It’s urgent for pressure to be taken off A&E departments which are currently overwhelmed. My suggestion is for two streams following triage. There *seems to be* only one stream following triage at present, with the most serious cases being treated first. But queue theory shows that this will result in thousands more hours waiting time than if a small number of doctors could be allocated to an additional stream that treated patients on a different sequence, based on which would be the quickest ones to treat, dealing with simpler and lower priority problems.
At present the waiting rooms are full to overflowing, speaking from a lot of experience in different London NHS hospital A&E departments, namely Northwick Park, Charing Cross and St Mary’s. The waiting time clocked up by those lower-priority patients is enormous, compared to little for the very serious, of course. Since the high priority are dealt with comparatively quickly, total waiting time can only be reduced by processing the lower priority ones immediately. This can be done by sending them to a different department. They would not have to wait while the high priority patients take hours and hours to be processed. Don’t think of it as a hospital treating low priority patients faster, think of it as two separate departments or hospitals. So after triage, you get sent to either “St Peter’s” or “St Paul’s”, as it were.
To visualise how that helps, think about waiting in line at a local Post Office where there is only one counter attendant. Maybe you have a parcel to send, or want to buy stamps – something simple. Probably most of the people in line also need something quick and easy. But there are also some in line, one at the front probably at any given time, whose business with the cashier takes ages and ages. He has a sack of parcels, is changing a lot of money, or has other complex dealings. You might be familiar with this scenario.
Now imagine if, on top of that, there were a triage system on entry to the same Post Office and it was setup so that the people who needed the most time at the counter had to be served first while the rest had to wait. Those who had what would be the quickest tasks would be made to wait till last.
And not only that but all the while, people with more time-consuming tasks for the Post Office cashier continue to come in and get sent to the front of the queue, so the quick task people may never get served at all. That is what’s happening in A&E’s now.
One anecdote I can cite as evidence that this is true. I was waiting in my GP’s waiting room and two or three other people were sitting close by. We didn’t mind because my GP at that time afforded plenty of time to each patient. I overheard the man sitting next to me, whom I didn’t know, telling his neighbour that he’d spent all night in an A&E waiting room – he actually said “24 hours” – and had given up. So what? you might ask. His complaint, which he mentioned, was “a sore throat”.
They rightly don’t allow filming or photographing in the waiting rooms but you really should see how bad it is at any hour in Northwick Park, which I think is the busiest of all. But also the others are overwhelmed too. Charing Cross hasn’t got enough space to seat all waiting. Getting through triage there only gets you into another separate waiting room “of the blessed” if I may be a little bit funny about it, though it isn’t.
None of this is the fault of the staff. They are heroic. So please give every triage room the option of sending their client to “St Peter’s” or “St Paul’s”.
Stephen Moran
Yvette Cooper, Gareth Thomas MP, Andy Burnham and others please copy.
