A&E needs emergency care itself

We had some biscuits but the 93-year-old in the wheelchair couldn’t face them during our night together in accident and emergency. When I arrived after 7pm that August evening at the NHS hospital on the East Anglian coast, there were nearly 70 of us waiting to be seen — a mix of farm and campsite injuries and the clearly sick or mentally distressed.

By midnight our number had dropped below 50, but it was still taking four hours even for assessment by the triage nurse. When at last I made it through what the crowd of patients had dubbed “the magic door” she advised me that, given the pressures on the department and lack of staff, the wait for a doctor would probably be as long or longer. Usually, she added, they would aim to triage within 15 minutes and then strictly prioritise by need.

As I was not in danger (a regular injection had produced profuse bleeding), the nurse made it subtly clear it was up to me whether to stick it out or come back the next day.

After a while, I went home, but not before a group of us had approached the efficient but overwhelmed nurse in charge, appealing on behalf of the elderly lady, still chatty but exhausted and in pain from a wound to her arm. She was taken to the toilet and then, after a further wait, for triage and treatment.

These stories have been all too common this summer. Launching her “plan for patients” in the House of Commons last week, even Thérèse Coffey, the new health secretary, added her own: a near-nine-hour wait, with no access to a doctor, a few weeks before mine. She also gave up and left but was seen swiftly the next day at a hospital three miles away.

Given that I was a visitor to Coffey’s beautiful Suffolk Coastal constituency, we might well have sat on the same plastic chair and bought snacks from the same machine.

On that hot night, eight ambulances were waiting outside, unable to offload because there was no way of clearing the patients from A&E on to wards or back home for follow-up care. This is a typical bottleneck across the system: one in seven patients no longer needs the bed they are occupying. Coffey last Thursday announced a £500mn “downpayment in the rebalancing of funding” for health and social care to tackle delayed discharges over the winter. She talked of spreading best practice, clearly puzzled by the variation in waiting times and outcomes.

Labour’s response to Coffey’s story was to accuse her of telling patients to “get on their bike” and shop around — but often NHS staff themselves hint that it’s better to do so.

A work contact of mine found one local A&E was improvising. Her elderly mother was treated in an ambulance: hospital staff were using the queue of vehicles as temporary beds to speed things up.

The hospital I attended was clean and modern, the patients were (mostly) patient and the triage guidelines were followed — the lack of exception made for the very old is standard, apparently. Conspicuously ill people were hurried through, one suffering fits, another with all the signs of a heart problem. It was dreadful yet seemed to work as a way to ration access to treatment.

But the staff were on edge: the senior nurse repeatedly apologised to the room and one of her colleagues was offended when, in a spirit of camaraderie not mockery, we applauded as the elderly lady was finally taken through. Patients were warned this behaviour risked ejection: the brief moment of cheer subsided.

This site is undergoing a massive rebuilding, due to culminate in a new hospital for the area by 2030. But there weren’t enough staff to man the one we were in. Coffey says an NHS staff plan is a work in progress. Without it, critics claim her ideas for improving patient care are unworkable. The Homecare Association, which represents domiciliary care providers, said the cash to speed discharge was welcome but had to be part of a long-term plan to address worker shortages.

Feelings of pride in the British talent for queueing resurfaced this month at the Queen’s lying-in-state. But when you’re anxious and need help, it’s a desperate expression of what’s wrong, not right, with the country you live in.

miranda.green@ft.com