/ Health

Are we putting unnecessary strain on A&E?

Emergency sign

When was the last time you went to A&E? Did you consider an alternative, like a pharmacy or a walk-in clinic? A new report says 1.5 million people are visiting A&E unnecessarily, but do we really have a choice?

I went to A&E about two months ago after concussing myself. Thankfully there was nothing seriously wrong, but with a head injury I like (well, maybe not like) to err on the side of caution.

And after four-hours of waiting around on a Saturday night, I’m not keen to go again. After being checked over by a doctor to ensure there was no seriously damage, I left with advice rather than treatment.

Why do we go to A&E?

According to research by Co-operative, 1.5 million people are visiting A&E ‘unnecessarily’ because their consultation only ended in advice or guidance. There’s nothing wrong with advice or guidance – in many cases this is the best response to an illness or injury.

But not all minor complaints can be diagnosed without specialist skills or equipment. Take a sprained ankle for example. Without an x-ray it’s very hard to tell the difference between a sprain and a close fracture (one that doesn’t have bone poking through it).

Going to a GP or a walk-in centre is all very well, but you’re likely to be referred on to A&E for an x-ray. And with a potentially fractured ankle, the last thing you want to do is stagger to A&E and join another lengthy queue when you’re in a lot of pain.

I also wonder about who went to A&E with ‘sprained muscles, stomach aches, minor burns and fevers’. How many of them were parents with children? I’m not a parent, but I know I wouldn’t be hanging about waiting to see my GP if I suspected my child’s high fever was meningitis.

A&E – what’s the alternative?

It’s better to be safe than sorry. And I don’t think that means we’re abusing the system or wasting A&E staff’s time. Most of us aren’t medical experts, and even if we have some knowledge of first aid, it’s just that – first aid.

And, as we highlighted in a previous Conversation, a lot of people head to A&E because they’re not conveniently ill during doctor surgery hours. Without an accessible alternative like a walk-in centre or polyclinic, there’s often little alternative.

While I agree with the report’s recommendation that some minor issues can be dealt with by your local pharmacist, they can’t prescribe medication like strong painkillers or antibiotics, so in some cases they’re not the most appropriate destination. They’re generally not open 24/7 anyway.

Untlimately, there will always be people who go to A&E for ‘minor’ issues, leaving with ‘just advice’. It may not be perfect, but until people are better educated about the alternatives (and the NHS is making a good start with its Choose Well initiative) we’re not going to see much of a change to the numbers quoted in this research.

Comments
Profile photo of dean
Member

Interesting topic, I think it’s worth having a credible out-of-hours alternative before we see much of a change, like you said.

I think though that there are many people who actually don’t go to A+E when they really should, due to the massive amount of waiting time, perhaps it’s evened out, although figures would never be able to prove that.

Because it’s a public service that we pay for through our taxes, I think people genuinely feel that they have the right to visit A+E when they think they have a serious problem. Whether the problem is serious or not is irrelevant in my view, if there is no-one else to consult during this time, then I don’t see any other option.

If private healthcare was mandatory for those earning above a certain threshold (public for those below), things would definitely change. In Germany, I earned above the threshold and paid about 300Euros into a healthcare system every month. Sounds expensive? well, check the benefits:

I was passenger in an accident on the Nuerburgring Nordschleife (60mph backwards into the armco) and I split my head open, had concussion etc. When the ambulance appeared on the track they asked me if I had German insurance, I replied “yes” and I was sped down to the hospital in Adenau (a bit too quickly) where in 15 minutes flat, I was registered, assessed, x-rayed, hair shaved, 4 stitches and a tetanus shot administered.

No issues of “is it necessary?” , “am I wasting the precious time of the A+E?” etc etc.

So in both countries, if you pay for it, you deserve to get the service. Yes you can choose to pay for private health care here, but that is on top of taxes, rather than instead of them.

Member
Sophie Gilbert says:
21 July 2011

I heard a very sad story last night on Radio 4’s Panorama about a family who lost a boy to meningitis because he was “treated” by a GP and not by an A&E specialist. My heart goes out to them.

Too right, we’re not medical experts! How are we expected to triage ourselves? And the choices are sometimes too confusing. Let’s have more, streamlined, one-size-fits-all centres, and once there we can be sorted out by the experts and treated accordingly, not be moved on, or back and forth, to the next facility, by which time it is too late for some of us!

Member
Helen says:
22 July 2011

I’m a nurse and have used the Minor injuries unit twice for what was a “minor injury” it doesn’t take an einstein to know what is minor and what is an “emergency”. On both occasions I never told them I was a nurse and still got fantastic service with very little time spent in the waiting room and a diagnosis with antibiotics within one hour of getting to the unit.
Too many people are using the A&E departments for the wrong reasons causing those who really need the service waiting around for hours. However, if in doubt then going to the A&E unit is vital, better to be safe than sorry. Anything other, sprains cuts etc can certainly be seen at the minor injuries unit.

