The Express & Star was given an unrestricted behind-the-scenes look at exactly what is happening on a daily basis. Reporters Tim Spiers, Adam Thompson and Mark Andrews and photographers Tim Thursfield, Steve Leath, Patrick Mulvaney and Alan Evans bring you the result of 24 hours in A&E at New Cross Hospital:
Daylight has not broken and in the Emergency Department a drunken man staggering around and the ‘major’ section of the department is at capacity. Senior Sister Emma Stewart is coming to the end of a night shift and keeping a check on 11 full cubicles – something she says is “typical at the moment” as it reflects how busy the hospital is. She says each patient going into A&E is assessed using the Manchester Triage System. Those rated higher risk are seen immediately but others go to the reception area and wait. Wait time on a whiteboard is an hour.
Once in triage a call has to be made if the patient is to be assessed and sent back into the waiting room, sent to for minor treatment or major treatment.
Sister Stewart says: “Tonight there have mainly been medical patients. They have been people who we have been able to admit to the heart and lung departments in the hospitals. We have a couple of broken hips but there has not been anything surgical. Surgical patients can be people who are suffering abdominal pains and obviously require more treatment. Fortunately there haven’t been any traumatic incidents such as stabbings or shootings.”
A phone rings and an ambulance on its way. There is concern over an 84-year-old woman and a bed to be prepared. Details are taken on a white board and passed to a nurse awaiting the patient’s arrival.
“That’s the one thing about this job, you never know when people come in or through what door,” adds the Sister. As she says that an unshaven, tattooed man, stumbles in. He’s a regular and known by first name nurses. A nasty cut above his eye may be from a fall possibly while drunk. He staggers but is quickly given a chair to sit down to relax by nurses.
Staff nurse Tracey Appleby starts an 11-and-a-half hour shift with a woman suffering sickness. Nurses coming on get a handover sheet detailing patients to look after and their medication. They greet the patient and say they will treat them during their stay.
Nurse Appleby logs onto a computer listing drugs patients require. Using her fingerprints to access it she can see each prescription. Press a button, a door pops open and she collects the medication.
As a precaution an injection is given. Nurse Appleby is minutes into a shift and she’s injecting patients but says: “It’s part of the job, it’s something you have to do so I just do it,” she says. “When I was a student at university we would practice on dummies and mannequins but I remember the first time I gave an injection. I was shaking – I was more scared than the patient I was giving it to. I felt sorry for her.”
Nurse Appleby adds: People think most of what we have to deal with is drunks, particularly on a Friday.
“But there is no day where it peaks and there’s no day where it’s quiet – it is all day everyday and you learn to deal with it. Most of the people coming in actually have a shortness of breath. Considering the time of the year it is common for this to take place. The challenge we face now is the variety of illness we are dealing with, this is because the population is growing.”
Patients are assessed to see if they need to go to the Acute Medical Unit (AMU). Dr Rhys Lodwick points to a white board with seven names from A&E of people waiting to go to the AMU.
He is to assess them but they are in A&E because there aren’t enough beds in the AMU. “It has been terrible in recent months, I have been here for 23 years and this is the worst that it has been.
“We have had a cold winter which has extended into spring and this has only made things worse. The biggest problem is the number of people you are dealing with on a shift. You always give your best to every patient that you deal with but it is hard work. We are dealing with about 100 patients a day and we have to make a decision that either the people go to a bed on a ward, go to their GP or simply go home.”
In A&E, Monika Jones, 68, an ex-Stowheath School teacher, waiting to go to the AMU, suffered pains in her chest. She says: “I came in and the way the staff worked installed confidence in me and made me feel I would be ok. I can’t thank them enough, they are really wonderful people.
A red phone giving ambulances a direct line to A&E rings. A woman in her 70s has had a cardiac arrest seen by her familywho can give information about her condition before and after she became ill.
Sister Sonia Edwards says they will start preparing medication for every eventuality as a nurse stands with doors, normally locked, open so a patient can go straight to the ‘majors’ area of A&E. “We have four cubicles in here at the moment and three of them are taken up leaving one of them free which is fortunate for us as we have a woman coming in having suffered a cardiac arrest,” she says.
