The highs and lows of frontline hospital services

DRUNKEN and drug abusing patients taking their aggression out on unlucky doctors or nurses is a common sight in Britain s casualty units. But despite a reported rise in violent attacks against NHS staff, morale appears to be running high among the A&E te

DRUNKEN and drug abusing patients taking their aggression out on unlucky doctors or nurses is a common sight in Britain's casualty units.

But despite a reported rise in violent attacks against NHS staff, morale appears to be running high among the A&E team at St Mary's Hospital in Paddington.

The department's high spirits could be related to the fact that they topped the Healthcare Commission's recent review of London and the south east's emergency services.

Julia Gamston, a 41-year-old senior nurse who I met while on a tour of the A&E, seemed particularly buoyed by her team's success.

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She said: "I'm quite proud of what we've achieved. I love working here - it's a great place and great people. I look forward to getting up and coming to work here.

"What I love about this job is that you don't have a typical day. You sometimes have fixed jobs but then when you come in something happens and you have to forget all that."

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But while managing to keep her zeal for the rough and tumble of frontline medicine during 18 years of service, she admits it can be tough at times.

"People don't wait a fraction of the time they used to - but if people are waiting they get anxious and sometimes they can be aggressive and abusive.

"That has lessened because we are dealing with people a lot quicker and informing them better.

"But there will always be an element of aggression and abuse in hospitals when people are coming in under the influence of alcohol and drugs.

"We have security guards to help but they can sometimes aggravate a situation that you could talk down yourself."

But these violent scenes are a world away from the serene calm I faced as I walked into the hospital's emergency department.

Children were playing happily in the play area near the waiting room, patients were lying quietly in their cubicles and staff were going efficiently about their business. There were no blaring ambulance sirens, no screaming babies and definitely no belligerent drunks.

The only teaser of the bone fide "ER" experience I had hoped for was when an alarm went off to let staff know a serious case was coming in.

A group of doctors and nurses swung into action on the instructions of the London Ambulance crew who had radioed ahead to tell them a stroke victim was on his way.

Emergency teams generally have three to five minutes to prepare before a patient comes in and, with a major trauma, there can be up to nine doctors and five nurses called in.

A patient with heart problems can expect to be in A&E for just three or four minutes before they go up one floor for a CT scan.

But disappointingly, I was denied the chance to see this process in action - led away before the ambulance crew and patient arrived.

After joking about how quiet the department seemed, I was informed by Dr Julian Redhead, chief of service for emergency medicine, that in fact they were relatively busy that day.

From a patient's point of view, it must be preferable not to be met with chaos and carnage - even if these are the images television script writers like to create.

During his 10 years as an A&E consultant, Dr Redhead has seen a transformation in emergency services.

"I've been here for five years and a consultant for 10 years," he said.

"There's been a huge change in A&E with the onset of hospital targets - aiming for four hours' wait and achieving the treatment of 98 per cent of patients within that time.

"Before these targets, patients were waiting up to 12 hours. But now we achieve the targets - so the expectations are being met.

"There were never the same expectations before. Nobody thought they needed to invest and reduce the waiting times.

"With targets, there was a change in the way we treated patients and we adopted a more efficient, whole hospital approach with much closer workings between medical staff."

A less welcome development witnessed by the 40-year-old consultant is the increasing numbers of teenagers coming in with knife wounds.

"We have also seen a rise in the amount of stabbing injuries," he said. "We see about four or five a month and the patients are getting younger - going down to 15 or 16 over the last year or two.

"People see programmes like Casualty where someone gets stabbed and they survive.

"But the reality is that many patients do die from small, innocuous wounds about a centimetre long.

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