The hospitals leaving patients on trolleys for up to 50 hours
Being rushed to hospital or taking your loved one to A&E can be a frightening experience. However, experts have recently highlighted a disturbing trend that will only make it worse.
They say hospitals are bursting at the seams, and a combination of poor out-of-hours GP services, budget cuts and a shortage of beds mean many patients are being parked on trolleys in A&E corridors and side rooms like left luggage.
Indeed, Department of Health figures, revealed last month by the Nursing Times, suggest nearly 67,000 patients waited up to 12 hours on a trolley in the first half of this year.
And this may simply be the tip of the iceberg, as NHS analysts say clever number-crunching by hospitals may be hiding the true extent of the problem.
As this Good Health investigation reveals, more than a quarter of hospitals have reported cases where patients have been left on trolleys for 12 hours or more — up to 50 hours in one case. In most NHS hospital trusts, patients waited less than three hours for a bed on a ward (the average was one hour 36 minutes). However, in six (7 per cent) of hospitals the average wait on a trolley was three hours or more.
Leaving patients on trolleys until a bed on a ward becomes available is known as ‘boarding’. Some argue that it’s an otherwise harmless consequence of an over-stretched health system.
The experts disagree. ‘Being on a trolley for an extended time is not good for your health — it can lead to patients deteriorating and is bad in every sense,’ says Dr Peter Carter, chief executive of the Royal College of Nursing.
‘There is a lack of call buttons and water — and many people are, understandably, too embarrassed to tell a nurse that they need to go to the loo.
‘And though words such as dignity and respect trip off the tongue these days, going to the loo on a bedpan in a corridor is one of the most undignified situations I can imagine.’
But there are more serious implications, too. ‘If these trolleys are in corridors, then it is usually not possible to get all the proper monitoring equipment and oxygen next to the bed.’
Patients have died when left alone on trolleys. An investigation was launched at James Cook University Hospital in Middlesbrough in June after a patient suffered a fatal cardiac arrest after waiting on a trolley in a corridor for more than two hours.
‘Long trolley waits can compromise a patient’s health — especially for the elderly,’ says Dr Taj Hassan, vice-president of the College of Emergency Medicine. It increases the risk of complications such as bed sores and dehydration.
To get a clearer picture of the extent of ‘boarding’, we sent Freedom of Information requests to 173 hospital trusts asking for the average waiting time between being referred from A&E and arriving at a bed on a ward.
The hospital trusts were also asked for the longest time a patient waited. The results make for depressing reading. The table below shows the ten hospital trusts with the longest patient waits.
Though some may argue that these are isolated cases, Dr Carter warns such long waits are, in fact, becoming increasingly common.
‘I was talking to an A&E nurse who was discussing the standard of care she witnessed in the Eighties and Nineties,’ he says.
‘She said she used to dread the days when she’d go off duty for two days and then see the same elderly people still waiting on trolleys when she came back. Sadly, this is exactly what is happening right now.
‘Ministers can deny it and dress it up with statistics, but we know that this is a reality. We’re warehousing people on trollies in inappropriate places.’
Hospitals argue boarded patients are not abandoned in corridors, but are placed in ‘clinical decision units’ or ‘transitional assessment units’ where they can undergo further observation or tests.
However, Dr Carter argues that in many cases these are corridors and side rooms — but re-branded.
Some hospitals may even stop recording a patient’s waiting time when they enter these units because, technically, they have left A&E and been admitted into the hospital. ‘There are increasingly all kinds of euphemisms for these areas, but they’re basically not designed to provide the best possible care,’ says Dr Carter. ‘They’re holding pens.’
Even when beds are found, they are often in the wrong ward — so a patient who has a heart complaint may be taken to a surgery ward because that is the only place where the hospital has a free bed.
NHS staff say they are sometimes given little option but to resort to measures such as boarding.
Some hospitals have managed to tackle long trolley waits by overhauling their A&E departments. For example, Luton and Dunstable Hospital NHS Foundation Trust built a larger emergency department, increased staff and ensured that a senior doctor sees every patient within an hour of them arriving, helping to identify who will need admitting.
But our investigation suggests that many hospitals are running at breaking point.
We also asked all the trusts about their bed occupancy rates and found nearly two-thirds of hospitals operated at above what some experts consider safe capacity.
Kathy Ollis-Brown felt a sense of relief when she got to A&E after a seizure in March last year. But she was then ‘parked’ on a hospital trolley for 17 hours as over-stretched staff rushed by her.
