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11 hours in A&E
A Sunday night that opened my eyes to this country's most pressing crisis
By Sophie Atkinson
It’s about five in the afternoon when my partner clutches at his chest, wincing. I’ve been away all week working in Germany, and he mentioned something about chest pain on the phone a few days earlier, but he didn’t seem concerned, so I wasn’t either. But suddenly there’s a persistent pressure and discomfort, like a hand pressing down hard on his chest and he’s short of breath. Sometimes this twists into pain sharp enough to arrest him mid-sentence.
He calls 111, describes his symptoms and they ask him to go to A&E at the nearest big hospital, which is the MRI (Manchester Royal Infirmary). They offer an ambulance, “but it would take a few hours,” they say, adding “but definitely don’t drive yourself.” Obviously, I drive him instead, quietly wondering how this moment must feel for people who live alone.
It’s relatively empty when we arrive at six that Sunday evening. The initial assessment happens after 40 minutes and then 50 minutes after that, he gets tests done. I am not worried, or maybe I am. He’s 28, and who has heart problems when they’re only in the winter of their twenties? But the discomfort seems constant and he is very quiet.
At a loss for anything else helpful to do, occasionally I bob up and ask the receptionist if he’s still on the list and she nods. I’ve been watching her for a second, and she is impervious to both charm and pressure — doling out darlings to everyone but not yielding an inch. You’d probably need this quality to work there long-term. Little by little, A&E is filling up.
A man in a grey t-shirt bursts into the room. By this time, the rows of seats are all full — we’re sat in near-silence, he’s the only figure standing: it feels like the set of a play. He starts shouting as soon as he enters the A&E: “Is there a wheelchair? Can anyone get me a wheelchair?” Everyone cranes to look at him but nobody answers, we’re all too taken aback. He paces up to reception. “There’s a woman outside — she can’t walk, she needs help, do you have a wheelchair?”
The receptionist gestures languidly around a corner: “There should be some there.” He returns a moment later: “Do you have to pay for them?” I didn’t understand this at the time, but later my partner will confirm: there are slots in the wheelchairs for coins, like the trolleys at a supermarket. He interrogates this further — are there any unchained wheelchairs? She thinks there may be some outside (the hospital later tells me they do provide free wheelchairs).
There aren’t any outside. He comes back in, asks the receptionist for help. Mostly, people are eyeballing the floor at this point, it’s become too painful. She doesn’t respond and he storms out. He doesn’t appear to have any coins for the wheelchair (you need a pound to unlock them). After a moment or two, I follow him out of A&E to the car park. A tall woman with blonde hair cut just below her chin in fawn-coloured PVC trousers and a grey jacket is slumped forward in the passenger seat in a small black car and he’s by the open door, trying to wake her and talk to her.
I ask if I can help, and he nods. He explains that this is his partner, that she returned from an evening out with a friend, they’d only gone for a few drinks, but something was off. After a couple of hours, she got worse and worse. Later, I’ll find out that she’s in her early thirties, and he looks around the same age. He reckons she’s had her drink spiked. She wouldn’t get this out of it on her own, they’ve got a seven-month-old at home. By this point, we’ve managed to wrestle her out of the car and her right arm is around the man’s shoulders and her left arm is around me.
The whole way we walk across the car park, he’s explaining the situation to me, and then he’ll break off to talk to her, encourage her, stroke her hair. I’ve never seen anyone who has been spiked before and it’s frightening. She doesn’t seem to be fully in her body: the lights are on but nobody’s home. Moving her isn’t hard because she’s heavy, but because her movements are so erratic that it’s hard to plan each next step.
We half-carry her to a seat near mine, but she still isn’t able to sit up by herself, so her boyfriend stands in front of her, propping her up under her armpits. He calls out her details to the receptionist, apologises for losing his temper before, but then backtracks: but it’s stupid that you don’t have any wheelchairs for someone who isn’t capable of walking.
Then he turns to the security guard, who watched us while we were moving his girlfriend from the car. “Why didn’t you help?” he asks him. “She helped, why didn’t you help?” The security guard shifts uncomfortably. “I can’t, mate. We’re not allowed to, it’s against the rules.” His voice gets louder: “So if a person was lying dying in front of you, you wouldn’t help them, because it’s against the rules?” The security guard tells him to quieten down.
