'There's no dignity in this' – A&E under pressure


Lisa Blackwell, an emergency department nurse at Chesterfield Hospital in Derbyshire, pleads for more oxygen as three ambulances are about to arrive at the already overburdened facility. Despite being a state-of-the-art A&E unit, it is struggling to keep up with the volume of patients it serves. BBC News recorded numerous instances where all 22 cubicles were full, causing an overflow into the corridors. Senior matron Stacie Russon states plainly: “There’s no dignity in this.”

An elderly woman has fallen on the ice outside and has a deep cut on her forehead. Drips of blood stain her cheeks as a nurse passes by with a blood pressure stand. Five trolleys are lined up outside the cubicles while a patient ahead is vomiting into a sick bowl on his bed. While flu numbers are finally dropping, the cold snap is causing further problems. “The cold and ice isn’t a good combination for elderly people,” says Dr. Dan Crook, clinical co-lead in the emergency department.

Another patient, 83-year-old Michael Alton, is in the resuscitation bay due to hypothermia. When Mr Alton arrived, his body temperature had fallen to 30.6°C (87°F). His neighbour found him and opted to take him to the hospital himself. As the hospital staff takes his blood, they quickly use heating blankets to restore his temperature back to the average range of around 37°C (99°F). He is weak and disoriented.

In the meantime, Dr. Dan Crook’s emergency pager beeps, and he rushes off to the ambulance arrival bay. James Oakes is an elderly, hypothermic, and confused patient who paramedics suspect may be in the early stages of sepsis. Unfortunately, the resuscitation bay is already full, meaning that he is assessed and stabilized in the ambulance area instead. However, once he is moved into a cubicle, a nurse finally has an opportunity to remove his muddy Wellington boots. “How long will I be here for?” Oakes asks. “I’ve never been to the hospital before, and I don’t want to stay here long.”

The flow of patients through a hospital, particularly moving on those who can safely leave, is a crucial and challenging activity. Dr. Hal Spencer, medical consultant and chief executive of the Chesterfield Royal, reveals that approximately 80 beds out of 540 are occupied by patients who are otherwise fit to leave but can’t due to social care or other home-related problems. Some have even been admitted when there is nothing fundamentally wrong with them, but they have nowhere else safe to go. “It makes it very difficult because it means we don’t have the capacity to look after people who need care most, but when it’s 2 a.m., we end up looking after these people – it’s the right thing to do,” says Dr. Spencer. The staff at Chesterfield Hospital is doing what it can, but it’s nowhere near what it should be, reducing their care capacity

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