The mother of two was taken to East Surrey Hospital, near Redhill, after losing consciousness briefly at home.
Once at the hospital, Kathy, 43, was placed on a trolley against a corridor wall and suffered two further seizures.
After three hours, she was wheeled into a small side room. ‘There were about 15 of us in there, like sardines — the room was filled with moans and groans,’ she says.
It wasn’t until her husband Bob spoke to the hospital’s chief executive that Kathy was given a bed — 17 hours after entering the hospital.
Tests revealed the seizures were due to an abnormal heart rhythm. The hospital has since apologised, blaming an exceptionally busy night.
‘High occupancy, more than 85 per cent, has been linked to every measurable bad outcome you can think of: boarding, raised infection rates, accidents and staff taking antidepressants,’ says Dr Rod Jones, a statistical adviser who has published research papers on this topic, and works as an adviser to NHS trusts.
He adds that larger hospitals can go up to 90 per cent occupancy, ‘but infection risk tends to kick in around 85 per cent, irrespective of the size’.
Our results suggest that nearly two-thirds of hospitals operate over 85 per cent capacity, with nearly one in three at more than 90 per cent occupancy. Perhaps not surprisingly, most of the hospitals with the longest patient waits had high occupancy rates. Dr Jones says hospitals are under increasing pressure to boost occupancy, as this reduces their costs.’
Just over half of trusts provided information — some claimed the cost of the time needed for staff to provide the information would exceed that allowed for a Freedom of Information request (£450).
Others said that they did not hold the information. In fact, hospitals are obliged to record how many patients wait between four and 12 hours to be admitted to a ward.
They must also report the number of patients who wait more than 12 hours. Some patients may spend this waiting time on a bed in a side-room; however, the vast majority will be on a trolley.
It should be noted that some hospital trusts will undoubtedly record waiting times differently — and this data is intended as a snapshot of patient experience in emergency wards, and not as a scientific study.
When we approached the trusts mentioned in the table below, King’s College Hospital NHS Foundation Trust and Oxford University Hospitals NHS Trust said they had provided incorrect data in response to our Freedom of Information request.
The other hospital trusts said that patients who experienced these long waits were particularly complex cases, who needed to be stabilised in A&E before being moved to a ward, and that most patients do not experience such long delays.
Commenting on our investigation, a Department of Health spokesperson said: ‘Delays to care are unacceptable — patients must be treated with dignity and respect at every stage of their care.
‘We know that, on average, people in A&E in England wait only 51 minutes for their treatment to start and 95 per cent of patients are in and out of A&E within four hours. We are modernising the NHS, so it can continue to improve care.’
Roswyn Hakesley-Brown, chair of The Patients Association, said: ‘The public will be shocked to hear this practice remains an issue in today’s health service.
‘The Government’s drive to save £20 billion from the NHS budget is adding to pressure on the number of beds available — which are already at full stretch from rising admissions to A&E departments. Health chiefs need to act to end disgracefully long waits on trolleys.’
Newborn baby was wrongly pronounced dead while she was still alive. Dies of neglect
Casual treatment of woman by African doctors faulted
A premature baby wrongly pronounced dead by paramedics lived on for more than 15 minutes wrapped in towels on the front seat of an ambulance.
A coroner criticised a doctor’s ‘gross failure’ in not examining Alison Davis, who was in severe pain, before sending her home to Eastwood, Essex, to a traumatic miscarriage.
Paramedics then wrongly pronounced baby Bethany Davis dead when her mother gave birth an hour later.
After rushing Mrs Davis to hospital, they left the baby on the front seat of their ambulance for more than 15 minutes while treating the distraught mother.
A midwife then spotted the infant was alive, an inquest into the child’s death at Southend Coroners’ Court heard; but by the time she was reunited with her mother she had died as a result of her prematurity.
When Mrs Davis gave birth to Bethany on her parents toilet, her family endured six ‘terrible’ minutes that ‘felt like a lifetime’ as an ‘overwhelmed’ paramedic waited for back up.
That paramedic, described by Mrs Davis’s father Trevor Webber as like ‘a rabbit in the headlights’, ‘regressed’ to training that a baby born earlier than 24 weeks was not viable. He refused to move Mrs Davis or Bethany or cut the umbilical cord before the ambulance arrived in case he risked harming her.
Mr Webber said: ‘It was terrible. Those six minutes felt like a lifetime.’
On arrival, the ambulance crew wrongly pronounced Bethany dead, wrapped her in towels and put her on the front seat as they took Mrs Davis back to Southend University Hospital in Essex.
