Why some patients still have to play a waiting game

Millions of patients are successfully dealt with each year and it is perhaps a measure of how highly the service is regarded that public attention is drawn to the tiny minority of cases where treatment goes awry.

The NHS is often most highly valued in an emergency when quick help for serious injury or illness is needed which is why pressures on hospitals have long been a concern of Government ministers.

Fast and efficient treatment of emergency cases was made the priority for the health service in the winter amid a significant and unexplained rise in the number of emergency patients.

Hospital chiefs have been ordered to put in place a host of measures to ensure the smooth flow of patients from accident and emergency where they are assessed and prioritised to beds where tests and treatment can be carried out.

The problem of waits on trolleys shows up in casualty - but the reasons for the hold-ups finding beds lie elsewhere in the hospital and can include use of operating theatres, staff shortages on wards or difficulties discharging patients home.

In Bradford it is understood GPs have had some problems accessing medical wards and patients have instead been sent to accident and emergency where they have waited on trolleys for admission.

A survey by the Association of Community Health Councils for England and Wales in January offered a snapshot of waiting times in accident and emergency departments which showed most hospitals including Bradford Royal Infirmary with the third busiest casualty in the country were coping with demands placed upon them.

A total of 280 people out of 2,700 surveyed had waited on trolleys for more than four hours while nine had waited more than 12 hours.

In the worst case a 60-year-old man with severe asthma had waited for a bed at a Surrey hospital for 37 hours.

At a London hospital another patient, aged 32, who had chronic renal failure, had waited more than 27 hours for admission for dialysis.

The problems with emergency admissions is that by their very nature they are unplanned and unpredictable.

Cases like those of Iris Wright, 67, of Wyke, and Willie Bakes, 72, of Thornton, who waited on trolleys for beds at Bradford Royal Infirmary for nine hours and nearly six hours respectively, occurred when the level of emergency admissions had been extremely high and there was no room on wards.

Lesley Sterling-Baxter, chief officer of Bradford Community Health Council, said waits in casualty in Bradford were regularly monitored as a key priority of the watchdog.

"We have been generally satisfied with the quality and level of care offered and in monitoring across the Northern and Yorkshire region Bradford comes out well.

"Obviously these are very unfortunate circumstances and we have great sympathy for the people who have been affected."

Roger Goss, helpline manager for the Patients' Association, a national pressure group which campaigns for patient rights and choice, said such long waits were deplorable but could never be entirely eliminated without huge investment in hospitals beyond the public purse.

Patients understood there were likely to be delays in some circumstances and complaints about the health service usually concentrated on waiting lists or GPs rather than waits for beds but if there were persistent problems they needed to be sorted out.

"Clearly leaving people on trolleys in situations which are sometimes very chaotic is not going to do them any good but that is the reality," he said.

"We don't get a lot of calls about how people are dealt with in accident and emergency in terms of delays because on the whole people take a realistic view that unfortunately if it's an emergency, emergency conditions are going to apply.

"In many ways if you look at how many beds, doctors and support facilities are available, it's amazing people are dealt with as well as they are.

"For the individual that is dealt with badly it is unacceptable and a disaster but hospitals in fact do remarkably well in difficult and very, very trying circumstances."

Rachel Mann, director of operations (medicine) at Bradford Hospitals NHS Trust, said a series of measures had been put in place to cope with winter pressures which had in the main worked well in dealing with the seasonal rise in emergency admissions that sometimes caused backlogs in casualty.

A total of 26 new beds for medical patients suffering mainly chest ailments had been opened using new money from the Government, and measures had been put in place to ensure people who did not need to be in hospital could go home instead of using up a bed.

Problems had arisen towards the end of March when beds were being phased out as the money ran out, which was coupled with a huge rise in admissions to one of the highest levels of the winter.

A total of 363 emergency admissions had been received in the week ending March 30, up 67 patients or 22 per cent on the same week the previous year.

"We had to run down the number of beds so that by the end of March we had none of those extra beds available to us," she said.

"We just cannot provide something we are not being given money for."

She said more money had been made available by the Government in the Budget for the health service, and some of Bradford's share would be ploughed into providing extra services to meet increasing emergency pressures which were still unexplained.

"We don't know what is causing this rise - if we did we might have some chance of dealing with it.

"Because of the way the system works in moving patients to create the next space, occasionally temporary backlogs do occur but they are always temporary and patients are moved according to a clinical decision based on their condition.

"We are very sorry where problems occur but we hope to avoid that wherever possible."

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