Emergency care in the UK

Specialties Emergency

Published

This letter to the editor was in our local paper today - I thought it would be worth sharing.

Eye-opening ER

This is in reference to your editorial "Fading Fast: Neglect of U.S. Health Care Takes Its Toll" (Aug. 20). On a trip to England in June, my wife developed a serious infection. We went to an emergency room in London that was packed. We almost went home because we thought we would be there for hours. Forty-five minutes later my wife, Judy, was seen by two physicians who consulted two other physicians. An hour and a half into our ER stay, Judy walked out of the examination room with a diagnosis and a prescription for medication. We were met with incredulous chuckles when we asked where we should pay for her treatment. "No one pays for emergency treatment in the U.K.," we were told by a smiling young nurse.

We were then directed to walk down a hall to get Judy's meds. Ten minutes later she received them. This time when she inquired as to the price of the meds she was told that no one over 60 pays for medication in the United Kingdom.

We were overjoyed by this wonderful treatment: Two hours after we arrived, my wife had received excellent medical care and medication all for no charge. We didn't have to worry about pre-approval, submitting claims or arguing with our providers about coverage.

We were not only embarrassed that our country doesn't provide such treatment, but angry at its failure to do so.

CHARLES W. BRICE

Edgewood

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

One thing I've read about UK is that there are laws designed to limit medical malpractice suits. I think the U.S. could learn from this. We waste incredible amounts in lawsuit prevention. In UK I've heard, the loser pays legal fees. This discourages people from trying to cash in.

Specializes in ITU/Emergency.
One thing I've read about UK is that there are laws designed to limit medical malpractice suits. I think the U.S. could learn from this. We waste incredible amounts in lawsuit prevention. In UK I've heard, the loser pays legal fees. This discourages people from trying to cash in.

Malpractice is not as widespread there but it is catching up. I think this is because alot of lawyers are now doing the old 'no win,no fee' trickto encourage people to sue and there are loads of commercials on tv including one called National Insurance Helpline', which makes it sound official but is just another bunch of bloodseeking lawyers(sorry, to any lawyers out there...I know you aren't all bloodsucking!). We still get the ambulance chasers leaving their cards all over the ED and their was definatly an increase in patients coming in,following RTC's in particular, with neck and back pain following very minor incidents. Very un-english as we like to grin and bear it: "no,no I am fine"....with a leg hanging off!!! Not true anymore unfortantly!

Specializes in LTC, Med/Surg, Peds, ICU, Tele.
Malpractice is not as widespread there but it is catching up. I think this is because alot of lawyers are now doing the old 'no win,no fee' trickto encourage people to sue and there are loads of commercials on tv including one called National Insurance Helpline', which makes it sound official but is just another bunch of bloodseeking lawyers(sorry, to any lawyers out there...I know you aren't all bloodsucking!). We still get the ambulance chasers leaving their cards all over the ED and their was definatly an increase in patients coming in,following RTC's in particular, with neck and back pain following very minor incidents. Very un-english as we like to grin and bear it: "no,no I am fine"....with a leg hanging off!!! Not true anymore unfortantly!

When I was a girl, advertising by lawyers on TV was forbidden. Then they loosened up the laws, and now you see big ambulance chasing firms advertising, mostly on daytime TV. All this seems aimed at people trying to cash in. It really leads to frivolous lawsuits. The lawyers know they often can get quick out of court settlements.

Health care is not free.

Maybe you will not get a bill. But, believe me, people pay for healthcare, and it is not cheap.

I think Americans think of universal health coverage as a restaurant where you can order everything you want, even if you don't really need it and never pay.

Specializes in Spinal Cord injuries, Emergency+EMS.
To be honest I think USA citizens are suppossed to pay for treatment they receive in the UK, but often the nurses and admin staff are reluctant to fill in forms.

EU citizens, I think, would get free emergency treatment due to reciprocal agreements.

I hope the patient mentioned got well fast and enjoyed the rest of her holiday.

