A lay perspective and commentary on the association between delays to patient admission from the emergency department and all-cause 30-day mortality.

Abstract

A&E is a brand; it is among the best known brands in the UK and is trusted and loved by the UK public. Why? Because they know when all else fails, when other agencies just don’t or won’t respond, their local A&E department will be there for them 24/7, 365 days a year. Confirmation of this is available daily in every emergency department in the UK, with patient attendances at the highest since the inception of the National Health Service (NHS). Yet, as the paper by Moulton and colleagues reports, this trust and indeed the dedicated service of the clinicians is being undermined by a killer and one that for far too long the government, NHS leadership, trust boards and their chief executives have chosen to ignore or simply blame patients for having the temerity to turn up. For at least the last 12 years and more, we have seen cuts after cuts to the budget of the NHS, leading to reduced bed numbers and staffing. This is bad enough in itself but has been further compounded by repeated large reductions in central government financial support to local authorities, with a devastating impact on social care. The result has been fewer beds in hospitals and a grave lack of social care provision for those patients ready for discharge, or as it is called, exit block and delayed timely admission. Thanks to this report, we now have confirmation that such delay kills patients. UK patients and the population as a whole love their NHS, they know only too well that it is not perfect, and they are prepared to be forgiving when things go wrong, perhaps too forgiving. Most people, for instance, wait patiently for hours to be seen in A&E. However, patients have an absolute right to be informed when their trust in a service has serious consequences for their wellbeing and also, possibly, their life. As ever, it is the elderly/frail and those living in deprived communities who are most likely to be affected. From the perspective of the patient, and certainly from those of us who have the privilege to represent patient interest, one statement and one fact stand out. Within the Conclusions it states: