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Reflections from A&E

Anonymous 13 January 2017

An anonymous improvement lead reflects on the last few weeks in their NHS trust, sharing both the extent of the current crisis and the remarkable spirit and dedication shown by staff to do the best for their patients.


Christmas and new year were very busy. On the Wednesday between Christmas and new year I had a day planned with meetings and training . The medical director asked if I could support my colleague with patient flow, as we declared a major internal incident in the emergency department due to the number of people waiting. I didn’t have my uniform, but I said I could go and help.

In the hospital there were 150 people waiting for social care packages, and there had been no assessments done; things were not in place. I was lucky, I worked with an expert porter to try and help move people out of the emergency department and move patients around, as there were so many people in the department. But there was nowhere to move anyone to. The staff felt they had nowhere to turn. It felt very unsafe for the patients.

In the last few months we’ve had five MRSAs and five Never Events because of the pressure, and a bed occupancy of 99%. We scored really well on our safety culture risk assessment last year – I’m afraid to repeat it now. This kind of pressure stops us doing work to improve services; we are firefighting.

We were at “black escalation”. [This is defined as ‘all actions have failed to contain service pressure and the local health economy is unable to deliver comprehensive emergency care.’ This means the hospital is at full capacity: escalation beds are in use, patients are waiting in A&E for beds, and routine surgery is being cancelled. A decision on this status would be made by the chief executive or chief operating officer].

When I left the department there had been twenty patients waiting on trolleys for more than twelve hours. The next day I went in in uniform, thinking it would still be bad. But I was amazed about how much it had calmed down, and how everyone pulled together. I work with some amazing people. I enjoyed being with the patients – you hear some fascinating stories. It reminded me of why I became a nurse in the first place.