Reflections on the Accident and Emergency (A&E) Crisis

Reflections
Reflections      Photo: Jean Tubridy

The ‘crisis’ of Accident and Emergency (A&E) is a very hot topic in Ireland at present and it sends shivers down my spine.

Basically, there is a log jam in our hospitals with lots of people waiting for hours and hours, days and days  on chairs and trolleys in A&E while there are hundreds of people in hospital beds who are ready for discharge but who are deemed to have nowhere to go.

The shivery bit for me relates to my experiences with both ends of this scenario with my late parents and, indeed, my work as a social researcher on health service reform over many, many years.

The discussion keeps coming back to the fact that we have an ageing population. This fact was flagged years back but it seems like nobody was prepared to plan for it and now we are in a ‘crisis.’

At one level, this makes me wonder whether there was any point in the wide earthly world taking a very, very conscious decision to work in social policy and planning as opposed to social work, which is about  patching up problems as they arise.

At a personal level, I know what it is to be ‘the family’ of older people. I came to know Accident and Emergency all too well when one or other, or both of, my parents suffered serious problems like heart attacks/strokes in the middle of the night.

I reckon one of the loneliest places in the whole world is sitting in the waiting-room of A&E, knowing that this could be the end. Hearing your name called by a tired-looking doctor who has to break whatever news has to be broken …..

To this day, the worst flashbacks I have about my parents last years relate to Accident and Emergency Departments ~ seeing their absolute vulnerability, frailty and need for my hand in theirs.

Mercifully neither of them died in the hustle, bustle, bright-lighted, sweatiness  of an A&E  Department but they did end up as ‘bed-blockers’ at the other end of the hospital system.

Tied Up
Tied Up          Photo: Jean Tubridy

So many times I was called in to discuss the ‘discharge plan’ and had to plead for a few extra days of hospitalisation as I knew they simply weren’t ready for home and would be straight back in to A&E if discharged too soon.

Other times, I knew they were way beyond their discharge time but were tied up in knots by red tape and lack of co-ordination.

My plea today is that over-stretched health services recognise:

1. That A&E is terrifying for vulnerable, ill people and their loved ones. There is definitely a case to be made for liaison people to be employed to help alleviate this.

2. That family care-givers have a depth of knowledge about their elderly relatives and should be seen as friends, not foe, in the whole discharge scenario.

3. That massive emphasis be placed on co-ordination of services both within hospitals (e.g. guidelines of speech therapists re food requirements of those with restricted swallow must be observed by all) and between hospitals and the available community care services.

4. That illness is a 24/7 situation that doesn’t take holidays at key times like Christmas/New Year.

While  extra funding is clearly important for the health services, I would argue that a huge amount could be achieved with a change in thinking, perceptions and work practices.

Finally, I would ask that the ‘powers that be’ question if they would act any differently if the ‘elderly patient’ in A&E or ‘blocking a bed’  happened to be their very own beloved mother or father.

Empathy
Empathy               Photo: Jean Tubridy

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I am delighted that this post has been Shortlisted in The 2015 Irish Blog Awards ‘Best Post Category.’ The subject matter means a huge amount to me as the A&E Crisis impacts on so many people ~ all those patients, families, hard-working care staff who are embroiled in it today, tomorrow and all our tomorrows.

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Author: socialbridge

I am a sociologist and writer from Ireland. I have worked as a social researcher for 30 years and have had a lifelong passion for writing. My main research interests relate to health care and I love to write both non-fiction and poetry.

24 thoughts on “Reflections on the Accident and Emergency (A&E) Crisis”

  1. Exactly the same debate/problems exist with the UK NHS – I am no expert but part of the problem here is that Local Authority care services have been cut back so much that there is nowhere for the elderly ‘bed-blockers’ to go (not the same scenario as your parents but certainly an issue for some in England).

