal and maternal mortality.

    The comment about waiting in hospitals to pick up an infection is the exact point I was making above. No point being admitted to the Mid Ulster with a heart attack, sitting there 10 days and picking up an infection. Much better to have a proper angiogram and angioplasty service in Craigavon or Antrim, take the patient there and discharge them at day 3. That is what is being proposed and shroud waving against change scares people and if it is allowed to inform health decision making will cost lives.

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  11. hfmccloy (profile) says:

    The facts of these matters prove you otherwise, these are not facts I made up these are facts from the DHSSPS, minor injuries is a false services that led people to believe there is treatment avaiable, some people strill think minor injuries are for minors only.

    people have died on as they have not got clt usters or vaccines due to ambulcanes being tied up in urban areas and rapid response vechilecs not being able to adminsiter , i know some of these people who have died while you still support your stance

    The safest maternity in Northern Ireland, Mid Ulster when open had the lowest still and infant death rates, which has risen is this area since its clousre, I will if you want introduce you to others who have been sent home with dead babies in ther womb as their is no room in the inn and if they had access to a maternity would be with their child now. I will introduce you to two mums who were induced and sent homes as there was no room only for their child to die before they made it back.

    I forgot to mention for a small hospital with the best consultants in the country with a fully functional ICU as defined today when it opened, with 200 fully actue inpatint beds which is roughyl the size antrim is now. Hospitals like this were made unsafe by health cheifs.

    These hosptials you speak of dont exist and never will, were not england we are Nothern Ireland, with tarmaced horse and cart roads, were not Birmingham were Northern Ireland we have lough neagh, the sperrins, mournes and glenns of antrim to contend with. Have you ever sat in the meetings with heath cheifs where this was discussed, also discussed and agreed that acute facilities are located in the worng place?

    How far from a acute A&E do you live?

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  12. tacapall (profile) says:

    Turgon those unfortunate enough to have to attend the Royal A+E cattle market would do well to bring a packed lunch along with a change of clothes and possibly the entire series of Harry Potter books to take their minds off or use as an analgesic while waiting for over worked doctors in an understaffed department, who after treating patients in a field hospital like environment treat or advise admittance then hand this responsibility to others to arrange. Patients cannot walk to their allocated wards and require transport and porters for this to happen and this is where it gets tedious and people become irritable, although the Royal is a large estate its not the length and breadth of Ireland but these porters who although are based a few hundred yards away either up down or across, including those from the City Hospital which is also a short distance away, take the slow boat from China to carry out what their employed to do leaving cubicles unnecessarily occupied and corridors jammed with those who require admittance, leaving other unfortunate patients in the waiting room outside who require attention waiting for hours for space to be made available so that a doctor or nurse can see to their needs.

    This is a combination of problems and staff shortage is the main factor but also ensuring those who are employed understand their job description and carry out those duties in a speedy but safe manner.

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  13. Turgon (profile) says:

    hfmccloy,
    Re meningitis and vaccines you are simply incorrect. It is antibiotics for acute infections. You are simply wrong.

    Re clot busters it is the same. The current international guidelines from European Society of Cardiology and American Heart Association / American College of Cardiology advocate primary PCI not thrombolysis if drive times are acceptable. For example in Denmark they use a three hour drive time cut off.

    I have worked in the Mid Ulster before it closed and am well aware that it did not have an ICU by the modern definition of the term. Again you are simply incorrect.

    The statistics on maternal mortality favour larger centres. It is not as marked as one would expect because the small centres only take low risk patients and as such the smaller centres are falsely flattered.

    I am not a fan of anecodate based argument or medicine but I have experience of my wife having a placental abruption and needing an emergency Csearian section. Had she been in a small hospital she might well not have had that straight away. She would then be dead as would my son.

    You keep pointing to Birmingham. However, Cumbria, the South West, parts of Yorkshire are all more rural than Northern Ireland with bigger distances on poorer roads yet they have smaller numbers of larger hospitals because it is safer. The same goes even more so for Wales where there are no dual carriageways outside the northern and southern costal strips. Mid Wales is much more remote than Northern Ireland. Northern Scotland and the borders even more so. Then if one moves the argument to the likes of Canada the parochiality of your thinking become blindingly obvious.

    tacapall,
    You are again confusing the issue of waiting to be seen initially in A+E (an A+E problem) with the wait after having been seen to be admitted – a different problem.

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  14. hfmccloy (profile) says:

    Prove your stats to back your article, I have already submitted to givernment and reviews figures that state otherwose,

    now i know you will try hold onto some hope as you wrote this nonsense , as a long term worker formt he Mid Ulster you will know Dr Hunter and you will know that the MId had all these services as I stated, and backed by his knowelgde what I say is said to be true, consultant v blogger i will trust the consultant.

    Your facts on maternity where are they? I have again alrady submitted these to government.

