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Sunday 19 August 2018

Terry Prone: A&E is already hell ... soon it will be the sum of all human misery

Just a few short years ago, Accident and Emergency was the solution, not the problem. You limped in or wheezed in, or if the worst came to the worst, were wheeled in, and within a tolerable length of time, you were sorted. Fixed. Maybe not cured, but at least treated. Possibly admitted, if you were sick enough.

Bottom line? Every old person worried -- a bit -- about the possibility of a fall or a stroke, but they didn't worry about actually going to the hospital.



Glass

Mothers worried -- a bit -- about their children stepping on broken glass at the beach or getting sunburned, but they didn't worry about going to A&E.

That's now been turned on its head. We all worry much less about what might put us in A&E. Our real terror is reserved for what will happen to us when we get there.

How many hours will it take before we're seen? How many hospital bugs will we pick up as we wait to be seen? Will we end up afraid to go to the loo lest someone nick our chair or the cushion we're leaning against? What are the chances that we will be terrorised by someone who's as high as a kite or so drunk they couldn't tell you their own name?

That's been the reality at peak illness and accident seasons, for a couple of years. Now, petrol has been thrown over our smouldering concerns by predictions that it's going to get worse.

Much worse. In the short, rather than the long-term.

Shortages of junior doctors. Switch-overs between junior doctors who have some clue what they're at and a bunch of brand new ones who have never served in the chaos that is A&E up to now.

Some A&Es possibly closing because they can't safely be kept open. You thought the last couple of years were bad? It could get ten times worse, we're told.

That's unimaginable -- but we can still imagine it and, depending on where we are on life's ladder, it leaves us unmoved or terrifies us into changed behaviour. If you're young, reckless and determined to have a great time, regardless of the consequences for you or anybody else, you'll continue to take whatever chemicals or alcohol offer a definitive high, and to hell with the possibility of ending in A&E. If you've got a chronic disease, like asthma or diabetes, you may actually take better care of yourself for fear of where you might end up, for hours, if not days, of exquisite misery.



Stinkers

The inevitable question is: How could anything this bad be getting worse? The inevitable answer? A cluster of inter-related stinkers. Because for too long, health money got spent on today's crisis or controversy, not on tomorrow's needs. Because the demographic snuck up on us, with older people breaking hips, going to A&E and earning themselves a moniker we never heard of, ten years back: "Bed blockers." Because consultants who couldn't get on with their normal admitted work because of this organisational constipation began to game the system in the interests of their patients. Because young doctors, looking at a non-existent career path, said "To hell with this, I'm off to the US or Oz."

The list goes on and on. It's not a can of worms Dr James Reilly has been handed. It's a barrel of worms.

If he'd been Minister for Health ten years ago, given his bullish inclination to take action, he'd have had a great time, because he'd have had the money to tackle some of the problems that add up to the picture of human misery which gets painted in A&E.

Now, he's got to persuade medics to be flexible, creative and problem-solving with no money.

It is an absolute and urgent imperative. Otherwise, this will be a summer filled with human misery, if not tragedy, centred on A&Es throughout the country.

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