They failed to ask Bethany’s father, Glen, if he wanted to hold her, as protocol demands. They took Mrs Davis into hospital on a trolley, leaving the infant on the front seat for 10 to 15 minutes.
When the crew finally handed over Bethany, a midwife noticed she had a heartbeat and was moving her fingers. But the baby had died before she was taken to her parents, who never saw her alive.
Mrs Davis, 33, said: ‘We were robbed of the precious time with her alive. ‘It’s the hardest thing as a mother, knowing she was in another room and if she could have called out “Mummy come and get me”, she would have done’
Registrar Dr Oludare Adeyemi failed to follow protocol and give Mrs Davis an internal exam after she reported excruciating pain in her abdomen, thighs and back, the baby kicking at a low position, bleeding and discharge on December 12, 2009.
He instead relied on an inadequate examination by trainee Dr Uzoamaka Odina, who was only 10 days into the job, before diagnosing a threatened miscarriage and discharging Mrs Davis.
No midwife was present when Dr Odina examined Mrs Davis, as hospital policy demands.
‘It’s a gross failure in the management of this very traumatic situation,’ said Coroner Dr Peter Dean. ‘The protocol wasn’t adhered to and as we have heard from the very frank and clear evidence, had things been managed according to the protocol it’s clear Alison Davis would have stayed in hospital.
‘The outcome is unlikely to have been different had she stayed in hospital. ‘But it’s undeniably the case if she had been kept in hospital she would have avoided the traumatic sequence of events that took place in the next few hours at home.
‘It’s clear the family went through an awful sequence of events on arriving home and one can only hope the pain of those awful events will diminish over time.’
Recording a narrative verdict, Dr Dean said Bethany died as a result of her premature birth.
Jacqueline Totterdell, chief executive of Southend University Hospital, said: ‘We again offer our sincerest condolences to Mrs and Mr Davis for the loss of their baby and the distress they have suffered.
‘While staying in hospital would not have altered the outcome for Bethany because of her extreme prematurity, we recognise that if our protocol for women presenting with a persistent or recurrent bleed to be examined by senior staff had been followed correctly, the family would not have suffered the loss of their daughter in such a distressing way without the immediate support of medical staff and our bereavement counsellors.
‘Since Bethany’s death in 2009 we have taken a number of steps to address the concerns this tragic case raised including better support and guidance for junior staff from senior colleagues, improved training on our guidelines and policies and increased awareness of the need for a good standard of note keeping and communication between doctors and midwives.
‘We have also updated guidelines around caring for very early term births to include better support and counselling for mothers at risk of delivering extremely pre-term babies.
‘We accept the standard of care the Davis family received at that time was not of the highest we would expect, and have listened carefully to the coroner’s comments and will ensure they are fully acted upon. ‘We once again extend our sincere apologies to Mr and Mrs Davis and family for our shortcomings in this very sad case.’
British students spend too long in bed or the pub
Traditional universities allow students too much time to sleep or go to the pub, AC Grayling has said.
The philosopher has rounded on modern institutions for allowing undergraduates too much time of their own, claiming there was “too much slack” on degree programmes.
His comments were made as he prepares to open his private university, the New College of Humanities (NCH). Some 60 students will be the first to take his re-imagined £18,000 courses, which have been described as “double degrees” because of their workload.
“There’s room in an undergraduate’s life for more,” Professor Grayling said, in an interview with the Sunday Times Magazine. “There’s too much slack. They could certainly spend less time in the pub or bed.”
This year’s intake will complete a “major” as well as extra modules in subjects such as science, logic and critical thinking.
Professor Grayling compared his educational philosophy to the Aristotelian principle of making “noble use of our leisure time.”
“The obsolescence-proof thing you can take with you to the future is an ability to think broadly,” he said.
His new college, which draws on the Oxbridge model of one-to-one tutorials, has been accused of encouraging elitism by charging double the fees at Oxford or Cambridge.
Among the lecturers on the books are Steven Pinker, a psychology professor from Harvard; a physicist who served Barack Obama, Lawrence M Krauss; and the historian Sir David Cannadine.
Earlier this year, Professor Grayling suffered the embarrassment of having one of his supporters, Professor Steve Jones, withdraw from the enterprise over its fees.
Professor Jones said at the time: “The fees that he has been forced to apply mean that it can now no longer really claim to be about public education, and, for that reason, I have, amicably, withdrawn from it.”
Professor Grayling defended its charges, saying he intends to extend the college’s £250,000 endowment fund. “I’d like to raise an endowment over time that can pay for everybody who would like to come to the college,” he said. “But I’m not going to wait for 10 years. I’ve started now.”
