Richard Kirkman: My finger was poorly and so I went to accident and emergency

The Journal's Richard Kirkman on one reason why casualty departments are under pressure - too many people with trivial ailments are sent there

Accident and Emergency
Accident and Emergency

This is going to sound bad. I had a poorly finger and I went to the accident and emergency department of my nearest hospital.

A&E departments are stretched, we all know that. It might be to do with a shortage of money, it might be to do with botched reforms in the NHS. It is certainly a lot to do with time-wasters turning up at A&E with precious little wrong with them. Healthy, middle-aged men with poorly fingers, for example.

I do, however, have an excuse. And it turns out I am among hundreds of thousands of people to have the same excuse. And it may go some way to explaining just why it is that A&E departments are under such pressure.

But first, back to that finger. One Thursday morning the ring finger of my right hand suddenly began swelling up as I was out walking the dog. First it was the top of the finger, then it spread down the whole of the digit.

By the time I arrived back at home the entire finger had reddened and assumed a sausage-like appearance. It wasn’t painful, but it certainly wasn’t comfortable. I couldn’t bend it. And I certainly couldn’t get my ring off.

I decided, being a man, that I would ignore it in the hope that it would go away. I did think that if I could get the ring off the swelling might have a chance to go down. But that ring, which I’d worn for 30 years, wasn’t coming off. I couldn’t even move it.

By the time my wife came home the finger hadn’t swelled any further but its colour was now an interesting purple, shading into black. “What do you think of that?” I asked her. Sensibly, she told me to ring the NHS 111 healthline, which, to be honest, I should have done hours earlier.

I’m not quite sure what I was expecting. To be sent to the nurse practitioner at my doctor’s, perhaps, or maybe to an NHS walk-in centre. But the lady on the line told me to get myself down to A&E.

According to Cliff Mann, the president of the College of Emergency Medicine, there were an extra 450,000 attendances at A&E departments last year, compared to the year before. Of those, 220,000 were advised to go there by the NHS 111 service, while another 220,000 had an ambulance sent for them by the 111 service. Therefore, 111 was almost entirely responsible for the steep rise in attendances in casualty departments.

Of course, this isn’t the whole story. A number of those 450,000 really were in need of emergency treatment and the reference by the 111 service would undoubtedly have saved their lives. But the extra numbers are too startling to be ignored.

The 111 line, which is staffed by call-handlers, replaced NHS Direct, which was staffed by nurses. The conclusion that must be drawn is that the nurses used their greater experience to diagnose who and who did not need emergency treatment. The call handlers’ greater number of referrals is a belt-and-braces approach that covers them but adds to the pressure in A&E.

As it turned out, my own silly experience didn’t cost anyone their lives or add to the chaos in casualty. I felt like an utter prawn walking into A&E at North Tyneside General, me and my purple finger. I turned up at about 7pm, fully expecting to go to the the back of every triage queue there was. I thought I’d be there until midnight.

But I was lucky. That Thursday night was quiet and within an hour a nice nurse had cut off the ring with a clever bit of kit and I was on my way home. By the following morning the swelling was coming down, though the finger retained its funny colour for a week or so.

I took the mangled ring to one of those cash for gold places and got a few quid for it. It won’t be replaced. I’m looking after that finger from now on. I never want to take it to A&E again.

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