“At the moment the lady hasn’t got a pulse and she is not breathing. The ambulance staff will continue to carry out CPR on her as they bring her in.
“We have a consultant at bedside waiting for the patient and all the time he will be thinking, ABC – airways, breathing, circulating.”
Moments later a woman is wheeled in, taken behind a curtain and about half a dozen people surround her to revive her. She is one of 43 in the emergency departmentand the numbers continue to rise.
Senior Matron Hayley Flavell follows the route an A&E patient goes through. At present people trickle in with reception relatively quiet. She says: “When a patient is admitted to hospital we run an assessment which is a points based system. We decide if they will go to minors, majors or to resus – which is the most serious admission to the hospital.
“From there they could go the AMU or for surgery where a decision is made by a consultant to either send the patient to a ward, to their GP or to discharge them from hospital.”
“From 11am right the way until 12 tonight the numbers of patients will go up and up and up. But with the new A&E department due in 2015 we’re hoping that will become a lot easier.”
She knows what all staff, from ward hostess to the man who decides which beds can be freed up, does.
“This is one big team and everyone has their part to play if one piece isn’t working together then the whole thing grinds to a halt.” A nurse is asked how the elderly lady is. She passed away.
Marilyn Nixon, 62 of Claregate, has waited with her mother, 98, for 11 hours.
Trollies become more frequent. Dr Fiona Shelley, a clinical nurse dealing with cardiolog, fills in an assessment sheet on a patient with heart problems.
She decides if they get immediate procedure. “When we get the scans from the doctors then we could have less than an hour for us to act in time.
“I deal with people who come in with heart attacks and I organise how their treatment is handled.
“We are lucky that at New Cross Hospital because no matter what time of the day or night you may suffer chest pains there are always people in cardiology who can treat you,” she says.
“I have only had the one lady to see who I suspect has had a heart attack. We are still waiting to see what the issue is because if it is a blocked artery then she will have to be seen straight away.
“Part of our treatment includes reassuring the patient. Firstly they are suffering pain in their chest then people are mentioning that there are problems with their heart and this can be scary for them.”
The collapse of player Fabrice Muamba in a football match changed people’s views on their hearts, she says. “You do get younger people more aware of looking after their heart and he was lucky he had good people around him. I wouldn’t say I’m seeing any more heart attacks from when I started.” Three clinicians see about 120 people a month but often for chest pains.
Jason Piper aged 42 of Eastfield, Wolverhampton, asks if he can remove stickers on his body after a heart scan. His partner, Diane Carnell, 54, made him go to the doctor after he complained of chest pains.
Trying to take deep breaths he lets out a sigh as he waits for test results. “I was only here minutes before they admitted me through to A&E. I’m still sat here waiting for my result but you can imagine how I feel it’s not the first time I’ve had issues with my heart but it still knocks you about a bit.”
Diane explains: “My dad suffered from a heart condition so I have always be wary of any symptoms. ”
A&E is at its busiest so far and the only raised voice is from a man rowing with Senior Sister Hazel Thomas. He shouts: “Until I am admitted to a ward I am not leaving this cubicle. If anyone even tries to remove I will floor them.” Sister Thomas reminds him about his abusive language but he continues to protest insisting he will die if he’s sent home. At that point Sister Thomas points to a corridor of packed with patients lying on trollies all waiting to go into A&E and tells the man: “There are 14 people waiting to use this cubicle. You have been told you’re fine to go home.”
At 1pm staff duck and dive for phones and test results. Outside A&E 14 trollies carry people queuing for a bed. All bar a handful of seats are taken in the waiting area where waiting time has doubled to two hours.A conference takes place about resus – at capacity with a room usually for four patients now with six. The minor injury ward acts as overspill for major patients.
One is a child who has had a fit and is being closely monitored. The man protesting is in the discharge area after asking to speak to the medical director.
There are 62 people receiving treatment. Sister Thomas says: “Eleven cubicles are filled at the moment. There are nine in majors and four in resus but we’ve just had to create two additional places because the admission are so serious”
At 2pm a middle-aged lady use colourful lanand storms out. In a better frame of mind is patient Monika Jones, who arrived with severe chest pains.
