Television dramas, such as Casualty or Grey’s Anatomy, distort our perception about what a visit to our local A&E is all about.
We imagine packed units, filled with people suffering from life threatening illnesses (incurred in the most traumatic of circumstances). These patients are tended to by high skilled, busy, attractive professionals who, despite battling to save often hundreds of lives, still find time to have tempestuous affairs with each other. What is also striking about the A&Es our television tells us about, is quite how well staffed they are. There is always an expert on hand.
Yet, as I blogged recently, the reality is more prosaic, and actually more frightening. Far from being packed out with people with life-threatening injuries, many A&Es are pretty desolate places most nights. They don’t see enough patients to be the specialists featured on television.
Today’s Dr Foster Good Hospital Guide reveals the other side of the story. There may not be many patients in some of these A&Es, but there also aren’t many consultants. In fact, in over 30% of hospitals, there are no consultants on duty in the A&E overnight. This is concerning, as more senior doctors (defined as being either a consultant or a senior registrar) on duty is associated with lower mortality rates. Poor staffing in so-called A&Es is probably resulting in unnecessary deaths.
It is therefore fair to conclude that, a sizeable minority of A&Es fail the television definition of what constitutes a casualty unit. They neither have enough patients, nor enough staff. This definition matters because it is the definition the public will use when assessing any proposals to close or downgrade A&E services. At these hospitals, the A&E signs should be taken down.
The Dr Foster findings are particularly disturbing because, of the ten hospitals with the lowest levels of senior staffing at the weekend, eight of them had a nearby A&E with a higher level of senior staffing. Given the outcomes impact of low levels of senior staffing, surely patients should be directed to these A&Es instead?
The Department of Health needs to come clean about this. The Secretary of State has said that his reforms are all about improving outcomes, but a situation is being tolerated which appears to have a significant negative impact on outcomes. It is being tolerated because public perceptions about A&Es do not match the reality. The first step to changing this is to set out clearly what services are available at every A&E, how many patients it sees, as well as how many senior doctors are on duty at any one time (perhaps this should be displayed in the reception at every A&E). The Department of Health then needs to explain the implications of this. Too many casualties are an accident waiting to happen.