Last Friday night, a young man walked into my A&E department, mid-hallucination, and started to lash out at a crowd of patients. After being wrestled to the ground by my specialist clinical colleagues and security staff, it didn’t take long to ascertain the problem: he was suffering from long-standing mental health issues exacerbated by serious alcohol and drug abuse.
None of this was particularly shocking. It was hardly the first time a mentally ill patient had attacked another on our watch; nor was the trigger of his psychosis anything but expected.
More surprising (and troubling), however, was the scene I witnessed when I returned to work on Monday morning: the patient was still there, standing in my ward, cursing staff and patients alike. When I asked one of the nurses why nobody had staged an intervention, she explained that the psychiatry team were still assessing his condition, and whether he should be sectioned. And as a result, he had spent two and a half days on the ward causing mayhem.
Eventually, the police carted off the young man to be processed through the criminal justice system. But we’re under no illusion that this will cure him. No doubt he’ll return to us soon: yet another reminder that Britain’s A&E departments are reaping the whirlwind of a disintegrated heath, social care and psychiatric system that lacks joined-up thinking, let alone joined-up action.
Only the week before, I was confronted with the case of an 86-year-old woman who presented with a fracture following a fall at home. Despite her injuries, and being shaken up by the accident, she was as bright as a button. But as her octogenarian husband has dementia, and she is his primary carer, due to safeguarding issues he had to accompany her in the same ambulance to A&E — only to find that there was no room in the emergency department for either of them. They were both left in limbo in a corridor for hours while multiple members of staff and assorted agencies tried to figure out what to do with them. Eventually, they were wheeled into another corridor. Out of sight, and out of mind.
Both cases are typical of people forced to survive on society’s fringes. Whether it’s through deep-seated mental health issues or a debilitating condition such as Alzheimer’s, if you find yourself in a crisis with nowhere else to turn, chances are you’ll wind up in A&E — along with the hundreds of other people. The patients I see often don’t have the money to pay for a carer or book into a hotel for a few nights, or family they can lean on in times of need. They have no one, except for us.
For the most part, these people have paid into a system through progressive taxation and National Health contributions — just like the rest of us. But do they get value for money? Or do they end up on a trolley in a crowded corridor until they die from neglect? This is, after all, exactly what happened to 39-year-old Inga Rublite, who was found unconscious, lying under her coat, slumped in a waiting room at the Queen’s Medical Centre (QMC) in Nottingham in January. She died days later of a brain aneurysm.
As Britain’s new health secretary, and as someone who has experienced this A&E anarchy first-hand, one would expect Wes Streeting to make fixing it a priority. In 2021, after being admitted to the A&E department at his local hospital, the King George in Essex, with a kidney stone, a scan revealed a cancerous growth on the same kidney, which was soon removed. “That A&E found my kidney cancer and our NHS saved my life,” he reiterated a few weeks before this year’s election. “Now I’m determined to save our NHS.”
But will he? Put to one side yesterday’s announcement that Labour might scrap the Conservatives’ plan to build or expand 40 NHS hospitals by 2030, how is Streeting faring?
Along with Queen’s Hospital, Romford — which, as the MP for Ilford North, is also on Streeting’s local patch — the King George is run by Barking, Havering, Redbridge University Hospitals Trust (BHRUT). In May, it came out of “financial special measures” after failing to pay suppliers on time, though it recently declared an “internal critical incident” due to an evaporation of bed spaces. Only last week, the trust came under fire for seeing a fivefold increase in patient complaints; a few days earlier, a BBC news crew filmed 17 patients from Queen’s being treated on beds in corridors, a situation the emergency department’s director of nursing called “customary practice”.
Perhaps understandably, BHRUT is seeking £35 million from the Government for an A&E rebuild. As the trust’s chief executive, Matthew Trainer says: “The A&E at Queen’s was built for 300 people a day. In March, the average daily attendance was more than 600.”
Now, given Streeting’s local connection to the trust, as well as his very slender electoral majority, I wouldn’t be surprised if he finds the cash for the BHRUT. But will other nearby A&Es be so lucky? There are, after all, at least six major hospitals in the Essex and northeast London catchment area surrounding his seat, all of which have high levels of deprivation, demographic change and patient acuity — a combustible mix when it comes to accessing health and social care resources. Just yesterday, it was reported that the BHRUT had the worst A&E waiting times in the UK, with a third of patients having to wait more than 12 hours.
None of this is to say that Streeting doesn’t feel passionately about the NHS, or that doctors aren’t rooting for him. Following a succession of careerist Tory health ministers, many of my colleagues feel reassured that we finally have a health secretary who seems willing to listen to our concerns. But even so, Streeting has a mammoth task ahead of him.
Indeed, look at where the money has been spent in recent months, and it becomes clear that this isn’t a question of competence or commitment — but of whether, given its profligacy, the NHS can be saved at all. A number of integrated care systems have been ordered to hire cost-cutting management consultants, with immediate effect, due to concerns over finances, while earlier this year, NHS England awarded £40 million to a consultancy firm to advise on “strategic and productivity matters”.
Both these developments might seem perfectly reasonable, especially since roughly three-quarters of England’s 42 integrated care systems have been unable to set balanced budgets for 2024-25. But we shouldn’t forget that these proposals are being administered by the same NHS England that has repeatedly thrown money at the very same problem — only to watch it go to waste.
Last year, in an effort to improve patient care and data efficiency, NHS England handed a staggering £330 million IT contract — the biggest in its history — to Palantir, an American spy-tech company. Palantir’s connections to the CIA and Ministry of Defence sparked concerns among campaigners about data privacy, but less discussed was the financial risk. Few senior doctors have forgotten the National Programme for IT in the NHS, which was launched in 2002 and supposed to improve services and patient care. It would have been the biggest non-military IT system in the world — but was eventually abandoned after costing more than £10 billion of taxpayer money. (The initial projection was £2.3 billion over three years.)
And yet, debates over the state of the NHS — and A&E in particular — are suffused with collective amnesia, with few willing to say that the honest thing: that the best Streeting can hope for is that Labour is able to secure a second term, beyond which point its reforms might actually take effect. But as things stand, Britain’s A&E departments embody everything that is wrong within the healthcare system, from social care to psychiatric support.
True, Streeting has taken the radical step of effectively dumping the Care Quality Commission, one of New Labour’s last innovations, which was long overdue. On the wards, it’s generally accepted that, as a regulator, it’s been hopeless. Several hospitals haven’t been inspected for years, including one which was last reviewed a decade ago.
But simply shutting down an ineffective regulator and hiring expensive consultants to tell us what we already know isn’t “reform”. It’s not even a sticking plaster. Every week, I see patients presenting with medical conditions ordinarily not seen in this hemisphere or century because they’re not being treated until it’s almost too late. They are the broken Britons of broken Britain — and I’m no longer convinced we’ll be able to save them.
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Source: UnHerd Read the original article here: https://unherd.com/