She is diagnosed with atrial fibrillation, an irregular heartbeat,hopes to leave soon. “I was extremely poorly when I came in, but they have picked me up and I have received first-class care,” says ex-teacher, 68, of Compton Road, Wolverhampton.
Doctors in an office next to the admin desk, are glued to computer screens, occasionally emerging to make a phone call. Speaking to patients, it appears 12 hours is about the standard turnaround time between patients arriving and being admitted to the Acute Medical Unit the following morning.
As demands begin to increase with the early afternoon rush, the small room we had been using as our base is called into action. It seems every nook and cranny of the unit is being utilised now.
A man from the Cannock area tells us he was sent to New Cross due to the night-time closure of the A&E unit at Stafford, something which seems to be quite a recurring theme.
At 3pm the foul-mouthed female returns and she seems to be equally angry. It is not clear what she is so angry about, or if she is a patient or disgruntled relative.
“We get all sorts of characters here,” says Senior Sister Hazel Thomas. “Some of them are regulars, and there are others who we have never seen before.” Yet despite this outburst, in the main waiting room, the atmosphere appears almost relaxed.
The room is about half full, but the mood is fairly peaceful, everybody seems reasonably contented, and it appears the angry lady has now gone away for good. While there are clearly some people who are in a serious condition, most we speak to seem to be in good humour, and it seems that opening up the extra unit to cope with the influx has done the trick.
There is still a sense of urgency around the main desk, though, as doctors and nurses jostle for position to use the phones and computers, while the green-suited paramedics from the West Midlands Ambulance Service stand nearby.
At 3.45pm Mrs Thomas does an audit of the activity so far today. By that time 202 patients have been dealt with. Questions about which are quietest times earn a jocular reprimand for use of the Q-word. “We never use that word here, there are no quiet times,” says Mrs Thomas.
At 4pm locum Dr Anton Mans comes on duty. Dr Mans, born in Rhodesia, trained as a medic in South Africa, and having also worked as a hospital manager in that country, he has very firm beliefs about how a hospital should be run.
“The important thing is to have an experienced manager who understands that it is not just target-chasing or box-ticking.
“If you put the patient first in everything you do, you won’t need to worry about ticking the boxes, you will meet your targets by default.
“When you lose sight of that, that’s when you get the problems we have had at other hospitals.”
There is a slight sense of frustrated resignation when he talks about the never-ending queue of people in the waiting room.
“There’s quite a large number of people who shouldn’t be coming to hospital,” he says.
“They should be treated by their GPs, but there are certain patients who just want to be seen at A & E, when they could have been seen somewhere else.”
There seems to be a cold chill in the waiting room, prompting an elderly man to ask a nurse to turn heating on. Back in the assessment area, patients on trolleys are starting to mount up in the corridors.
At 5pm the number of people in the waiting room has dwindled to about 15, and outside a tattooed man in his early 40s braves torrential rain for a cigarette. He says he fell down stairs two days ago, but found pain so unbearable that he went to see his GP, who directed him to the unit. “I’ve been here for around three-quarters of an hour,” he says, peering under the brim of his baseball cap. “I’ve had an X-ray, I’m just waiting for it to come back.”
Also in the assessment area is the man in charge, clinical director Andy Morgan. “As you would expect, we do get quite a lot of industrial injuries in Wolverhampton, but I remember when I was at Worcester, there were lots of horse injuries, because lots of people around there had horses, and strangely enlough, a lot of incidents with chicken vaccinations, because there were lots of chicken farms.
“The good thing about the people of Wolverhampton is that they usually deal with things with humour.” He says lines of patients on trolleys in corridors is a very new phenomenon, and on which he finds very frustrating.
“It’s something we didn’t really see until about 18 months ago,” he says.
The man in the baseball cap appears to become increasingly agitated andstarts muttering obscenities to himself. Across the room, a smartly dressed man in his 30s bites his nails, and any peace is shattered by a small baby whaling the place down.
At the front of the room, a dapper looking young man in a flat cap looks to be in good form, exchanging banter with his friends.
He is Saki Nuur, a 22-year-old IT worker from Wolverhampton University, who broke his leg playing football on Tuesday night.
“I thought I would try and soldier on for a bit, but I had to come in today because the pain was too bad.”