    Mid Ulster agian before being run down was one of the only consultant led maternities where consultants delivered babies, safe? you decide

    NISAR facts prove mortality and other esearch documents from charites prove morbidity,

    Next time you blog propaganda try researching your own article instead of stealing other news from UTV

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  15. Crubeen (profile) says:

    Turgon,

    There’s no shortage of beds but there’s an acute shortage of staff … apart from management- those whose function is to abuse and massage statistics to prove that there is no problem at all in the NHS that cannot be cured by pouring more money into management.

    A few weeks ago, on a Friday night, my daughter (who is chronically epileptic and profoundly learning disabled) suffered a seizure of a type we have not seen before and was taken by ambulance to AAH. A&E was bunged to the gills and out again – far too small for what it is asked to do. For the first time ever, A&E could not allocate any place for her and, as she came out of seizure she became more and more agitated and was detaining an ambulance crew who could and should have able to have been away on another call.

    Fortunately we were able to get her onto the ward quickly where she settled (though suffered another seizure later). She was discharged on Saturday morning by a Consultant in the course of his full ward round. If the staff are there, whether in A&E or on the ward (and there is no acceptable reason they should not be there) patient throughput and turnaround can be achieved. It is preferable that our “wee un” be cared for at home – indeed we have taken her home on occasion where the ward staff were more than willing to keep her for a further period. Nobody ties up beds other than poor hospital management.

    The fundamental problem with healthcare is that it has lost its way and forgotten its purpose. GP practices are not concerned with health – they are profit centres where treatment is driven by extra payments for target achievement than the best interests principle. Indeed GPs are no more than licensed drug peddlers and good health and drugs are not compatible.

    One solution would be to turn all A&E units into minor injury units and then have Major Trauma Units – admission primarily by ambulance. Joe Public, with his broken wrist or drink induced muddle would avoid Major Trauma Units lie the plague and they could do their job without hindrance. A&E units could then stream their admissions into those who have genuine complaints and those who are self injured i.e the drunks and hypochondriacs. The former are treated expeditiously and the latter simply observed until such time as they sober up and either go home or are capable of being treated.

    We need to fashion A&E services in the way the military deal with their casualties on the battlefield – paramedics at the front line to stabilise and triage with casualties then directed, on merit, to the appropriate next stage of treatment – the aid station or full hospital.

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  16. Turgon (profile) says:

    “consultant v blogger i will trust the consultant.”

    Well in this case that would be a mistake. If you doubt me ask Mick.

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  17. hfmccloy (profile) says:

    Yes trust a consultant with years experience and was the thread that kept services, backed with the local gp’s and other consultants in the hospital v you , I know where my trust lays.

    Trust the facts that are already submitted to government proving increase mortality, morbitiy, infant death and still births v you, again I knwo where my trust lays

    Trust ambulance serivce staff who know they cant administer life saving medical services, bit of a patternern emerging here,

    Trust new pathways into a crowed room and minor injuries that has proven to be a risk and failure in the northern trust.

    Life exists outside of Belfast and lesson are not being learned, send a grave digger to dig a grave with a spoon or a shovel he aint going to care as long as he gets paid, and thats the problem with health

    you never said how far from an acute A&E do you live?

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  18. Zig70 (profile) says:

    I’d front up GP’s with nurses for minor ailments. GP’s themselves seem to rarely make an actual diagnosis and refer any technical issue. Millions of GP visits every year and most with ailments the chemist could deal with. Nurses these days have degrees and we should respect their abilities. The south’s tactic of charging for GP visit seems to make people think twice before heading off with a blocked nose. The GP’s would also benefit from more diagnostic abilities, a small ultrasound machine would have saved my recent trip to A&E.
    I think acute and minor injuries should be seperated.
    I’d put hospital doctors on 24/7 and run units similar to any high asset manufacturing business would be run. A few lean manufacturing consulants would have a field day in the nhs.
    I’d also be in favour of a seperate minor injuries unit for people who have been drinking (city centre?).
    For a tangent, I’d also introduce a sugar tax until chocolate bars are considerably more expensive than natural food and should help our local farmers. baked spuds all round

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  19. In the way that life with children and grandchildren is unpredictable….my 4 year old grandson (plus his mother, uncle, aunt and myself) spent the night at the local A&E.

    Indeed all night. We arrived about 11.10pm last night and we dropped mother and toddler off at their home just before 8am today. Roughly eight and a half hours at A&E.

    The child was sick. And had a rash. The Out of Hours doctor (on phone) told us to bring the child directly to A&E and to phone A&E with the details.
    A&E was of course crowded (many young children already there) including a baby two months old.
    After 50 minutes (ie midnight) the child had not seen a Triage nurse. But when my daughter in law pointed this out, all the children (at that stage about six of them) were brought thru to the treatment area.
    They were all in a more “secure” and comfortable waiting area. At various stages we had access to them……..but it was after 4am…..ie about five hours before any of the children was actually seen by a doctor.
    At that stage only four children were there.
    One mother had already brought her child home. The parents of the newborn had driven about 20 miles ……as had the mother of a girl about 7 years old. We were “local”.