“Eat drink and be merry” is GOOD for the British taxpayer
Because abusers die younger — as even insurers recognize
Those with prohibitionist fantasies can bang on as much as they like about costs to the NHS of unhealthy lifestyles, but then it’s not their own money which is being discussed, is it?
If their salaries were linked to truthfulness of their statements, I think we’d see an entirely different rhetoric. After all, their current abject failure is simply not being punished, sadly.
The opposite applies to industries where proper, accurate economics – as opposed to the fairy tales told by ASH and Alcohol Concern, for example – decide what level of profit and pay actuaries are entitled to.
Binge drinkers are to be given better pension payouts by insurance companies, it emerged last night.
Those who swig more than four bottles of wine or 15 pints of beer a week could qualify for up to £2,000 a year more than someone who is clean living.
Set aside, for a minute, the laughable emotive claim that someone drinking just over two pints a day is a ‘binge-drinker’. The point here is that insurers have identified, quite rightly, that those who enjoy a drink here and there are – on a macro-economic scale – less likely to live as long as health nuts and are therefore a better financial risk.
By extension, the NHS should be very happy that the highly expensive parts of their creaking system – geriatric care – are lessened by those of us who enjoy life to the full and are quite happy to take the risk of careering into our box sozzled and stinking of cigars. The fact they are not just shows why we don’t go to our local surgery if we want a financial adviser.
It might help to explain why the NHS is bankrupt in many areas too.
Edmund Tirbutt, a health consultant and author of Help Them Beat the Booze, said: ‘There is a real danger of insurers sending out the wrong message.
‘It might make perfect commercial sense to offer more to drinkers, but it will verge on the irresponsible if insurers now start using it as a selling point.’
This is probably one of the most stupid things I have ever read from any health dickhead anywhere.
Safe in the knowledge that it isn’t his money he is risking (it never is with these people, is it?), he is adamant that the irresponsibility is with those who understand money and risk; who are the world’s prime experts at it; and realise that the insurance industry would collapse if they took idiot advice like this regularly.
Beggars belief, doesn’t it? The arrogance of the health lobby never ceases to amaze as they stray from their core knowledge base into professing themselves global experts in anything from market economics to global trade. When did the concept of doctors restricting themselves to what they are trained at, that is curing people when they are ill, cease to be applicable?
Remember, too, that insurers do not benefit from hugely inflated monetary contributions from smokers and drinkers like our government (and by extension, the NHS) does. The bonuses are being paid out despite all policy-holders paying an identical premium.
Next time you see the regular sheep-like refrain from some dull-headed online commenter that the NHS suffers financially from those who choose a lifestyle which includes booze or baccy, spark up a tab, pop open a cool one and toast their generosity in exhibiting their hilarious ignorance to the world.
Cold, hard, unbending numbers expose them as being weapons grade deludos
British Greens routed as shale gas wins new enthusiasts
Last week saw a truly momentous defeat for the green lobby groups which, in the past decade, have exercised almost complete control over Britain’s future energy policy. The fact that this took the form of a mighty slapdown for Lord Deben (formerly John Gummer), newly confirmed chairman of the Climate Change Committee, makes it all the more telling.
As his first act on being appointed to head this committee, set up to advise the Government under the 2008 Climate Change Act, Lord Deben wrote an extraordinary open letter to Ed Davey, the Secretary of State for Energy and Climate Change. This expressed his committee’s “great concern” over a statement by Mr Davey in July that indicated that Britain must continue to rely heavily on gas to produce electricity. Although Mr Davey is still proposing to build 30,000 inefficient and unreliable wind turbines, he was implicitly recognising that these could only help to keep Britain’s lights on if they are supplemented by a massive new “dash for gas”.
As I wrote at the time, this drives a coach and horses through Britain’s legal commitment under the Climate Change Act to reduce CO2 emissions by four fifths in less than 40 years. Lord Deben’s letter made exactly the same point. In the letter, signed by seven members of his committee, all unquestioning believers in the need for renewables to combat global warming, he and his colleagues went even further. Astoundingly, they called on Mr Davey to issue a statutory instrument banning the use of fossil fuels to provide electricity. Of course, they did not put it like that. They urged him to impose a maximum emissions limit on power generation of 50 grams of CO2 per kilowatt hour (kWh). But since only nuclear and renewables are below that threshold, while gas emits 400 grams per kWh and coal 700, what in effect they were calling for was an end to any further use of the fuels that currently supply some 75 per cent of our electricity.