He is accompanied by his friend Shaun Gabriel, a 28-year-old student at the university, who also has a broken leg, his caused by running.
“We thought as we both had broken legs, we might as well come together,” says Saki.
There is a brief exchange of banter between Saki and the increasingly impatient man in the baseball cap, when he asks one of the nurses if there has been a mistake and she really meant to call his name out.
The new shift starts at 7pm, and Senior Sister Emma Stewart is back for another shift joined by Sisters Sally Williams and Michelle Redding. The queue at reception has gone, and the number in the waiting room has settled at around 35, begging the question of whether the big crowds coincide with the arrival of the buses.
The unit is dominated by parents with babies and small children, and at 7.05pm a small boy with a bandaged head and a blue helium filled balloon is called in for assessment, to emerge minutes later.
The atmosphere in the waiting room is light and serene, with none of the unpleasantness of earlier.
Broken leg victims Saki Nuur and Shaun Gabriel are about to leave after being examined together, but don’t seem impressed by the speed of service.
“It took me an hour to see a nurse and one hour 45 minutes to get an X-ray,” says Saki.
By 7.45pm the number of patients is now down into the 20s, but 10 minutes later there is an entertaining new guest in the waiting room.
Flanked by two G4S security guards, a handcuffed prisoner is in good form as he takes his seat.
The man is in with a leg infection, and is determined to enjoy his trip out.
He exchanges banter with guards, who seem to be enjoying his company. Remaining patients know that the food in Sheffield nick was “immaculate”. They’ve closed it now, I think it was going to be a hotel,” says our man in the know.
And the food in another one of his temporary places of abode improved no end when they sacked the chef, the prisoner tells his new friend, as the conversation begins to take the tone of a guide to Britain’s best prisons.
We also learned that a warder received a real good beating from one prisoner, and that our friend has been offered £10,000 in compensation for a broken jaw. “They also offered me £3,000 for food poisoning,” he adds.
“The trouble is, money is no good to you in jail.”
The man is adamant he does not want to be given any drugs during the course of his treatment, prompting one of the warders to joke: “You can probably get better stuff than that over the fence.”
For all his fond memories of life in jail, it does seem he is beginning to become a little disillusioned with a lag’s life.
“I’m through with jail,” he says. “I’m getting too old, I’m much too old for jail now.”
According to Senior Sister Emma Stewart it is quite common for prisoners to come in for treatment.
“If somebody comes with injuries that appear to be consistent with a stabbing or being hit with a bottle, we will inform the police so that the police can apprehend those who are responsible. But otherwise we tend not judge.
There are more forces of law and order in the waiting room at 9.04, when a young man in a cream jumper and fawn trousers arrives escorted by no fewer than three police officers. He is not handcuffed, and appears to be on friendly terms with the police. It is not clear whether he is a prisoner or a victim of crime.
They chat for a while with the check-in clerk, before wandering over to the seating area next to the X-ray department.
By 9.40pm, there is barely a spare seat in the waiting room, the number present has swelled to around 60, and it’s mainly parents with children and quite a few teenagers.
The elderly lady with the bad foot says she hurt herself when she tripped and ripped a toe nail out earlier in the week. She says she has been waiting a very long time.
Having snuck in unnoticed, the prisoner and his escorts are ready to go home. It will probably be a while before we get his verdict on hospital food, then.
A man admitted to hospital with suspected heart problems is finally given a cubicle, almost four hours after he was first taken ill.
Despite having waited for almost three hours on a trolley, he has nothing but praise for the staff, saying that the way they have attended to him is superb.
It’s almost peak time for A&E with 54 patients. Some have already waited nine hours for a bed. A stiflingly hot waiting room is full to the brim of patients waiting to be seen and the current waiting time is two hours.
There’s a quiet, serene, almost surreal atmosphere in the waiting room, which is still full.
On the other side of the door there are five people lying in the corridor – a maximum of 14 are allowed.
Go past that number and patients will have to wait on the ambulance they arrived in, which is what happens at other hospitals in the Black Country.
Sister Redding is the woman tasked with frantically trying to manage the workload.
Tonight it’s her job to get patients moving as soon as possible and to ensure her fellow nurses know exactly who is where and what needs doing next.
