Accident and Emergency (A&E)

When people can’t get an appointment with a GP, they can phone their usual GP surgery for out-hours services, or go to an NHS walk-in centre if there is one locally, where minor illnesses can be treated without an appointment. Many minor things will get better on their own, or people can wait until the GP surgery is open again. When Hannah couldn’t get an appointment with a GP and the walk-in centre had closed, she took her 11-month-old son, who was ‘covered in chicken pox’, to A&E instead because she was very worried about him.

The walk-in centre was about to close so Hannah had to go to A&E. There, she was given antibiotics for her baby.

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I had to take my son, he had chicken pox as I said and he was very ill. So I called the doctor, oh that’s right I, my son was about 11 months old when he got the chicken pox and they were really, he was absolutely covered in chicken pox. They were all in his mouth, they were everywhere so he was really unwell. He couldn’t eat or drink anything as he was in a lot of pain.

So I called the doctor in the afternoon because I was getting really worried about him one day and they said Look we can’t see you’ you know. I was hoping to see them that day, you know, cos there actually has been times where I’ve been able to take him down that day, which I can tell you about after. And they said, Sorry you’re going to have to go to the walk-in centre.

So I think I went to the walk in centre which perhaps closed at about 5:00 or something and they said We can’t see you because we’re closing. So then I had to take him to A&E.

Did you walk there?

I drove.

You drove, yeah.

And they couldn’t see him, like I wasn’t even allowed in the gate, you know. So then I had to go to A&E and he was in hospital, he wasn’t hospitalised but I was given antibiotics and things like that by the hospital.

That’s quite a long…

Yeah, yeah definitely.

What would have been better in this situation, what would have been more helpful for you?

Just to see my GP if, yeah but I also understand that GPs have appointments, they finish at a certain time and they 99% of the time go over that time and stay late and work through their lunch, you know. I can, I can sympathise with that as well.

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People who have an urgent, serious problem (like a broken arm) can go straight to a hospital Accident and Emergency (A&E) department. A&E departments offer access to medical care 24 hours a day, all year round. If anyone’s in any doubt about whether they need to go to A&E, they can call the NHS non-emergency number to get advice (insert link to ‘General Health and Medicine’ pdf).

An A&E department (also known as emergency department or casualty) deals with serious or life-threatening emergencies. These include head injuries or loss of consciousness, seizures that aren’t stopping, and broken (or fractured) bones

When Vinay fractured his finger, he was given an x-ray and had his finger plastered. He was disappointed when he couldn’t get a follow-up appointment.

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I had an issue when my finger was broken or fractured. And that was the day before Valentine’s day. And the incident occurred and I ended up going in a taxi to be taken to [hospital name]. And they got that sorted quite quickly, within three hours they could see obviously the blood there and the finger was out of place. And they did an x-ray and they told me it had been fractured. And they just told me to bind it together. So that was the main thing they told me to do but…

Did they bind it together?

They bound it together originally. But after that they didn’t give me a fracture clinic appointment. And I rang through on many occasions and there was no service. There was no-one to even pick up the phone. So I couldn’t, I didn’t have any way of getting in contact with the fracture team.

So I actually had to bind it myself for the next five or six months and, yeah I rang, I tried to ring through. I went to the hospital and they said to me that I would have to get checked out again, just to go by their services again, and I didn’t. I couldn’t be bothered with it. I sort of just taped it myself and it’s kind of healed. It’s kind of sort of a little bit out of place but it works, that’s the main thing.

Did you go back to the hospital again then after…

I did go back in, when I tried to, obviously I showed them, Look, clearly there’s a break here. There’s this and this, can you put me through the referral with the fracture clinic again. They were adamant that they would do and I still didn’t hear anything from them for a while. And I think I got quite frustrated and just, because I’d carried on taping it myself, because I had my, I was doing my Masters and working and there was a lot of things on at the time, but I just couldn’t, didn’t have the time to chase it up.

Yeah. Did you ever go to the GP at all about that or…

No, no. I knew what, obviously it was a fracture and it just needed to be bandaged up.

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Winston went to A&E when he broke his wrist. He went again after a car accident. The wound was cleaned, which was painful.

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When I broke my wrist first I didn’t, there wasn’t enough time obviously to try to go to clinic, and so I just went straight to A&E and they looked at it and they just told me to wait. Even the wait was quite long, and yeah they just, well I did get another injury though when I got hit with a car. And then there wasn’t, the only bad thing was, because the information, it wasn’t clear. Like I was hit by the car, it was my fault.