Furthermore, they were pressing for this act of economic suicide not just to meet our legal “low carbon” requirements but also because any “dash for gas” would divert investment away from the “renewables” industry they so passionately favour. As we know, Lord Deben himself has long been heavily involved in various “green” companies that stand to benefit from the subsidised renewables bonanza. Before he could be confirmed in his new post, he had hurriedly to resign as chairman of a firm planning the world’s largest offshore wind farm and as director of another planning a Severn tidal barrage. Only thus could his nomination by David Cameron be approved by the Commons committee on energy and climate change, chaired by Tim Yeo, who is himself heavily involved with various green energy firms, which last year paid him £200,000 on top of his parliamentary salary of £80,000. As Lord Deben’s letter to Mr Davey pointed out, Yeo’s committee has also backed the demand for a ban on electricity from fossil fuels.
What they could not have expected was Mr Davey’s response. He trenchantly dismissed their calls, restating his view that we urgently need a massive new investment in gas generation. Only after 2030 would this require the “carbon capture and storage” that, as Mr Davey has already admitted, is still an “unproven technology” (and is likely to remain so). So the first message of last week was that the once hugely influential Climate Change Committee in effect has been kicked into touch. In the name of keeping Britain’s economy running, the Government seems now determined to break its own law.
What makes all this even more significant, however, is that it is taking place against the background of a truly astonishing worldwide energy revolution. As can be seen from the website of the Global Warming Policy Foundation, country after country is now rushing to exploit the shale gas that, in the past four years, has more than halved gas prices in the US. China, Germany, France, Russia, South Africa and others all have immense reserves that promise to provide the world with cheap energy for centuries to come. And, here in Britain, determined moves are at last being made to reverse the Government’s grudging negativity towards our own vast shale gas reserves, led by our new Environment Secretary, Owen Paterson, who seems to be winning surprising support for his enthusiasm for shale gas from key officials in his own department and the Environment Agency, which has regulatory responsibility for this new industry.
After years when our energy policy was being dictated by green wishful thinking, by the likes of Lord Deben and by state-subsidised pressure groups such as Friends of the Earth (which first invented, then helped to draft, the Climate Change Act), reality is at long last breaking in. The green make-believe that has cast such a malign spell over our country for far too long is finally on the run. Truly, last week was history being made.
‘I couldn’t think of anything worse than being brought up by two dads’
Homosexual actor Rupert Everett’s stinging attack on homosexual parents sparks outrage
He was seen as a champion for gay actors when he decided to come out of the closet two decades ago. Now Rupert Everett finds himself in a somewhat less enviable position.
The 53-year-old actor has been rounded on by gay rights groups after saying: ‘I can’t think of anything worse that being brought up by two gay dads.’
Ben Summerskill, chief executive of the gay rights group Stonewall, said: ‘Rupert should get out a little bit more to see the facts for himself. ‘There is absolutely no evidence that the kids of gay parents suffer in the way they are being brought up or in how they develop.’
In a provocative interview, Everett – who played a gay father opposite Madonna in 2000 comedy The Next Best Thing – said his mother Sara, 77, wishes he had a wife and children. ‘She has met my boyfriend, but I’d imagine she still wishes I had a wife and kids,’ he said. ‘She thinks children need a father and a mother and I agree with her. ‘Some people might not agree with that. Fine! That’s just my opinion.
The only community I belong to is humanity and we’ve got too many children on the planet, so it’s good not to have more.’
In the same interview, Mrs Everett said she wished her son – who came out in 1989 – was not homosexual. In the past I have said that I wish Rupert was straight and I probably still feel that,’ she said. ‘I’d like him to have children. He’s so good with children. ‘He’d make a wonderful father. But I also think a child needs a mummy and a daddy. ‘I’ve told him that and he takes it very well.’
She added: ‘From what I’m told, Rupert can be a little outspoken, but I don’t think he tries to upset anyone on purpose. He just says what’s on his mind and doesn’t suffer fools gladly.’
‘Offensive’ comment about Gypsies prompts equalities training for British councillor
“Equalities training”! How Orwellian can you get? People often make sweeping statements in private but privacy is under a lot of attack these days.
A councillor, who said a minefield should be planted around a travellers’ site, has been told to attend equalities training, it was reported.
Mervyn Loynes, a member of South Cambridgeshire District Council, was investigated after he made the “silly remark in private”, according to the Conservative council leader Ray Manning.
The investigation found he had breached the council’s code of conduct over “respect, equalities and disrepute”.