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Don't sweat the small stuff

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996172.  Mon May 13, 2013 5:35 pm Reply with quote

On the BBC you can see which stories are the most read and shared, and other media websites also have similar features, so it's not exactly a big surprise to anyone who visits such sites that some of the most prominent political stories are not usually the most read.

I like the Populus idea of surveying people about which stories they most noticed in the previous week, I think it's worth keeping an eye on.

For last week:

996174.  Mon May 13, 2013 5:37 pm Reply with quote

Makes you wonder who the Tory backbenchers are really representing with their fascination with the EU referendum.

996179.  Mon May 13, 2013 5:49 pm Reply with quote

Themselves, I rather fear.

My wonderful MP once claimed to "know" that "most of his constituents" are with him in wanting to leave the EU. He may be right or he may be wrong, but he can't "know" that because he hasn't asked them.

He also claims to "know" that "most of his constituents" are opposed to the Estuary Airport idea. On this one he probably is right - but he can't "know", since he hasn't asked most of them.

996194.  Mon May 13, 2013 7:40 pm Reply with quote

I also note that more people noticed the rise of UKIP than the local elections, and I blame the hysterical response from the Tories and the over reporting from the media.

Sadurian Mike
996265.  Tue May 14, 2013 5:12 am Reply with quote

I wrote to my local MP putting down sound reasons why our local A&E shouldn't be closed, and asking for him to oppose it.

He wrote back to tell me that he supported closing the A&E and wouldn't oppose it.

Am I missing something?

996295.  Tue May 14, 2013 7:07 am Reply with quote

Depends on which party he belongs to and whether their manifesto includes closing down some A&Es.

Did he give any reasons why he wouldn't oppose it? If not I'd write to the local paper and publish that response to show him up. No matter whether an MP agrees or opposes what you ask, at least he should explain his reasons, not simply follow party lines.

Sadurian Mike
996302.  Tue May 14, 2013 7:26 am Reply with quote

No reasons given other than he was in favour of closing it down. It did subsequently close, which means Rugby, population over 60,000, has no A&E at all, and has to use the A&E at Coventry (a half hour journey in light traffic). So much for the principle of the Golden Hour of emergency medicine.

Because a local MP is supposed to represent the concerns of his or her community, I was somewhat surprised that no explanation was given as to why he supported closure. The local consensus is that Coventry is a government-backed Foundation Trust hospital, and is therefore having all the patients possible sent to it to reinforce how successful it is in attracting trade....

Let's hope my angina doesn't deteriorate.

996374.  Tue May 14, 2013 3:06 pm Reply with quote

There are perfectly valid reasons why the closure of an A&E department would benefit the healthcare of a community, especially in an urban environment, The problem occurs because the argument is so emotive, reason often goes out of the window.

Sadurian Mike
996388.  Tue May 14, 2013 4:01 pm Reply with quote

There are perfectly valid reasons? Such as making a five minute journey into 30 minutes or longer?

The A&E centre in Rugby was perfectly good and the building is still being used a specialist centre for some conditions, so it is not a case of the buildings being sold off or being somehow inadequate. There are no beneficial healthcare reasons for closing it, purely financial. It served a large enough population to be busy and thus viable. There are and were no access issues to the site.

Now that it is gone, the already busy A&E at Coventry will have more to cope with without being expanded, inevitably negatively impacting on the quality of service. It is also in a completely different city, at least half an hour away, and considerably more if the motorway is shut or busy. The 'Golden Hour' of emergency care says that the sooner a patient is properly treated, the better their survival. An hour is the maximum where this applies, as a patient will have either died by then or is not serious enough to die in the first place.

Ambulances, already stretched, now have at least an hour round trip for a single patient, not taking into account handover at a busy A&E. That effectively takes more emergency ambulances out of commission.

Lastly, and not least. A patient taken by ambulance to A&E and released now has a long and expensive journey back home, often in the middle of the night, because they have been taken out of their home town and taken to another city.

That is not an emotive issue, that is one of sensible emergency health care being subsumed by politics.

996399.  Tue May 14, 2013 4:39 pm Reply with quote

When they closed the Edgware A&E there was a lot of uproar, and I think that because of this they stopped short of getting rid of the whole hospital altogether and created a walk in centre which is busier than Barnet or Northwick Park A&Es.

A friend of mine works in Edgware and she tells me they reckon more than half the ambulances that arrive in Northwick Park are from their walk in centre because of the number of people they have to send there when it's something they're now not equipped to deal with.