Eventually, the glare of the overhead lights and the strangeness of the room must bring her back into herself, because ten minutes later the woman comes to enough to register her surroundings. She looks around in sudden panic and begins crying, and her boyfriend strokes her hair, soothes her: don’t worry, I’m here. A nurse and doctor appear from nowhere and take her away, along with the man.
It soon seems like the doctor, who is very justifiably attending to one of the most urgently ill people in the room, is in fact one of very few doctors on call tonight. The rate at which people are being called in to see the doctors was slow before, now it’s slow motion. My partner gets talking to a 70-year-old man in a wheelchair who has been waiting since 2pm (he ends up getting treatment at 3am).
The room gets more and more full. It’s just past half ten, we’ve been there for four and a half hours. An announcement comes through the tannoy: there are now 53 people waiting, the average person who registers now will see a doctor in eight hours.
I flew from Berlin that morning — my flight was delayed, so I’ve already played the waiting game for another four hours earlier that day. The story above might paint me as a Good Samaritan, but this is deceptive. Ultimately, I’m a flawed and disappointing person. Which is to say, when my partner asks me if I want to go home, I say I do. I’ll leave my phone on and he’ll call me if there’s anything.
At five in the morning, my phone rings. I’ve taken his keys, so I have to let him in. I go downstairs. “What did the test say?” He shakes his head: “I’ve not been seen.” He had waited for eleven hours. He wears contact lenses, so his eyes are bloodshot to the point where you can barely make out any white.
The staff, he insists, were great. It wasn’t that the doctors or office staff we saw weren’t hard working enough. It just was that there weren’t enough of them or enough of anything. The water cooler stayed empty for 10 hours and someone had forgotten to fill it, or hadn’t had time. The security guard left the front door open for over five hours, which meant the entire room was freezing, people shivering in their coats. Somebody asked him to close the door and he didn’t know how to do it. Eventually, when a new security guard took over the shift, he finally figured out a way to close the door.
There’s a weirdness to the layout of that A&E department. What person, reeling from some awful injury, needs to buy a lottery ticket while they wait to see a doctor? If they wanted to, they could: there’s a lottery vending machine in reception. Why, for that matter, is there a WHSmith next to reception but no free water?
Later, he saw a man and his girlfriend approaching the receptionist. “Excuse me, there’s a sign here saying that we should let you know if we are in a lot of pain. My partner is in a lot of pain.” The receptionist looks up, nonplussed: “Most people here are.” There was a man who had come all the way from Preston with a head injury, his head was bleeding and as the hours ticked by, his speech became more and more slurred. When my partner left at 5am, he’d been waiting for three hours and the man with the head injury hadn’t been seen yet.
A teenage boy arrived with a bleeding hand, he’d cut it on some glass, he called an ambulance and waited for two or three hours but it never arrived, so he took an Uber instead. There was a man with severe mental health issues talking to himself, which was fine, up until the point when he started swearing, when the security guard warned him he’d be ejected for using “foul language.” They seemed less worried about whatever he was there for: he hadn’t had the initial assessment by the time my partner left.
In the Uber on the way home, the driver commiserates with my partner’s misfortune: “But you should never go to A&E in the Royal Infirmary. Go to Salford instead.” (Perhaps this is true, although as The Mill revealed in August, inspectors from the Care Quality Commission described Salford Royal’s A&E as unsafe on a visit so disastrous that an inspector had to comfort a nurse who had broken down crying). In the morning, I shake him awake, call his local GP over and over (there’s no service allowing you to wait on hold, you just get a busy signal), drag him there. The GP claps him on the back, provokingly hearty. “Bad luck!” he said. But nothing serious: costochondritis, an inflammation of the cartilage that connects your rib to your sternum. Hurts badly but you just have to wait til the pain passes.