I just came from school. It was dark and I sort of, I fell asleep in the bus and I saw the other opposite bus when I woke up. I tried to run for it and a car hit me. And then it hit me, I got up, then I walked to the pedestrian and then they, the random people, they just called the ambulance whatever, and then they came. They picked me up, put me in the, what’s it called?

Stretcher

Yeah. And then they took me away and then, the only bad thing was the person who was doing it was a trainee. There was a doctor there and a doctor trainee nurse she was the one who done it. And the only bad thing was because she was – she did – I don’t know whether it was meant or, I don’t know if that’s how they do it. But it was an open injury and she did try to clean it with something that was dry. It wasn’t wet so it was just like, it was like rubbing an injury that’s got, you know, it was quite sore here.

When I hit the ground again I’d like sand not sand, like gravel in my, on my injury, so she was trying to clean it off with a dry bandage whatever and it wasn’t really working. So I did tell her to stop and just cos it was like, you know, rubbing stones onto your open flesh innit so, I did go to the sink whatever and just, you know, and did it myself, but she was a trainee so it was OK.

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Kyle recalled going to A&E when he was seven and broke his arm. Aaron went when he was younger too because of football injuries. Less severe injuries can also be treated in Minor Injuries Units or Urgent Care Centres.

People can also go to A&E because of:

ongoing severe chest pain or difficulty breathing
severe bleeding that can’t be stopped
severe allergic reactions
severe burns or scalds
stitches

Gentian burst his lip during football. He needed to have stitches at another hospital. He’s been to A&E a few times because of football injuries.

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I was playing football and I got kicked in the face and my lip bust so I had to go to the hospital then.

Where were you, were you at school or were you somewhere else?

No, I was just playing football for my team on a Sunday.

So, who took you there?

My mum again, yeah.

Was she watching?

No like

They phoned her?

They phoned her and then we went and then they took me home, and then my mum took me to A&E.

So they took you home first and then to A&E. Can you remember what happened there when you went to the hospital?

I had to wait in A&E for a bit, and then a nurse came and asked me some questions about what happened. Then I had to gothen they gave me some paracetamol. Then I had to go back and wait. Then they took me in and said that they couldn’t stitch it up then, so I had to wait for the next week to go to a different hospital to get it stitched up.

Right. So did you see the doctors that day as well or just a nurse?

I’m not sure if he was a doctor but I’m pretty sure it was justit was only nurses.

And what were they like?

They were OK but it was just like a bit long having to wait for them to first come and ask questions, and then I had to wait there for another like two, two and a half hours. Then, when they came and they just told me they couldn’t do anything, I felt like a bit annoyed.

Because you’d been waiting a long time hadn’t you?

Yeah.

And what did they actually do while you were there, did they?

They cleaned it up and then five minutes later they came and told me that basically I had to go because they couldn’t do anything about it.

Did they say anything about your next appointment?

They said that the earliest that they could do it was the next Friday, and I had to go to a different hospital as well.

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Sometimes people have severe pain and don’t know why. At the age of 13 Rowan started getting severe stomach pain. He saw a number of different GPs but it was unclear what was going on. He was advised to go to A&E if the pain got worse, where he was admitted and had tests done. Six months after Rowan first saw a GP about stomach pain, he was diagnosed as being lactose intolerant. This is when the body is unable to digest lactose, a type of sugar mainly found in milk and dairy products.

A couple of days after seeing the GP, Rowan went to A&E again. It was late at night and the pain was very severe. He hoped that he’d get tests done quickly.

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I was just in so much pain and after, as I say, when they did the ultrasound, I got taken down to A&E and I wentI ended up having to go back a couple of weeks later actually. It was the GP that advised me to go back.

To go back to the hospital through A&E?

Through A&E. And I ended up being admitted, and because they still weren’t sure what it was. But they said, “Look, if we admit you, then you’re going to get a faster you’re going to get a closer appointment with the other hospital,” which they had to transfer me to, the larger hospital in the partnership, where they had a specialist gastroenterologist.