It’s a difficult juggling act, she admits.
“It’s awful at times,” Sister Redding said.
“You don’t want patients in the corridor but there’s just no alternative – you have to accept the conditions and do your job as best you can. It wasn’t like this two or three years ago though.
“Fortunately we’ve got an amazing team here.”
She and other nurses are in the middle of a 12-and-a-half hour shift, which began at 6.45am.
The list of waiting patients is split into eight different categories – GP service, see and treat, await triage, waiting room, minor injuries, children, major injuries, corridors and radiology.
It’s pub closing time and security guard Peter Brown is getting ready to use all of his 16 years’ experience in the job to deal with any troublesome characters who make A&E their last port of call of the evening. Amazingly Mr Brown is one of just two security guards on duty tonight – for the whole of the hospital.
He works 12-hour night shifts, from 7pm to 7am, for four nights on and four nights off. Mr Brown said he knew many of the drunkards by their first name, as did they with him, and that he has seen some of them on up to 400 separate occasions.
Coming to A&E is just standard part of a night on the tiles for some people.
“It can be like Groundhog Day in here,” the 62-year-old said. “It does get physical, we do get staff threatened and some are even assaulted, unfortunately it’s part and parcel of the job.”
There are a couple of seats free but 50-year-old Kevin Griffiths won’t be taking a space up – he’s got a searing pain down his side and can’t sit down.
Through grimaces Mr Griffiths says: “I’ve just got here and they said to take a seat but I’m in so much pain I can’t do it, it just hurts so much.
“I think I’ve got a torn muscle but I had a heart operation a couple of weeks ago so I’m a bit concerned.” The smoking area outside the department is busy as people try to pass away the hours waiting to be seen.
Inside A&E the corridor is still stocked with patients, while paramedics are waiting for the go-ahead to be sent back out onto the road again.
After being in A&E for four hours Matthew Southam is off home – and he still hasn’t been properly seen to.
The smile on his face belies his frustration at having been told that the eye specialist he needs to see won’t be on site until the following morning.
Mr Southam was grinding metal at his home in New Invention when a minuscule piece flicked into his eye, shooting past the safety glasses he was wearing.
The 33-year-old is in pain whenever he blinks and the metal is still in his eye.
“They’ve had a look at me and frozen the area but when I blink it still really hurts,” he said.
“We went in and they’ve just said the person who I’d need to treat me isn’t here.
“They said they’ll phone me in the morning to book an appointment.
“If they’d said that straightaway then fine, but we’ve been here four hours so it’s pretty frustrating.”
As midnight hits there are 49 patients in the department and one woman has been there for 10 and a half hours waiting for a bed.
Other females have been waiting for 10, seven and five hours and the reason is because there are currently too many women in A&E.
There are no longer mixed sex wards in the hospital so although beds might be available elsewhere, if they’re in male-only wards the women waiting in A&E can’t take them up, or the trust which runs the hospital will be in breach of regulations.
Sister Redding reveals 326 patients came through on the previous day. About 350 is the highest they deal with and 300 is a standard daily figure. She asks bank nurse Angela Povey – who isn’t on a fixed contract and passed her training in January – to pop into the waiting room and ask people if they want anything to eat or drink.
“It’s important to make sure everyone knows we haven’t forgotten about them,” Sister Redding said.
With the department being so short staffed Nurse Povey has been drafted in to help out and tonight is her debut in A&E at New Cross.
“It hasn’t been a great night for her,” Sister Redding added.
“She’s been in the corridor a lot and been helping out here and there.”
The new nurse, aged 34, is looking for permanent work but, having worked in care all of her life, is enjoying getting her teeth stuck into her new role.
“It’s something that comes naturally to me,” she said.
“I’m doing a block bank at the Surgical Assessment Unit but I’ve got to find my own job.
“Having done all my training I’m really enjoying getting my teeth stuck into it.
“It’s fast-paced here but also very good work to do.”
Cue a drunk with a minor injury. He’s not happy and judging by the substantial bandage on his forehead, who can blame him.
After a brief approach it’s clear he’s not in a chatty mood – unless four-letter words count as chatty – and paramedics are doing their best to keep him calm.
