FEATURE - Behind the scenes at A&E
There are four people sitting in the waiting room - it's 8.45pm on a Friday night and it's quiet, not that you mention the '˜Q-word'.
It’s the night after the staff in the Accident and Emergency department at Chesterfield Royal Hospital have dealt with a serious bus crash in the town, injuring seven.
The department has also been inundated dealing with seasonal flu for the past three weeks - not helped by the mild weather. It has been stretched to the limits, and a quiet night wouldn’t go amiss.
I’m escorted through to the central corridor - containing treatment rooms and the main nurses’ station.
You only see this area of the department if you are seriously unwell, if there is a good chance you are doing to need transferring onto a ward.
Minor injuries and ailments are treated in separate cubicles out front.
The corridor is empty, but the nurses’ station is a hive of activity. Most of the treatment rooms are occupied.
All patients currently being treated are listed on a computer screen - the top four are flagged up in red, meaning their four-hour waiting limit is closing in.
Since midnight the department has seen 193 people. The four-hour target has been breached a total of 18 times.
They are operating at around 90 per cent efficiency, another monitor on the wall tells us.
Sister in charge Laura Wilson tells me there are currently seven nurses working on the department and three healthcare assistants.
There are six doctors on shift plus one A&E consultant, Dave Prosser.
But by 2am doctor numbers will be down to just two.
Dave Prosser is officially on until 10pm, although she expects him to still be around by the early hours of the morning.
Laura says: “It’s difficult at nights as they can be as busy as the days but with fewer doctors available. The consultant is on call through the night and he can be called back at any time.
“We have an escalation system for serious incidents but it can be extremely difficult to escalate if you don’t have the resources available to you. It can be difficult to cope, but we manage.
“A lot of my focus is about meeting the targets - that’s always on my mind when I’m here, but at the same time you are also aware that you might be dealing with a child or an old person and you don’t want to keep them waiting on a trolley.
“The social scene has changed as well - we used to get all the alcohol-related cases coming in on a Friday and Saturday evenings, but with all-day drinking you can get them in at any time now.
“We get our regulars - the place can be full and all of a sudden you’ve got to deal with somebody who is creating, and you’ve got children in here or bereaved relatives.”
Back in the corridor an old lady is now parked on a trolley.
She is quickly joined by a paralytic teenager with his concerned mum and furious father. The lad doesn’t have the faintest idea what is going on.
Along the corridor is ‘pitstop’ - where the ambulance cases are brought in and initially assessed.
There are two assessment rooms down there.
They are full and a young man with a serious laceration to his wrist is lying on a trolley waiting to be seen.
There are also two resuscitation suits at the bottom of the corridor, one for children, one for adults.
The hospital has now built a separate children’s waiting areas - to keep the kids away from the drunks.
In child’s resuss’ is a three-year-old girl.
She has suffered a severe asthma attack and is in there because she needs oxygen. She will soon be transferred to a ward to be observed overnight.
She has been on the unit for almost four hours.
Next door is a 47-year-old man. He has walked in with a pain in his neck, which he has been putting up with for weeks.
He is seriously unwell. The pain is caused by a blood clot. Staff are worried.
They don’t know where the clot was formed - in his head or in his chest, and until its source has been identified they don’t know whether he needs to be transferred to Derby or Sheffield for more specialist care.
He is waiting for a scan. Time is of the essence.
All the cubicles are now full. There are four patients parked in the corridor.
Outside there are 25 people waiting to be seen.
Dave Prosser comes to talk to me. He doesn’t pull any punches.
“This is an A&E which was built for 40,000 patients and sees 80,000 patients per year,” he says.
“The number of presentations has gone up by five per cent nationally, and here it’s gone up 10 per cent but we don’t have any increase in staff - in fact quite the opposite.
“We have had our nursing numbers and our doctor numbers reduced and the big challenge we have is how to cope with this increasing demand with the same amount of staff, or fewer.
“Our staff are incredibly resilient and resourceful. Our nurses are working at a rate that would break most nurses, and our doctors are incredibly special people too, so we have been able to soak up a lot of the additional pressure. A&E is a very difficult department to recruit into - there are not many nurses prepared to work in this kind of environment.
“We currently have six vacancies for doctors in this department alone and we’re also trying to recruit more consultants.
“Guidelines dictate that a department of this size should have ten consultants and we have a total of seven.”
It’s 10.30pm now and there are 29 people sat in the waiting room. Senior staff nurse Nicole Lomas has just been dealing with a frantic mum who thinks her toddler has swallowed a paperclip.
She tells me that if the child had accidentally swallowed medication, as a lot do, she would have had to involve social services.
They have a legal duty to protect children, she says, even though most incidents involving young children are entirely innocent.
“You get quite a few walking in with children who can be very unwell by the time they get here,” she says, “particularly with the really young ones.
“Parents may have tried to care for them at home, they may have taken them to the GP, then dialled 111 and waited for an hour or so to get a call-back, so by the time they present here they are really quite unwell.
“We regularly go and walk through the waiting room to see who is out there and how they look and quite often we have had to literally scoop up a baby out of its mother’s arms and rush it off to resuss’ as it has deteriorated so badly.”
The department is also dealing with a massive spike in teenagers with mental health problems - 16 to 18-year-olds who arrive having self-harmed or overdosed.
There has also been a huge increase in the number of young people turning up having taken legal highs, which could further strain the system in the years ahead.
“These drugs have repercussions,” Nicole adds. “They cause mental health problems. It’s going to be a massive issue in the years ahead - in ten years’ time. “The mental health system can’t cope at the moment, so without proper funding being put in place it’s not going to work.”
I leave at 11.25pm.
The corridor is full of trolleys. There are 33 people in the waiting room.
It is still quiet.