Newspapers in the UK have carried very alarming reports of overcrowded Accident and Emergency departments with prolonged waits on trolleys, which can go on for more than 24 hours.[1] While they are on trolleys, patients cannot be properly looked after. Such trolley waits are unsafe. Not only are they unsafe, but they are almost unbearably unpleasant. There have even been reports of one patient vomiting on top of another.[2]
There is not much that can be done about this at the supply-side. At least not in the short-term. The wards are full and there is insufficient capacity in social care to absorb demand. This suggests that we should look carefully at the demand-side. I noticed in the report by The Times newspaper [2] that most of the human stories they reported related to people in their 90s, who often had dementia. This made me wonder whether they should have been referred to hospital in the first place. Would many of these people, if they were aware of circumstances that awaited them in the hospital, have chosen to remain where they were? Many were presumably sent in from nursing homes where the care may have been no worse than what they would receive in hospital.
So, I propose that nursing homes and community clinicians should receive an up-to-date stream of information about conditions in local emergency departments. Then they could legitimately take these into account when counselling patients who are able to give consent and in making decisions on behalf of those who are unable to consent. As hospital-at-home / integrated care is rolled-out, we can hope (maybe even anticipate) that a policy of non-referral will become ever more acceptable.
In many circumstances, keeping a patient in the community would be both more humane and no less safe than sending them to hospital. Such a policy should be officially endorsed to minimise the risk that staff would be compelled to send people to hospital, to remove the threat of litigation or investigation.
— Richard Lilford, ARC WM Director
References:
- Triggle N. Patients dying in hospital corridors, say nurses. BBC News. 16 January 2025.
- Hayward E. Deaths in corridors and miscarriages in waiting rooms: the NHS’s A&E crisis. The Times. 16 January 2025.