Colchester's A&E - behind the headlines

After all, as a journalist, I am one of those people who helped make the headlines recently when it comes to reports on Colchester Hospital University NHS Foundation Trust, which runs it.

Those headlines tell us there are not enough nurses to cope, a lot of the ones there cannot speak English fluently and patients are frequently waiting more than four hours to be seen.

So I am here to find out about the life which lies beneath the headlines.

The accident and emergency department falls within the trust’s urgent care division.

Jamie Morton, an A&E nurse, greets me in the “minors” area of A&E.

It is here that patients are typically assessed by an emergency nurse practitioner as to where they need to be either – majors, minors, resuscitation or to use other services such as their GP or walk-in centre.

There is a brief patient history given, and the staff’s decision is based on clinical experience and judgment.

Jamie’s shift in minors could entail anything from patients with mild burns to fractures, so it is obviously calmer than being in majors where ambulance patients might come in with patients with more alarming conditions or resus where patients are taken if they have potentially life-threatening conditions.

Alongside Jamie is nurse Becky Boyd who is filling out some paperwork and disappearing every so often to tend to patients in the adjacent waiting area.

Jamie says: “Some days when I was working over Christmas there were four patients a day.

“But on a really busy day we can see 30 to 40 patients each, that’s just your individual workload.”

In the corner of the room is a screen displaying which patients have come into the urgent care division that day and which section they have gone to.

Green text indicates which patients have been waiting for up to three hours, while an amber is three to four and red is more than four.

It is this national target of treating 95 per cent of patients in four hours which staff are aiming for.

But, like hospitals across the country, Colchester is still falling short.

Just 76.7 per cent of patients were seen within this time frame in February.

But despite this pressure, Jamie says he has to “keep a cool head”.

“The important thing for me is we concentrate on the individual.

“As long as you can go home at the end of the day feeling you have made a difference and that patient is safe, that is my priority.

“It is difficult but it is a case of having to prioritise the sickest people at the same time as update the people you would like to see as quickly as possible.”

Today is one of Jamie’s long days. His shift starts at 7am and he will not finish until 9.30pm.

He will do three of these, then have a couple of days off, then work a night shift from 9.15pm to 7.15am.

It is an on-the-go environment which understandably runs partly on adrenalin.

At that moment, Jamie’s next patient comes in via ambulance.

It is an elderly lady with a swollen ankle. Jamie assesses her and refers her for an X-ray to ascertain the extent of the damage from her fall.

If Jamie can assess patients quickly, the right person can care for them in the right place.

And while it is relatively quiet in minors for now, the figures show this is not always the case.

Jacqui Richards, advanced nurse practitioner, explains there will always be a minimum of two nurse practitioners.

“All A&Es are in the same position,” she says frankly.

“We are all struggling.”

The lack of nursing staff at the hospital trust has not helped.

In a bid to cope, Colchester Hospital University NHS Foundation Trust has spent millions of pounds on agency staff and has also recruited nurses from abroad, including Italy, Romania and Spain.

“It’s not been bad,” Jamie says.

“To begin with sometimes it can be tricky for them as it is a new way of life for them.

“They have done really well in A&E.

“The elderly patients can struggle a bit but that could be because they are hard of hearing, not because it’s a different language.

“Sometimes there are odd things the other nurses might not understand because procedures are done slightly differently from them to us – but equally we can learn from them.”

Staff from overseas also get an extra week of training in medical terminology and English colloquialisms as part of their induction.

Away from Jamie’s workstation, I manage to sit down with Helen Bennett, the urgent care divisions’s associate director of nursing, who oversees 250 nurses and healthcare assistants

Her role is both hands-on and in the office as a manager.

She tells me the accident and emergency department has a shortfall of more than seven full-time nurses compared to 23 a year ago.

At the emergency assessment unit, the nursing deficit is eight.

Both departments are propped up by agency staff.

In accident and emergency and the emergency assessment unit, it is a combined total of about 20.

It was a concern the Care Quality Commission (CQC) picked up on when its team of inspectors examined the trust in September.

The CQC report said there were not enough staff on inpatient wards to meet the needs of patients.

It also said agency staff which had been brought in did not always have the required skills.

Helen admits the long-term goal would be to have staff permanently employed by the trust.

She adds: “We recognise the support and commitment our agency nurses have provided over the last 18 months.

“They come from all over the region and have been quite insightful and given thoughts on how it is done in other trusts.

“I think there are improvements still required.

“We want to be really open with patients and relatives because we have been quite open to our critics.”

Natasha Tuck, who is the matron for emergency department and urgent care, shows me the board which is being displayed to patients to demonstrate the improvements being made.

And there are improvements.

In January, the department was found to have made progress, leading to a change in CQC assessment from inadequate to requiring improvement.

Little steps, but steps nevertheless in the right direction.

And there are monthly learning and sharing forums in which staff hear from experts, including radiologists, who come in and suggest how improvements can be made.

My two-hour stint with the nurses is a mere snapshot of their daily working lives.

Would I change any of the stories I have written?

Honestly, I do not think I would.

The facts and figures speak for themselves.

But I have learnt a lot from seeing the staff on the ground and have witnessed at first hand their unwaning dedication to their patients.

Helen sums it up well when she says: “We are privy to a patient’s life.

“We see them in their most anxious state and by the time we put them in place to go home, we have put them on a healing journey.”

Visit gazette-news.co.uk to:

*See a snapshot of Jamie and Becky’s day at work

*See the board staff have created in the urgent care division which aims to show their progress following concerns by the Care Quality Commission prior to the most

recent visit.