The future shape of accident and emergency servicesBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7033.720 (Published 23 March 1996) Cite this as: BMJ 1996;312:720
- Penny Newman
- Fellow King's Fund, London W1M 0AN
Cannot be considered in isolation
Emergency services are under strain across the board in Britain, as demand for out of hours visits from general practitioners, new attendances to accident and emergency departments, and emergency admissions increase. The crucial importance of scarce specialist resources as back up to accident and emergency departments was illustrated in the recent case of Nicolas Geldard, who died in December after ambulance crews visited four hospitals before finding one that could provide computed tomography and a neurosurgical bed.1 The latest report from the Audit Commission into initial hospital emergency care2 substantiates reports of pressure on accident and emergency departments. Increasing attendances and staff shortages mean that patients still wait for long periods before they are seen by a doctor, delays that are often related to meeting Patient's Charter standards. Junior doctors are in short supply, 60% of departments have only one casualty consultant, and only three of the 11 sites visited by the commission had on site, around the clock, experienced medical cover.
Once a patient requires admission, the commission found that long trolley waits for beds and “logjams” in …