Well, in-between times, because we hadn’t heard anything from the smaller or the bigger hospital, then I went back to the GP. And the GP actually at, during the consultation rang up, I can’t remember who she rang up someone from the Trust, and said, “Look, I’ve got a patient here whose inflammatory markers have been raised, and you’ve notyou’ve said you’ll do something, and you’ve not given them any follow-up.” And she said, “Look if it gets” this is the GP, said, “Look if it gets any worse, then go down to the A&E at the bigger hospital, and because we mightif you’re admitted there, then you’re likely to be seen quicker.”

It’s again this kind of idea of playing the system. And so in fact we did a couple of days later when it justit got so bad, and theyI think this must have been about, I can’t remember what time of night it was, it was about ten or eleven o’clock at night. And I was in there, and they werethey did blood tests on me but the blood tests they seemed to do there, they did a lot more of them, and they were far more thorough than at the other hospital I’d been to.
And also because they were open they had a twenty four hour paediatric A&E, and they also had a twenty four hour pathology lab, and so they were able to get my blood test results back to me there and then. Kind of it was either”Stay here for a couple of hours, and we’ll see what we can do,” or, “because we don’t want you going home like that.”

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Jal‚àö¬© also went to A&E because of severe and ongoing stomach pain, which meant that she couldn’t sit up. She felt that the nurse she saw in hospital listened and took her seriously, but the consultant only listened when her mum told him that Jal‚àö¬©’s sister had recently had ovarian cancer. A few months later, she had to have her thyroid gland removed.

Jalé is aware that some people go to A&E for minor things. When she had severe stomach pain, she was scared and wanted to know what was causing it.

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At one point when I hadI’d completely forgotten to actually, just thought of it one point that I had the severe abdominal pains I actually ended up in A&E because I couldn’t sit up. I was in so much pain I could not sit up. And theythe first nurse took it very seriously, and she was like, you know, “What tablets do you take, like what painkillers do you take, what do they do, do they help or do they not?” And she said, “You know, I’ve taken everything. I understand they’re not helping. I can’t sit up. I’m actually scared that I might go paralysed.”

And by the time I got to see the next doctor, he kind of looked at me as though I was a little girl coming in with a stomach ache. And I was saying like literally, when somebody’s saying to you for the last three weeks they’ve not been able to sit up properly without feeling pain, that’sit’s not a normal stomach ache. It’s not, you know, it has to be taken seriously. And it was only when my sister said my mum said that my sister’s had ovarian cancer and we’re now worried, that he kind of had to take it seriously, and then moved on with it. But, obviously I’m more than aware that some people do turn up at A&E with the most silliest things in the world.

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Sometimes people are unsure whether go to A&E especially if they’re in a lot of pain. Vinay had lower back pain for several weeks when he was home from university over the summer holidays. He saw GPs in two different cities and suspected he had kidney stones. It was confusing knowing which GP he should see and he travelled back and forth for several months between his home and university doctors. When Vinay started having chest pain as well as kidney pain, he decided to go to A&E. Later, when the kidney pain seemed to be getting worse, he went to A&E again in the hope of having tests and a diagnosis.

Vinay had an ECG and urine tests, and was given painkillers. Later he was referred by his GP to see a specialist (urologist).

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It got to the point where sometimes I’d be having chest pains as well and I didn’t know if it was all linked.

Yeah. So when you went to A&E the first time can you remember what happened?

They put me on the, they put me, they did an ECG when I entered and they tracked, they said Oh your heart rates a bit quick, or whatever it was. And then they put me through the paces of going to get seen. But they just, they said that it wasn’t indicative of kidney stones, through the urine tests that they did or something, and then they just sent me back off and said, Take some Paracetamols or Ibuprofen or something.

So did you do that? Take painkillers?

If it really hurt.

Yeah. And then at, when was the next time you went to A&E? Did you see your GP in between at all?

Yeah, I did.

Yeah. So did you, when did you go back? After A&E when did you go back and see your GP?

So the second time I went back to A&E was closer towards the point where nothing was happening and it still, the pain was still present and I was losing sleep over it. So I went back and saw them to try and, a last ditch effort to try and push them to try and get some testing done.

So then after that did you go to A&E again?

No, then it was going, from that second point I went to [my home town], and then tried to go back and see the urologist there.

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Like Rowan, Ambeya was advised to go to A&E by a health professional. She saw a GP about an eye problem and was told to see an optician. The optician advised her to go to A&E. There, she waited seven hours to be seen.

