How hospitals manage emergency admissions needs to be examined

EDITOR—Smith was right to suggest that the debate on the NHS should shift to something more important than waiting lists.1 Waiting lists are used by politicians as an indicator of the success or failure of the health service, yet they are merely a measure of how much we as a society wish to spend on the health service. What should be exercising our minds is the ability of hospitals to manage emergency admissions other than those politically important ones occurring over the winter as a result of inclement weather. In 1984 it was recognised that over half of all surgical admissions were emergencies,2 and this has not changed; yet patients admitted as a surgical emergency receive a poor service. At worst they may be operated on at inappropriate times by inappropriate surgeons, although we know this is wrong. Alternatively, they may wait for days for expert opinion or investigation and, when finally scheduled for surgery, find themselves jockeying for position on the emergency theatre list, if such a list exists.3

Hospitals need to examine what happens to emergency patients after admission with as much attention to detail as they currently examine waiting lists. They could find the results worrying, from both a financial and a quality point of view.

Medical profession must change things itself

EDITOR—Smith's editorial about health policy is timely, but I wonder about relying on the government to ensure good quality care and improve health.1 As Smith points out, globalisation and economic forces limit the government's ability to improve health. The recent …