News: The Vote with Frank Le Duc

Accident and Emergency departments have come to symbolise many of the challenges being faced across the NHS

When the spotlight shines on the NHS, more often than not it shines on A&E – the Accident and Emergency Department. It sometimes seems to symbolise not just the hospital but the health of the NHS as a whole.

It’s certainly a place where patients and their friends and relatives experience hope and despair. And the same can be true for the medical staff battling what must often seem like overwhelming odds. Yet, some of our worst moments are their routine. While patients can cherish recovery, for the medics the next cases are already waiting.

In Brighton an A&E consultant, Rob Galloway, recently shared his heartfelt thoughts on Facebook. Not versed in the ways of the media, the ensuing publicity must have come as quite a shock. He has resisted the lure – if lure is the right word – of furthering his 15 minutes of fame. Instead he has kept his head down and got on with the job of mending broken bodies.

The man in charge of the Royal Sussex County Hospital, Matthew Kershaw, is not unaware of the issues faced by the team in A&E. He took the top job at the hospital trust – Brighton and Sussex University Hospitals NHS Trust – as the emergency role was expanding. The Royal Sussex is the main trauma centre for a much wider area than Brighton and Hove.

Too few patients know where to turn when their doctor’s surgery is closed

He is also wrestling with the challenges of bringing the neurosurgeons who are currently based at the Princess Royal Hospital in Haywards Heath on to the Kemp Town site of the Royal Sussex. This will ensure that more people with complex injuries, such as those who have been in a car crash, can be treated near their home.

At the moment, many are flown to hospitals in London such as St George’s in Tooting. Also, some patients are stabilised at the Royal Sussex and treated for injuries to their bodies before being sent to Haywards Heath to have their head injuries dealt with. This will change for the better.

There is, though, finite space on the current site in Brighton. And preparations are under way for the £420 million modernisation of the Royal Sussex. The Chancellor George Osborne came to the hospital to announce the news in person. He is expected to give his final sign-off soon.

Another challenge faced by the Royal Sussex – and hospitals elsewhere – has been the relentless rise in the number of patients arriving at A&E. Many should be treated elsewhere as their problems are neither accidents nor emergencies. Some have pinpointed the government’s 2004 contract with GPs – family doctors – as a cause. It ended the old out of hours arrangements.

Too few patients know where to turn when their doctor’s surgery is closed. The walk-in centre in Queen’s Road, a few doors down from Brighton Station, has soaked up many extra cases. A similar facility by A&E could help. But these things cost money at a time of public spending constraints. Even so, most are cheaper than A&E.

Mr Kershaw knows that the queue at the front door is one part of the equation. The flow from A&E – having beds free on the wards – is another challenge. Linked to this is the flow out of hospital once patients are fit for discharge.

Here, Mr Kershaw and his staff depend on others being able to take patients who may be medically fit but need more general care – the old and frail, for example. Changes to working patterns in the adult social care team at Brighton and Hove City Council are taking place. Those changes should help. And Sussex Community Trust – the local NHS trust responsible for community nursing – is under pressure to keep up with rising demand.

It’s not just the numbers. As we live longer, those who end up in hospital seem to be older, have more complex problems and may not heal as quickly. A&E is unlikely to be empty any time soon.

Matthew Kershaw talks more about A&E and the challenges facing staff at the Royal Sussex on The Vote on Latest TV tonight (Tuesday) and tomorrow (Wednesday) at 8pm.

Pic above is Matthew Kershaw