Member
trachet says:
23 July 2011

Last year I had a nasty chest infection, antibiotics hadn’t helped so the doctor put me on to steroids as I am asthmatic. Unfortunately they made me ill and on a Saturday evening I thought I would pop along to my local treatment centre. I was aware of people wasting doctors time in A&E so I felt my ‘minor’ problem of D&V wasn’t worthy of a hospital visit. Firstly they had a go at me as it is a nurse – led centre & they can’t prescribe. Secondly they called for an ambulance to take me to hospital where I was admitted for three days. If I am in a similar situation I will go straight to hospital as the walk in centre is not really any use.

Profile photo of Jo Gibney
Member

Thanks for your comments.

Helen I do agree with you. I think the problem often arises when there are no minor injuries centres… or they’re not well advertised. Living in London there are more, but the location and convenience doesn’t always make them easy to access. My local hospital used to have one as part of the A&E – I only discovered it no was longer there when I went for antibiotics one weekend (couldn’t get a same-day appointment with my GP and had a nasty dose of sinusitis – my third that winter). The nearest minors is now at least a 3 bus-ride journey away (we don’t have a car and it’s not near a tube). However, the A&E does now have the GP out of hours based there (again, only found this out when in A&E).

In more rural areas, such as where my parents live, it’s even more tricky, as they don’t have minor injuries units for out of hours, and the nearest hospital is 10 miles away.

Obviously we can’t have a hospital or minor injuiries unit on every street corner. Perhaps there should be more minor injuires units based at hospitals so people can be directed to the right treatment through a central reception (which is what my local hospital used to do). Then people get the right service from a central place. If they’re going to go anyway, might as well take advantage of that fact.

I also think there’s a place for educating people better how to treat minor injuries and illnesses themselves. But that’s a whole new Conversation!

Member
Sally says:
10 August 2011

What do you do when the facilities are just not available? I’ve moved from a city with an A+E,walk in centres and a minor injuries unit to a town with only an A+E. It narrows down your options. It feels like the NHS website is guilting me not to visit the A+E with my burn which does require medical attention but isn’t severe. But the alternative options are to wait a week for a GP appointment or get a bus 17 miles to the nearest minor injuries, neither of which are appealing.

Profile photo of Jo Gibney
Member

Sally, having grown up in a rural area I appreciate your situation. I’m not sure what the answer is though.

Interestingly I spotted today on the BBC website that Department of Health figures show the number of people waiting more than 4 hours at A&E has almost doubled in one year – from over 86,000 to over 165,000. However the percentage has actually decreased, showing that more people are visiting A&E. This is still above the target time of 95%.

http://www.bbc.co.uk/news/health-14508678

Profile photo of Jo Gibney
Member

I see this is back in the news again, with an article on Friday in the Guardian reporting on Department of Health data showing one in 13 people return to A&E within a week.

http://www.guardian.co.uk/politics/2011/aug/26/patients-returning-emergency-departments

Profile photo of julieshrive
Member

I went to the Royal Free with severe acute back pain & stiffness that goes in 24 hrs when uti medication upped & paramol kicks in .I am single on my own .There was no wheelchair or trauma unit just what appeared to be GPs not doing testing . Good job not a child with meningitus. I I have had 4 episodes of this yet Camidoc & GPs not researching neither is my cardiologist or urologist appropriately” as not their remit ” & tier one hospital .
As I have spina bifida occulta ignored by NHS [ returned the research notes from Royal Free- legal ? ] in 10% of population going round in circles, is it any wonder.I had research in late 60’s to prevent me being made to wait in walk in clinic & AE every 3 weeks for 5 hrs [ punishment ] . Thatcher directed the non prescription of antibiotics which caused permanent flu like symptons & boils I lost my monitoring appts at 5 hospitals consequently had cardiac arrest 6 years ago never having seen a cardiologist when informed of symptons by a specialist & private test 2 years prior .
While NHS neglects all conditions it can’t cure such as Alzheimers is it suprising people turn to A&E . If you have multi or rare conditions you are rationed or not diagnosed . Why don’t the Doctors think of getting to root causes.Are admin restricting? Health is not an exact science. Doctors should not be working in 2 systems contracted in ignoring medical oaths as a result.I now have been referred to rheumatology via choose & Book for one appt ? when probably ischemic kidney, neuropathy? Anyhow having to get Harley Street to check not abused by the system.

Profile photo of EmmaC
Member

Once I sprained my ankle . My parents are nurses so they checked me over at home . Of course they knew about overcrowded a and e so they didn’t send me to hospital because I would have to wait a long time .Im not sure this was right because every so often I get the pain in my ankle again and I can’t walk on it.

Profile photo of duncan lucas
Member

Emma -as I am sure your parents ,being nurses , have told you a sprain takes a while to heal but after several months ,if you are still suffering it could be ligament damage .