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Dr John Heyworth says with demand for A&E care increasing year on year there are not the number of senior staff needed
"Emergency medicine involves all patients, all ages, all illnesses and injuries, and at all hours. Demand for that type of care has been rising by between 4% and 7% a year for the past few years now and shows no signs of abating. We are seeing more of everything: more and more patients every year with a wide variety of medical problems, all of which require A&E staff's expertise in investigation and treatment.
"Our ageing population means we are seeing more elderly patients who have had a collapse, maybe due to a heart attack or stroke, or suffered a fall, or got pneumonia or have heart failure or diabetes. We are also seeing more children coming in. They have things such as a fever, perhaps due to a viral illness or meningitis, or asthma.
"More patients are also turning up with chest pains, both male and female. That may be due to a heart attack or simply a result of the big national advertising campaign telling people to get chest pains checked out. They can be aged anything from 25 to 95.
"We're also seeing more people with breathing conditions. That can be anything from an asthma attack to chronic obstructive pulmonary disorder, which is severe bronchitis or emphysema. The rise in the number of people with long-term conditions such as cancer, obesity and diabetes is also having an effect.
"People think A&Es are just about drunks and alcohol-related problems. While drunks can be disruptive and challenging, they are a small percentage of our overall workload. That said, we are seeing more people who are very drunk or have a chronic liver problem than a few years ago.
"Then there are all the people who have had a fall, or been in a car crash, or been shot or stabbed, or broken their leg playing soccer, or fallen off a horse, or been knocked off their bike or need to be resuscitated because they have a life-threatening condition such as meningitis, a stroke or severe infection.
"People underestimate the variety, volume and seriousness of what we do. The vast majority of patients who come to A&E really need to be here. They aren't wasting our time.
"When I came to work here at the A&E unit of Southampton general hospital in 1995 we saw just over 40,000 patients a year. But now it's 95,000, and that's typical of the general trend across England.
"The problem is that, despite this increasing demand year on year, we still have a very fragile system of A&E care. We don't have the numbers of senior staff – consultant doctors – that we need. In England there are 940, based at around 180 A&Es. But that's less than the 2,220 we in the College of Emergency Medicine believe is required. Reaching 2,220 would mean consultants being available in each emergency department up to 16 hours a day seven days a week. While in major trauma centres there is 24/7 consultant cover, that's not the case in most hospitals. "
Dr John Heyworth is president of the College of Emergency Medicine and an emergency medicine consultant at Southampton general hospital. Interview by Denis Campbell