When I asked them about my partner’s experience, a spokesperson for Manchester University NHS Foundation Trust told me: “Like many Emergency Departments (ED), Manchester Royal Infirmary ED regularly experiences periods of high demand, and patients are triaged and treated according to clinical priority. Our teams continue to work extremely hard, however there will be occasions when some patients may need to wait a little longer; and we thank them for their support during these times.” A North West Ambulance Service spokesperson said: “Emergency services remain under significant pressure, and we are working hard to ensure everyone who needs an ambulance gets one as quickly as possible. We would always advise patients suffering chest pains to call 999. Still, we want to reassure the public that our staff within our emergency and non-emergency call centres are highly trained and use the same clinical triage system to assess the condition of patients and prioritise the most seriously ill.”
The NHS has a well-known target for A&E waiting times: that 95% of those who visit A&E should experience no more than a four-hour wait time “from arrival to admission, transfer or discharge.” According to the Independent, this goal has been missed by a long shot, with just 56.9% being seen within this time in September. The same figures show 32,776 people waited more than 12 hours in September — the highest number since records began in August 2010. More locally, NHS statistics show that in Manchester University NHS Foundation Trust (of which the MRI forms a part), the number of people who waited over 12 hours rose a staggering 657% between September 2021 and September 2022, from 26 people to 197, or 50 people per week.
Earlier this week, the health editor of The Sunday Times tweeted about University Hospitals Sussex’s “business continuity incident” — in plain English, when patients were waiting for up to three days for a bed on A&E. As LBC reported yesterday, an 84-year-old man in Blackford, Somerset was told there would be a 30-hour wait for a hospital bed after spending 15 hours in A&E waiting and doing tests following a collapse.
When I was 20, I misdiagnosed myself with a very persistent case of flu combined with an inexplicable ache in my back and decided to sleep it off. In fact, I had a kidney infection and left it so many weeks to go to a doctor that I was forced to go to A&E in central London, where I was living at the time. I got a hospital bed after just an hour of waiting. As I learned from two nurses whispering just a few metres away from my bed, thinking I was asleep, despite how promptly I’d been admitted, they were concerned I would die — I was on a drip, but my temperature had remained dangerously high. I wonder what would have happened if I had experienced the MRI’s average wait time on Sunday night.
People with enough money will be okay, just as people with enough money are almost always okay in a country where it’s considered appropriate for wheelchairs in an emergency department to be secured via a coin lock. A report by the think tank IPPR from earlier this year described a trend they dubbed the “opt-out” — people supplementing their NHS access with private products like insurance “as a direct consequence of NHS access of quality falling behind what is possible.” According to the report, out-of-pocket expenditure in the UK has increased more quickly than any other G7 country since the 1970s. They argue that what we should be worried about isn’t sudden, near-overnight NHS privatisation, but something closer to the state of dentistry in this country — effectively, a gradual deterioration into a “two-tier system”.
According to Liz Harris, Head of Professional Standards at the College of Paramedics, who spoke to BBC Radio 4 about record A&E waiting times in July, it’s a system-wide issue. I would agree with this — the A&E wait issue is complex and there are multiple factors at play: more people presenting there than before, escalating staff shortages combined with the difficulty of retaining emergency staff, an ageing population, underfunding, plus clogged wards caused by delays with discharging patients who are medically fit to leave hospital but who don’t have appropriate care arrangements lined up.
Even knowing this, what I saw was shocking. An A&E in a city centre hospital in one of the largest municipalities in Britain shouldn’t be this stretched on a Sunday evening in October. You shouldn’t have to consider going further afield to be sure of getting treated. I should stress: this is not about staff, who, for the most part, were doing all they could. This is a systemic issue. The Manchester Royal Infirmary’s A&E is stretched to breaking point, as many others are too.
There are times when media coverage spreads fear unnecessarily or hypes up public concern in order to sell more newspapers or get more clicks. We can probably all think of instances like that. This is not one of them. This is an emergency. The state of our A&Es is a genuine national crisis in one of our country’s most important institutions — the one tasked with keeping us alive.
I know this from the doctors, nurses and consultants who have spoken to The Mill’s reporters in recent months, and who say the current situation is much graver than they have experienced in past years; I know it from the numbers released by the NHS; and I now know it from personal experience. In Westminster, the politicians are talking about tax cuts and leadership plots. They should be talking about this.
What experiences have you had in A&E recently? Please post them in the comments (members only).