    1. Hi Robin, thanks for writing. Yes, I’ve been hearing on radio about the NHS situation. Similar story here now unfortunately and I truly pity anyone who lives away from their frail, ailing, parents who is depending on the State to somehow provide the necessary services.

  2. First people are encouraged to live healthy lives so they will live longer, and then they’re labelled as elderly ‘bed-blockers’ for daring to live long enough to require medical attention. Next thing, government medical officers will recommend the unthinkable — that word beginning with ‘e’.

    1. Hi Sarah, I agree with you about the longevity issue. I think, though, that maybe the time has come for people to be legally allowed to make decisions about the ‘e’ word while they are of sound mind. There’s so much that we expect humans to endure that we wouldn’t put our beloved animals through. I know this is a very complex subject but, for me, quality of life and quality of dying are key.

      1. I had the self-same conversation with Mister the other day. What I said to him was that the state of hospitals and nursing homes is such, that it would be cheaper and kinder to take me to Switzerland if I was terminally ill, so I could get the whole business of dying over with. But that’s easily said when I’m not in that situation. Who knows what I would feel under such circumstances? Maybe desperate to hang on to life at any cost. Some people who have made “living wills”, change their minds when it come to it.

        It’s an extremely complex subject, upon which I once had to write a uni assignment as part of an ethics module. I have also written a post on the subject on my blog, which you probably haven’t seen as it was from before we met up blogging. Here’s the link to it, if you’re interested http://sarahpotterwrites.com/2013/03/14/the-slippery-slope-to-compulsory-euthanasia/

        1. Hi Sarah, thanks for a great read and it seems like we’re on the same hymn sheet!
          Yes, a very complex subject but still I think it would be good to know that there was a way out if one ended up with absolutely no quality of life. Choice is very important so long as it remains in one’s own hands and not in that of others with some some completely different agenda.

  3. I understand this Jean. Many a time did I end up in A&E with my mother and there were a number of times I knew she’d been discharged from hospital too soon. There was one day when she was sent home in the morning and we were back in A&E the same evening – and I was distinctly made to feel that my mother was putting it on because she liked being in the hospital rather than at home.

  4. You’re preaching to the choir. My regular hospital visits have made me sensitive to what happens to people in the system. Here’s one for you Jean. I do dialysis three times week and see the regulars each time. The nurse who tended to my treatment on Friday – Jeannie – is a kind and compassionate soul. She was telling me of a staff meeting they just had to address costs. They were told that outpatients could only have one heated blanket during treatment. The cost of linen laundering was getting too high. Now dialysis machines have temperature settings on them so they heat or cool your blood during the treatment. This is especially important for the elderly as the blood vessels will dialate more at a warmer temp and this is not good for dialysis. So, they set the temp at 35. C. Typical body temp is around 36.5 C. I do not allow them to do this to me because it is bone chilling. Anyway, they get elderly out patients from nursing homes, etc, and they turn their temp down to 35. Now they are going to deny them any more than 1 blanket. Typically I use two sheets and two blankets even set at 36 C. How’s that for taking care of the elderly?

      1. The fortunate thing is that the nurses are too compasionate to obey and their union will back them and protect them. But at what point did we create a system where the union has to protect its members for treating patients with respect and dignity and in good faith?

  5. There is some gallows humour at present with some Irish people open mouthed at Britain’s A&E crisis and wishing Ireland could have such a crisis.
    I know little of these matters but I tend to believe, Jean, that the answer isn’t always money. In which case why on earth can’t all the clever people get together and sort it? It has to be down to the political imperatives in Ireland which are striving for, or clinging to, office and the consequent rewards.

  6. Hi Roy, I’ve no doubt that money isn’t the magic key to this one.
    My sense is that short-sightedness and lack of co-ordination are major components as well as mega panic stations now that the problems are escalating by the day/night.

  7. This post is so eye-opening and thought-provoking and asks many questions that are so difficult to answer. My head is awhirl. I like the way you answer the whirlwind of confusion and questions in your next post’s poem!

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