It’s all smiles from them as they try to placate his angry demeanour and trouble is always simmering beneath the surface when alcohol is involved.
The two female West Midlands Ambulance Service staff will be working until 7am, driving around the region and escorting patients to the Black Country’s four main hospitals in Wolverhampton, Sandwell, Dudley and Walsall.
They take it in turns to drive the ambulance and are regular visitors to Wolverhampton city centre at this time of night.
Slowly trundling past the pair, pushing an empty trolley bed, is 64-year-old Ken Hamilton.
Mr Hamilton and his younger colleague Jamie Edge are porters. They spend their shift ferrying people and objects around the whole hospital – excluding the maternity unit which has its own porters – and are two of eight porters on night duty, with up to 40 working during the day.
There are now 22 patients in the department. Their injuries are varied in the extreme and are listed on a sophisticated computer system which the nurses can all view.
The page on screen tells them the patient’s name, what their current status is, how long they’ve been in A&E and the complaint or injury they’ve been diagnosed with.
Of the 22, two are fits, two are falls, there are four drug overdoses, a head injury, an assault-based injury, a migraine, two people with breathing problems, one with abdominal pain, one stroke victim, a pregnant woman has bleeding problems, one person has pain to their right side and three children and two adults are merely listed as being unwell.
The man with pain to his right side is looking remarkably chirpy compared to his condition four hours ago.
Mr Griffiths couldn’t sit down then, but now he’s lying comfortably on a bed with a smile on his face.
“They’ve given me some pain relief,” Mr Griffiths said.
“They think it’s a ripped muscle and I’ve had some muscle relaxant for it.
“It just slightly twinges now, it’s much better.
A real-time ambulance screen – run separately by the ambulance service – informs staff of imminent arrivals.
Using GPS technology the ambulances are tracked to their precise street location.
Two are currently on their way to New Cross and nurses can see what the patient’s injury is so they know what to expect.
An alarm alert tells them if anyone with a critical condition is due to arrive. When they do arrive the clock starts ticket – New Cross aim to get all ambulances back out again within 15 minutes, but often this can run to an hour, leading to costly fines for the hospital’s trust.
It’s still unusually and mercifully quiet for a Friday night. In a cubicle multiple sclerosis sufferer John Mullinder is waiting to be moved to a bed – and has been for five hours.
He didn’t want to come to A&E but paramedics insisted he did as they were concerned about his heart.
After being treated to have his blood thinned, the 60-year-old from Bilston is waiting on his own as his partner won’t be in until the morning with a bag of essentials. “The staff are really great but I didn’t want to come in.”
A heated discussion is underway as to why a patient with mental problems is still in A&E.
He overdosed early on Friday morning before discharging himself at 2pm.
Police were informed and the man returned of his own accord a few hours earlier, but the crisis team at New Cross cannot treat him until he has been assessed by specially trained staff from Penn Hospital, who don’t start work until 8am.
It’s a recurring problem. Sister Redding says that as with GP care, the links with mental health care often aren’t good enough.
“We’re stuck with a patient who we want to assess and who doesn’t want to be here, but we can’t do anything
The man leaves the hospital again shortly afterwards. There are just nine patients left in A&E in what is turning out to be a quiet end to most people’s shifts.
With not much on the nurses’ plates (apart from communal wine gums) the conversation switches to the quickest route to drive to Willenhall as the night winds down.
But then there’s an alleged assault victim severely inebriated.
After being put in a bed the man is soon on the floor, thrashing and shouting, having attempted to get to the toilet.
Mr Brown’s security partner in crime, 50-year-old David Warr, is keeping a close eye on the patient.
“It looks like he’s had a bit of a kicking,” Mr Warr said. “We’ve got a duty of care to people, whatever their condition and whether they’re drunk or not.
“I love the job and every night is different but sometimes it’s pretty impossible too.
“You become hardened to some sights, but never fully used to them, and you’ve got to keep headstrong in a crisis.
“You’ve got to be a bit of a people person – if they want our help it’s here and it’s the same with the nurses. It’s been up and down tonight.”
The drunken man duly begins shouting and banging from inside the toilet.
According to Mr Warr: “Just another ordinary day in A&E.”