Some people visit A&E because they have self-harmed. Nikki, who’d had depression and self-harmed, said she’d ‘lost count of the amount of times’ she’d gone to A&E because of self-harming (overdosing). She disliked medical staff at A&E and said she’d overheard a nurse saying that she was ‘the dramatic type’, which made her feel like ‘a waste of space’. Nikki felt that A&E could be improved by having staff who dealt specifically with mental health. Shane also took an overdose. He had bad memories of being assessed in hospital and never wanted to go through that again. Fran had overdosed on recreational drugs and been to A&E three times. Like Shane, she disliked hospitals. Shane’s experience made him determined not to go back there again.

Auberon went to A&E after self-harming. The waiting time to see a GP or nurse was ridiculously long. He was referred to a psychiatric team.

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And has the situation ever come along where you haven’t been able to make an appointment and so you’ve gone to A&E or any other out of hour’s services in any way?

Oh yes. Well I would say yes, because regarding I self-harmed to do with my depression quite badly. So I was going to see my registered nurse or GP or someone, but I couldn’t make any appointments and the waiting time was just ridiculously long. So I went to A&E.

And was that helpful?

Yeah.

Did you see a good doctor?

I saw a good doctor and they also referred me to like the psych team who I know, and it’s in my borough area. That in my mental health area catchment, so yeah.

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Shane was prescribed a high dose of antidepressants, which he used to overdose on. It was then that he had to tell his mum what he’d been going through.

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It was a combination of self-harming and the tablets, and I ended up having some friends that I know call me an ambulance and essentially be carted off to hospital for overnight assessment, which wasn’t fun at all, so yeah.

So your friends were around were they or they came over or something?

They drove over just because we were helping each other out with that sort of stuff.

So they knew what you were going through?

Hm mm

They had gone through something like that as well, or were going through it?

Yeah.

So did you find that they could understand a bit more then? How, you know, having gone through that, or did you find everyone’s experience was so different?

It was different in a way because the people, my friends that came round, they had divulged this stuff with their family whereas I didn’t, so it was varied in that respect. But other than that it was mainly the same stuff, and it actually helped having them there because they knew the ambulance crew that came to pick me up, so it was a lot more personal and informal and stuff like that.

So their families knew what was going on with them, but you hadn’t talked to yours, no, because it’s somethingit’s very hard to talk about these things. And you went to the doctor. Was that the first time then that your family kind of realised what was going on or….

Yeah, because my friends said that they needed to take mephoned for me and called my mum just because next of kin and stuff like that. So, I ended up with my mum driving to the [name of] hospital, and I had to tell her there and then thatwhat I was going through because I couldn’t exactly hide it anymore because I was in a hospital bed.

And then you would havedid youyou stayed overnight; you said you had tests and things like that.

Hm mm.

And that wasn’t a nice experience?

No.

Were you able to come back home the next day or did you stay in for a few days or more than a few days?

I stayed in from six o’clock Friday till four o’clock in the morning on Saturday, so I was home within a couple of hours. But because of the experience that I had with the hospitals it sort of, I guess in a way it haunts me just because I have nightmares of the hospital machines and noises that they make because I had to sleep there. So I guess it affected me psychologically of the noises that the machines made.

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Shane was seen by members of the crisis team. He decided to stop taking antidepressants as he didn’t want to end up in hospital again.

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What kind of health professionals were there?

There wasI got seen by two members of the crisis team. And then the next day I got phone called by them, which I’ve said, but they went through and they talked to me about what I’m willing to divulge just because they needed to go through like a meeting with my mum to tell her what was going on. And that her son wasn’t crazy, which she probably was thinking at the time of seeing me in hospital.

Because a lot of people don’t know very much about these kinds of things. It’s not out there for everyone to know much about, which we’ll talk about later about, you know, raising awareness and getting people to know more about that.

OK yeah, sure.

So you then came home. Were you given any more medication at that point or… Can they just stop the medication or they had to wean it down to lower doses?

The medication continued just because they thought that it might help. But it was not given to me, it was given to my mum

so she could keep a hold of it. When I did eventually stop the medication it was just an impulse decision of I don’t want to go back into hospital. And I just quit the forty milligrams on the spot, which hurt for a couple of days just because of the effect of the drugs trying to get out my system and stuff like that, yeah.

So when you say you hurt for a couple of days, the symptoms were you getting?

I’m guessing withdrawal, yeah.

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NHS walk-in centres

NHS 'walk-in centres' are usually managed by nurses and are available to everyone. Some also offer access to doctors. No appointment is needed, though there...