Standing room only at A&E as waiting times rocket

Date published: 05 November 2009

The co-location of the accident & emergency department, the walk-in centre and out of hours GP services has caused a crisis at the new site at Rochdale Infirmary.

At certain times on any given day the waiting room is packed out, with standing room only, and numerous patients are being forced to wait more than four hours for treatment.

Councillor Wera Hobhouse, who chairs the Council's Health Overview and Scrutiny Committee, said: "On Saturday 10 of October I took my son to the Rochdale A&E with a head injury and witnessed a crisis. The waiting area was badly overcrowded and patients had to stand or sit on the floor; it took almost an hour to be seen by the triage nurse and when my son was finally attended to nearly four hours later, which is just within the target, he wasn’t seen by an A&E doctor but a GP who covered for the Out of Hours GP services.

"My colleague Councillor Jean Ashworth, who accompanied a friend to A&E two days later, experienced a similar situation; waiting times had increased for some patients to six hours. Once waiting times go beyond four hours, which is a national target for all hospital trusts, the red lights go on."

Health chiefs have been forced to admit that on any given day unexpected patterns of patient arrivals have put a tremendous strain on triage nurses, creating a bottleneck of patients waiting to be seen in either the walk-in centre or the A&E department. The A&E department has now fallen well short of the Government target to have 98% of patients seen within four hours of them entering the department.

Initially the move, which took place in the middle of August, went well and through to September the hospitals Trust Pennine Acute were reporting that patients were happy and that waiting times had gone down. But into October and unexpected surges of patients have left doctors and nurses unable to cope.

Lesley Mort, Director of Integrated Commissioning at NHS Heywood, Middleton and Rochdale, said: “Over the past few weeks there have been a number of as yet unexplained peaks in patients attending A&E at certain times of the day which has placed great strain on the department. Total patient numbers have not increased but the department has been inundated with patients over very short and random periods of time.
“We are working closely with Pennine Acute to understand the causes of these peaks and to make sure, particularly over weekends, that the right levels of staffing are in place to deal with potential surges."

With all services now under one roof, health chiefs said that there were problems with some patients not knowing which service they required and that many were attending A&E with problems that could be dealt by their own GP. The A&E Department will never turn away a patient without offering treatment, again increasing pressures on the department, no matter how minor a patient's complaint.

Lesley Mort continued: “What is clear is that many patients go to A&E when there is no need. We would strongly urge everyone to think about other options for treatment available to them. NHS Direct can offer advice, local chemists can help, phone your GP or the emergency GP service. A visit to A&E should only be a last resort. Our message is choose well and help us keep A&E free for emergencies."

The Pennine Acute Hospitals Trust, which runs the Infirmary, has been working with partner organisations to introduce new measures to address the problems. These included changes in staff shifts and better management of patient flows. Managers are monitoring the situation on a weekly basis to see if these improvements are having an impact.

Councillors on the Health Overview and Scrutiny Committee have given the Primary Care Trust and the Acute Trust until their next meeting on 8 December to assess whether or not these measures have been successful. They also asked health chiefs to create a feasability study as to how long it would take to move the Walk-in Centre back to Whitehall Street while the problems are ironed out.

All parties agreed that the patient experience was being badly affected by the problems and that staff moral was low and everything possible should be done to address the problems before staff started walking with their feet.

Lesley Mort said: “The move of the Walk-in Centre into the A&E area has not had a major impact on the surges in patients attending A&E so there are no plans to move it out of the department.”