If it's not an accident or an emergency, where do you go?

Recently I have begun to feel that I might resemble a cod fish which has evolved to become smaller than its ancestors, so that it could slip through the holes in trawlers’ nets in order to avoid being made into fish fingers. Inadvertently I seem to have evolved into a life form that slips through the mesh of the NHS in North West London in 2013, albeit with less positive consequences that is the case for the abovementioned fish.

One of the several ailments that afflict my legs causes them to swell, then, if the skin breaks, fluid can seep out. About a year ago I had an outbreak but this problem which was effectively treated by the nurse at my local GP practice. For a while this entailed wrapping the leg in several layers of bandages which had to be changed about every two days since the leakage soon soaked through the dressings. Gradually the leg healed up and the leaking ceased, I was then able to treat myself at home with creams and a stocking bandage.

This self-medication worked well until about a month ago, when the leaking started up again. I tried to apply layers of more absorbent bandage myself, but my efforts weren’t very effective and the leg seemed to leak more and more. 

I rang my GP surgery but they couldn’t make an appointment for me for a week, but my bandages were soon both falling off and soaking wet, so I sought treatment elsewhere. I went to an NHS “Walk-in” Centre, about five miles from my home. The nurses there did what they could, but said that the “Walk-in” Centre did not keep a sufficient stock of bandages to treat cases such as mine and advised that I should be seeing my GP.

The temporary bandaging just about held out for four days until I was able to see the GP nurse again. The sopping bandages were removed and replaced with more extensive bandaging, but this too was wet through within a day, to the extent that one of my shoes was filling up with fluid whilst the bandaging was slipping down my legs, but the next GP appointment that I could now get was in six days’ time, so I decided that fresh bandaging was needed.

I looked at a full page advert from the NHS in free magazine posted to me by my local council. It was headlined “If You Are Unwell, Choose The Right Place to Go” (NHS Brent Clinical Commissioning Group  p.8 Brent Magazine, June 2013).  This ad detailed the various NHS services provided locally, but also emphasised the message: “Choose Well: Only Use A&E in an Emergency”.

I had already been to the GP and the Walk-in Centre, so I tried ringing up the Urgent Care Centre at a local hospital, (Central Middlesex), which was mentioned in the NHS advert. When I described my problem, I was told that the Urgent Care Centre was not the appropriate place for me and that I should go to the A&E in another hospital (Northwick Park in Harrow) as the local A&E in Central Middlesex was now “appointments only”.

This contradictory arrangement which might seem to imply that a patient should be clairvoyant enough to know of an emergency before it happened to them, placed me in a quandary. Harrow A&E is a fairly difficult journey, I could, I suppose, have phoned for an ambulance, but I did not consider my condition, no matter how unpleasant it was, to be an emergency and I did not want to waste the time of ambulance crews and A&E staff in dealing with it. So I was effectively house bound for about three days until my GP appointment came up. Luckily, I had enough food at my home to last out, otherwise I might have gone to the A&E for lack of groceries, rather than for any medical reason.

The GP treatment, when I got it was adequate and I have l also now been referred for specialist treatment, so I make no blanket criticism of the NHS, but there do, locally, at least seem to be some gaping holes in its net.

Recently I have seen and heard, media coverage that suggests that A&E’s can no longer meet the demand placed on them by many people presenting with non-urgent conditions, and it could be that such pleading might cover for pressure caused by A&E closures, when no adequate service for non-emergency cases, such as mine, seems to be in place.

I know that there a places in the world where there have never been ANY health services and I know that currently, in other parts of the world (like Greece and parts of Spain), previously adequate health services are being systematically destroyed by mad neo-liberal austerity policies. So my whinges, as a relatively affluent, educated British urbanite, are minor; but someone more disabled, and/or less articulate, and/or with less access to transport, might find things far, far worse than I did. Public adverts advising people to use services that don’t really exist are annoying at the best and potentially dangerous at worst.

ADMISSION TO HOSPITAL via A&E; North West London, July 2012

At about 7.30 pm on Monday 9^th July 2012, I was told by a member of the STARRS District Nurses, (based at Central Middlesex Hospital), that based on my blood tests, STARRS and my GP had decided to have me hospitalised by ambulance. I assume that this was because my mobility was very restricted at the time and that this was the quickest way to get me to hospital.

The ambulance arrived at my house in Dollis Hill at about 8pm.  I asked the ambulance crew if I would be going to Central Middlesex Hospital, as this was where I had gone when I had been hospitalised previously. I was told I could not go there as the Accident and Emergency dep’t at CMH closed at 8.30pm. It was therefore decided to take me to Northwick Park Hospital in Harrow.

The ambulance arrived at Northwick Park A&E at about 9pm. I was wheeled into the hospital lying prone on a stretcher accompanied by two ambulance men, the three of us immediately joined a queue of other potential A&E patients on stretchers or wheelchairs, each also accompanied by ambulance crews and sometimes also by friends and/or relatives. As far as I could make out in the queue in front of me consisted of about six or seven patients and others were frequently joining the queue after me.

I don’t recall any of the other patients in the queue shouting out, crying or giving any indication of being in great distress, so I have no idea if there was any procedure for emergencies to go to the front of the queue. If such procedure existed it would have made the wait of the “more routine” patients longer.

The restriction that was causing the queue seemed to be the number of available curtained –off A&E treatment areas available, until one became vacant, patients had to queue. When an earlier a patient was moved out of one of these treatment areas, a patient from the queue could be moved into it and also then be formally transferred from the care of the ambulance crew into that of the A&E dep’t.

I don’t know, but I assume that as well as arriving at Northwick Park A&E by ambulance, potential patients may have been arriving by other means.

By about 9.55pm, I was at the head of the queue, at this stage the member of A&E personnel in charge of handover ‘re-designated’ two Gynaecology rooms as being empty spaces available for A&E admissions.  I was wheeled into one of these rooms by about 9.58pm.

The ambulance crew who had had charge of me until then explained that if a patient was logged as waiting for one hour, this became logged as an “incident”, which apparently meant extra paperwork for both the ambulance crew and the A&E staff.

Within about 15 minutes I was moved from the Gynaecology room to one of the curtained –off A&E treatment areas and the use of the Gynaecology rooms seems to have been a temporary ad-hoc measure to deal with the queues of ambulance patients, but it was taking place at 9pm on a Monday night when there were no adverse conditions or unusual events adding to the number of potential A&E admissions.

After my wait in the queue, I was not fully tested and assessed in A&E and transferred to a ward until about 2am, but I think I was dealt with as promptly as possible by the A&E staff. My concern is how much of the initial wait before I was assessed by A&E was due to Northwick Park A&E having to deal with extra cases such as mine who might otherwise have gone to Central Middlesex Hospital.

It seems that the run down of A&E facilities at CMH, (let alone their total closure), may displace demand onto other facilities which may not have the capacity to deal with them promptly. Further more the reduction or closure of CMH A&E cerates a ‘self-fulfilling prophecy’ in regard to ambulance admissions, because ambulance patients have to go where they are taken, which may not necessarily be the nearest or best source of treatment.

If an ambulance can’t take a patient to a closed facility does this show a lack of demand for the facility that has been closed?