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NHS Networks blog March 2014

The levelling smell of A&E

This week’s blog comes to you from A&E. This is not to give the blog extra med-cred, like those television interviews with doctors and nurses shot in their natural habitat, or because the author is moonlighting as a CQC inspector, or to ask for your sympathy, or to explain the lack of jokes, or to make up for being insufficiently horrid to Sir David Nicholson last week.

The relevance of this background information is that anyone who spends time in a busy hospital department, and particularly A&E, can’t avoid being struck by a few things.

The first is difficult to state without resorting to clichés about tireless dedication and consummate professionalism, so we’ll take it as read.

The next obvious conclusion is that compassion has nothing to do with culture or training, and everything to do with recruitment. If your staff lacked compassion when you hired them, they won’t have acquired it in the classroom or on the ward.

But that’s not really the point either. Spend a couple of hours watching the nurse putting the bewildered patient back to bed for the third time, explaining to the man with an important job to get back to that he’ll have to wait his turn, or reassuring a frightened patient who doesn’t want to be kept in overnight that the pain in her stomach is nothing to worry about.

The vital ingredient is not compassion but patience. You can have the former without the latter, but a caring person with a short fuse is no good to anyone.

The other thing you realise is that most people really don’t want to be here. They are not hell-bent on the destruction of the NHS through mischievous acts of inappropriate attendance, they are here because there was not a more suitable service or, if there was, no one had explained where to go for it.

The swaggering young man, flanked by police officers, with gashes to his shaved head turns up on cue. Chances are he didn’t get his injuries making an advert for The Guardian about the dangers of social stereotyping. Him and people like him are costing the NHS money it shouldn’t be spending, just as people like us are running up unnecessary bills when the baby’s distress turns out to be colic, or the suspected multiple fracture heals on the way to hospital, leaving only a bad bruise behind.

There’s a difference in degree, but not a difference in kind. The beer-fuelled brawling thug is an unlovely character, but who would really leave him bleeding in the street?

Try asking an A&E nurse how many times in a week she inwardly curses a patient who shouldn’t be in her department. Chances are the question will never have occurred to her.

There’s a Perspex holder on the wall by the toilet and a few others tucked away where only the sharpest eyes will spot them: “Tell us about your care”.

Those of us who notice it will fill in the form, gratefully confirming that we would recommend the service to family and friends. It’s an odd graft from the world of corporate marketing this question.  We are being asked to recommend an experience we would not wish on anyone, surrounded by the cries of the suffering and the levelling smell of excrement.

“I hate it here,” said one woman, queuing with her little plastic carton to produce a specimen.

“I’m here all the time,” she added, with a hint of pride.

Which is the last point that a visit to A&E brings home.  Even at the sharp end, the NHS is not only a medical institution but a place where the deserving and the undeserving have equal rights. Measure A&E by resources, targets, outputs, clinical need or entitlement and you’ll miss that point.

The people who work here already get it. It’s the rest of us who need to catch up.

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