How that helps the community, or the costs for the local councils, I really don't know.

996475.  Wed May 15, 2013 1:07 am Reply with quote

The problem is that a lot of A&E usage is for things you should be seeing your GP for. They are trauma centres not walk in clinics.
The one thing, and the most important thing in healthcare, is the quality of care that you receive and once you have a hospital with no A&E you then free up the GP appointments that the majority of people are attending for.

Lets use your angina as an example.
With no A&E dept in your hospital, your full treatment can be managed by your cardiologist, not your GP. That is because he doesn't need to be on stand by just in case someone walks in to A&E with indigestion. You won't have to wait for 18 weeks to get an appointment to be told that you are now on the second step of your treatment, because your GP will be able to know when the right appointment is available because he knows that the chest pain clinic will be run on the second Wednesday of the month, and the specialist will be available all day (because he won't get bleeped by A&E for the indigestion case). You'll get to your appointment a 2pm on the second Wednesday, and the appointment will be at 2pm not 3.30 because the doctor you are seeing has been called away.
So far - this is making your treatment better for you (royal you not just you individual) because it is more efficient.

That now takes your concerns about your treatment and illness away from your GP, giving him (or her) more time to treat those that currently use A&E as a walk in health centre (which is quite a lot of them), leaving the A&E dept to deal with the accidents and the emergencies rather than the can't wait to see the GPs. So that improves the patient experience in A&E.

The one down side to this is that it gives people a longer journey time to get home after they have been seen, well that is a bit tough because the hospital is responsible for the care of the patient, not the transport. That is the patient's concern. And most hospitals have a transport department that will gladly take you home if you find yourself unable to get there after you have arrived by ambulance.

For those that take longer to arrive by ambulance, the most important thing to them is they get better, that means the patient needs to be in a stable condition before transporting them, the last thing the paramedics want is for you to take a turn for the worse while you are being moved, so in the vast majority of cases that extra time taken will not make any difference to you recovery. What is key in your recovery following an ambulance call out is the quality of care you receive, not the time it takes you to get to that care once you have been stablised on the scene.

As I said, it is an emotive issue because all you can see is that part of your hospital is closing, not the benefit you will get once our local hospital becomes elective.

On a side note, this closure of departments - for some reason it seems to be the coalition that are getting the blame for stripping back services. That isn't the case. It takes a good 5 years of consultation before an A&E is closed, and they haven't been in charge long enough for them to be closing A&Es

Sadurian Mike
996486.  Wed May 15, 2013 1:51 am Reply with quote

So... because some people misuse the A&E, it is right that it gets shut so as to force them to see their GP? That will improve health care across the board?

Your case is a very weak one, and based solely on an assumption that everyone going to A&E is a time waster using it instead of a GP appointment.

Oh, and I have never been to A&E with angina, apart from once when the first-aiders at work panicked and called an ambulance because they saw me doubling over with chest pains and I was in no position to explain.

996488.  Wed May 15, 2013 1:55 am Reply with quote

WE have similar problems in Australia with misuse of our A & E departments. At my local hospital, a lot of the welfare recipients think that they'll be seen quicker there than at a clinic nearby, which does have a wait of around an hour or more.
But surely that is better than 5-6 hours in the hospital, sometimes with their fussy kids as well, who get bored.

Sadurian Mike
996497.  Wed May 15, 2013 3:10 am Reply with quote

The problem is of throwing the baby out with the bathwater. Obviously you are going to get people using A&E for routine complaints that should be seen by a GP.

GPs, however, cannot and should not have to cope with emergency heart attacks, trauma, third-degree burns, strokes and so on. This is what A&E departments are for and by closing one down, those patients are genuinely put at increased risk.

Ambulance paramedics are able, in many cases, to stabilise patients on the scene, but even they are aware that the priority is get the patient to the A&E facilities as soon as possible. Stabilising is not the same as saving, and that's why ambulances do not usually treat and leave, they treat and take the patient to the facilities of the A&E department. Stabilising only delays further deterioration, it is not a cure.

In any case, closing an A&E does not solve the problem of inappropriate use, it simply moves it on to the next available A&E.

Sadurian Mike
996508.  Wed May 15, 2013 3:30 am Reply with quote

I should also point out that people who are ill and usually cannot get to see a GP quickly (within the week in our case here), might genuinely believe that their illness is more serious than it actually is.

Not everyone is able to self-diagnose accurately, and using a reference such as the internet is more likely to result in a more serious indication than is actually the case, simply because it is natural to see a little hypochondria creep in when you are feeling rough.


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