Emergrency dept care is free other than the prescriptions ( assuming you aren't exempted by age or other valid Uk exemption) ...

if a none EU citizen is admitted they are meant to be billed for their inpatient care - assuming whoever does the data cvollection on admission flags them as a 'overseas visitor' in which case an admin bod should come and do a 'stage 2 ' billing assessment

the Uk has front loaded Emergency department working practices to aim to get 98+ % of patients through the ED and either admitted or discharged in under 4 hours

4 hours to admission is certainly a very valid idea- an emergency department is not an approrpaite setting for inpatient care, however for minor injuries / illness care it's really just an arbitrary target

Specializes in ITU/Emergency.

the Uk has front loaded Emergency department working practices to aim to get 98+ % of patients through the ED and either admitted or discharged in under 4 hours

4 hours to admission is certainly a very valid idea- an emergency department is not an approrpaite setting for inpatient care, however for minor injuries / illness care it's really just an arbitrary target

I agree that the ED is no place for inpatient care but the introduction of a 4 hour limit in the ER has led,according to the BMJ,to an increase in admissions and therefore exacerbating the problem of blocked beds. This is particularly true with medicine, where previously CP patients would wait for negative trops, etc and then be discharged. Now, they are admitted to a medical admission unit, which is supposed to act as a CDU but in practice is a holding stage for the rest of the hospital and these patients get stuck there. In the hospital where I worked if they were admitted to the MAU, they were usually be there a minimum 24 hours later. Same with head injurys, we used to do neuro obs overnight but now these pateints get admitted, which further blocks beds for those acute admissions. I know the system works in some hospitals but it has caused huge problems in others. Creation of proper CDU's would help but theres no finance for that!

Specializes in Spinal Cord injuries, Emergency+EMS.
I agree that the ED is no place for inpatient care but the introduction of a 4 hour limit in the ER has led,according to the BMJ,to an increase in admissions and therefore exacerbating the problem of blocked beds.

the 4 hour target is a system wide target, some hospitals seem not to have cottoned on to this

This is particularly true with medicine, where previously CP patients would wait for negative trops, etc and then be discharged. Now, they are admitted to a medical admission unit,

then don't admit them to an inappropriate unit - any 'admission unit' is an inapprorpaite and outdated concept

Assessment units need to re think how they work ... admission units are just a holding stage changing trolley waits into a waiting in a bed

there needs to be

- defined pathways ,

- regular senior review ( which means Assessment unit lead clinician role for seniors not just the on take consultant and dedicated Assessment unit middle grade cover ),

- Nurse led discharge ( especially for things like head injury obs and OD not requiring active medical treatment )

- suitable diagnostics guideleines and processes in place

- initial treatment regimes

- good links with early specialist review ( the 'in-reach' model - works very well for elderly, respiratory and cardiology patients assumign i nthe case particularly of elderly and /or respiratory patients the community based services are there, functional and willing to play the game

which is supposed to act as a CDU but in practice is a holding stage for the rest of the hospital and these patients get stuck there. In the hospital where I worked if they were admitted to the MAU, they were usually be there a minimum 24 hours later.

system failure becasue the systems in the 'admission ward' are set up to admit people not to assess , diagnose and dispose appropriately...

a culture of someone is 'not admitted' until they have a plan which specifies that

a.) they need acute hospital care for more than arbitrary (small ) number of days (we are currently working to a model of 12-24 hours on the assessment unit CDU, having short stay beds for those who need

b.) their condition is such that no alternatives to acute hospital care are viable ( e.g. the community respiratory scheme etc)

Same with head injurys, we used to do neuro obs overnight but now these pateints get admitted, which further blocks beds for those acute admissions. I know the system works in some hospitals but it has caused huge problems in others. Creation of proper CDU's would help but theres no finance for that!

it needs to be looked at systems wide - there is the money to do these things by looking at how the existign funding is spent - from a pathways point of view additional nights stay represent a cost of hundreds of pounds so once you start saving even 0.5 bed-days per amdmission a big pile of cash stacks up

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Our hospital does ER holds on the units. It works well.

my trust has both a cdu and eau with most medical pt being admitted to assessment unit.

with limited a&e beds and trolleys at least in cdu pt aren't pushed from pillar to post due to the deparment needs.

our out pt pharmacy is opened quite late for presriptions

+ Add a Comment