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3 January 2019 0 Comments
Posted in Medical Negligence

The growing pressures and strains on our A&E departments: what can NHS Trusts do and what responsibilities do patients have?

Author headshot image Posted by , Paralegal

With increasing pressure on A&E departments across the country, Stephanie Maggs from our medical negligence team asks: what can hospitals and patients do to try and reduce the strain?

NHS England’s research shows that between 1.5 and 3 million people who attend A&E each year could have their needs addressed by other medical areas of support within our care system, including GPs, ‘111’ and pharmacists. This is only one pressure on A&E departments and by all means not the only factor causing the ever increasing strain.

Some action has already been taken by Trusts to guide patients to help towards reducing this strain. But what happens when A&E staff members overstate waiting times without fully understanding a patient’s needs and these patients go home thinking that they are doing the right thing?

Action taken by Trusts and patient responsibility

According to Parliament, in 2017 16.2% of people spent more than 4 hours in major A&E departments. This has risen from 4.8% of people which was recorded 5 years previously.

Arguably, one small contribution for this rise in waiting times, and increased strain on A&E departments, is the failure of patients to attend the correct area of medical support within our care system which is applicable to their individual needs at that time. For instance, there are statistics to show that increasingly, patients are attending A&E departments for infections and common cold or flu like symptoms. It is recognised that these ailments may be better treated by a GP or local pharmacy in the first instance, rather than being addressed by A&E departments initially.

Trusts have rolled out various campaigns and website guidance to help patients to understand the severity of their condition and choose which service would be best to approach in the first instance. For example, The Royal Free London NHS Foundation Trust has reference to a ‘stay well this winter’ campaign on their website which provides guidance for patients to understand whether the A&E department is right for them. Furthermore, other Trusts such as the Humber Teaching NHS Foundation Trust, has a ‘choose well’ service chart to outline which areas of support within our care system to approach, depending on your condition.

Therefore, patients have some degree of responsibility to ensure that our NHS can operate as efficiently as it can to reduce waiting times. Whilst this may make a small impact, ultimately, there are other factors which play a part in delays and pressures on the NHS, such as resources and staff shortages, amongst many more.

What happens when A&E staff members overstate waiting times?

In the recent case of Darnley v Croydon Health Services NHS Trust, the responsibility and duty of care of an A&E receptionist was considered. In this case, the receptionist overstated the waiting time for a patient and the patient decided to go home, relying on the information given by the receptionist, on the understanding that there would be a wait of up to 4-5 hours. It later transpired that the patient’s condition was very serious and he had required the urgent attention of a doctor at that time, but instead, was lead to believe that he could go home due to waiting times. Had he waited, it was  likely that he would have been seen in 30 minutes, given the symptoms he was presenting. Rather, he went home, suffered distress, required the assistance of an ambulance and was taken to hospital for emergency surgery to treat pressure on his brain but suffered a severe left hemiplegia (paralysis on one side of the body), resulting in permanent brain damage and leaving him disabled. The patient brought a clinical negligence claim and the Supreme Court ruled that the receptionist owed the patient a duty of care, even though she was not medically trained.

This case highlights the seriousness of understanding the priority of patients’ needs whilst also managing waiting times, in accordance with those who are meant to be within A&E and those who could reasonably be treated elsewhere. It is the responsibility of all members of staff (medically trained or not) within A&E to ensure that their actions do not adversely impact upon the treatment of patients.

The rise in waiting times within A&E departments is one of the main reasons why patients complain. In some instances delays can severely impact upon a patient’s prognosis and available treatment options. In these instances, a patient may potentially have rise to bring a claim in clinical negligence for the delay in being treated.

Whilst it is important for patients to recognise when (perhaps) the A&E department is not the most appropriate place to visit in the first instance, it is equally important for A&E staff to understand when someone is in the right place and how quickly they should be seen given the severity of their symptoms. It is therefore encouraging that Trusts have their own individual ways of informing potential patients of what options they have, either online or in the hospitals themselves, but perhaps it’s time for the government to put more of an effort into helping people understand – perhaps through TV campaigns or by updating GP holding messages to avoid mention of 999 as a next option – rather than letting them know when they’re potentially already in A&E?

We hope that this case will ensure that patients are assessed efficiently and that lessons are learnt from it.

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