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Tuesday, December 22, 2009

Christmas recess on tour

Having spent an interested morning yesterday at Swansea Council's Neighbourhood Support Unit and freaking out my work experience student at how detailed the CCTV coverage of Wind Street is, I called in this morning to meet doctors and nurses at Morriston Hospital's Accident and Emergency Department.

Despite it being early in the day the department was still very busy. Obviously the snow has taken its toll but so has the fact that Morriston Hospital is running at 95% to 100% occupancy on its acute beds and some wards are closed to admissions in Singleton due to a novovirus outbreak. This means that a few patients spent all night in the trolley bays awaiting admission, whilst the staff's ability to admit people quickly and make room for new patients is limited. As a result breaches of the four hour target time are common.

This is not a criticism of the staff. As ever they are dedicated and hard-working but with some on long term sick and with agency and bank workers not always available the unit is under-resourced. Indeed I was told that the department's budget only allows a 4% leeway for sickness. In my experience 15% is more normal to ensure full coverage. Together with the shortage of acute beds this leads to bottlenecks, with ambulances not always able to handover patients promptly and with trolley bays being unavailable for new patients.

All of those I spoke to said that alcohol was a problem with between one fifth and half of all patients presenting themselves at A&E being under the influence. Verbal abuse is a daily occurrence though violence less so but the Health Board operates a zero tolerance policy towards all such incidents. All agreed that CCTV in the unit would be an advantage. Unfortunately, Morriston was not included in the recent pilot scheme announced by the Minister.

Of some concern was the position of the paediatric accident and emergency unit. Ideally this should be open 24 hours but there are not enough staff to ensure this happens. Instead it is open 9am to 9pm. Outside those hours children attend the normal accident and emergency department, which is not good practice.

I was shocked when I was told that although the staff have access to the child protection register and the list of looked-after children this only applies to the Swansea Council area. This is despite the fact that Swansea is a tourist area and that as a matter of routine Morriston receives patients from Llanelli, Neath Port Talbot and further afield.

This is the case with all accident and emergency units so it is possible for someone to bring a child to a different hospital after each incident without staff having access to the necessary information to establish a pattern. It is far easier to flag up concerns and to follow them through if staff have access to these registers.

It seems to me that there is a case for an all-Wales register of vulnerable and looked after children that can be accessed at Accident and Emergency Departments, which are often not restricted to local authority boundaries in the patients they see. Such a register could improve the way that health professionals respond to incidents and save lives.
My grandfather was recently treated at Morriston for a non caergonic basal cancer and is due to visit again on Christmas Eve for a check up. Would you like his opinions of the service at Morriston?
Like mine, again it's not the nursing staff although sitting listening to two nurses talking about which doctor they want to bed, and then a doctor talking to a nurse asking is she on the pill because he does not want to risk kids yet. It was entertaining. Then a doctor said better get back to the animals. when he came in a lady snorted like e pig and he just went red as he realized everyone had heard his talk on sex education to the nurse.
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