    It was of course Friday night. And in fairness a busy one. Several police crews, seemingly a bad night on the roads. One injured man in handcuffs and a few drunks in different degrees of aggressiveness.
    On reflection the staff had a default……..siege mentality.Defensive. No communication. Avoid eye contact.
    In part that was the biggest problem. Conversation with others in the waiting area was about how bad the NHS had become, this hospital in particular and how things would be different if a politician (ANY politician) brought his/her child into A&E.
    As the night wore on anger and frustration gave way to a certain relief that we were not part of the steady stream of relatives seemingly going into another part of A &E. It looked like some people were having a worse night than we were.
    In the nature of this, children slept, mothers chatted…..children woke up (still unseen by a doctor) and were surprisingly energetic and thankfully “better”.
    The baby was actually brought up to a ward. The little girl sent home with steroids for a chest infection. The diagnosis for our guy fluctuated from tonsilitis to chicken pox…….and ended up with a “non specific viral condition” and advice to bring him back if the parents are worried. And the additional information that children get an average of seven to ten such infections a year.
    So sometime around 7.30am we were going home……and predictably my grandson wanted to stay and play with the toys.

    Probably a bad night all round. The anger and mumbled threats to each other “I am going to complain about this……” gives way to a certain relief that it was not as bad as it could have been, an anger about the drunks and admiration for the long suffering PSNI crews who came and went. Probably about fifteen police officers (some of course hardly more than kids themselves) were in and out of that A&E during the night. It all has a knock on effect. And of course a large degree of admiration for the hospital staff.
    But really the best and worst of humanity walked into A&E last night. And the best (the parents of sick children) and worst of humanity the selfish brutish drunks) is a genuinely cross community experience. Perhaps the only thing we really share.

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  20. Mr Ulster (profile) says:

    My wife is currently in the Neurosciences ward, about to be referred to Musgrave, but two weeks on we are still waiting God-only-knows how long for a requisite PEG surgery, which I have been told will happen on a Thursday (which Thursday this year they cannot say). I am discovering firsthand the insane economics of the current system of managing investigations and treatments (i.e. Monday-Friday, 9-to-5). I am preparing to escalate this situation.

    BTW the quality of treatment by A&E, doctors, nurses and consultants has been top class. It’s some scheduling manager whose neck I’m after.

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  21. Turgon (profile) says:

    Mr. Ulster,
    I am sorry for your problems.

    It is unlikely to be any one person’s fault. The simple fact is that your wife’s problem demonstrates the foolishness of the current system. We simply do not have enough people doing specialist procedures such as she needs. That means that patients sit about waiting, taking up beds, getting no better, costing money.

    The solution is to have more procedures and more things done. The way to pay for that is to have less small hospitals capable of very little save keeping patients till they are moved for the procedure. It may even be having less beds but getting people through the system at a sensible speed. This is what patients, staff and relatives all want. The problem is every time anyone proposes rationalisation of how we do things one has shroud waving and complaints that whichever small hospital must be kept open come what may.

    I hope all goes well for you and her.

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  22. dwatch (profile) says:

    “BTW the quality of treatment by A&E, doctors, nurses and consultants has been top class.”

    Here here, couldn’t agree more. But this problem is only going to get worse as long as Edwin Poots is at the Ministry of Health helm playing politics to promote the DUP’s MLA’s & MP in North Belfast at the next elections.

    The Mater ( over 100 year old hospital) should never have been allowed to keep its A & E open in favour of the City ( a more modern hospital only opened in 1986.

    Ironically its the Royal which has become a patient bottleneck instead of the Mater. Seems to me its obvious citizens seeking emergency medical attention are all flocking to the Royal and refusing to attend the Mater. So why is this happening, anyone on slugger know why?

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  23. Comrade Stalin (profile) says:

    The thought of having to sit in an A&E on a weekend with drunks everywhere is horrifying (more so if a small child is involved) and it’s the sort of thing that creates sympathy for some of the government’s efforts to try to curb binge drinking.

    It also makes a person very angry to hear that senior doctors and consultants are insisting that they work regular office hours. These people are paid stupendous amounts of money; I don’t have a problem with that but surely it is reasonable to expect that they lift their end of the log once in a while. It feels like a pattern has been emerging over the past decade or so where the government routinely agree to massive hikes in payments for doctors, dentists, consultants and so on and yet get very little back in return.

    dwatch:

    Here here, couldn’t agree more. But this problem is only going to get worse as long as Edwin Poots is at the Ministry of Health helm playing politics to promote the DUP’s MLA’s & MP in North Belfast at the next elections.

    The Mater ( over 100 year old hospital) should never have been allowed to keep its A & E open in favour of the City ( a more modern hospital only opened in 1986.

    I’m not sure that this the case. If Poots were to choose to close the Mater A&E it’s hard to see where the political fallout would come from. SF can’t protest as they proposed the same thing when their current MEP proposed the closure of the Mater A&E, back about ten years ago. The UUP barely exist at council level in North Belfast anymore, never mind regional or Westminster level.

    What do you think?
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