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As is well documented in the media, A&E departments across the country are under increasing pressure to cope with demand and it is likely the landscape of health services in the NHS may change in the future.

But how does all this translate to life on the ground within a busy A&E department? What does it mean for the nurses and doctors providing these services at St Peter’s Hospital?



Helen Lawrence, Lead Nurse

There is no doubt that we, like every other A&E department, can feel overstretched some days and sometimes it is challenging to cope with the volume of patients coming in.

First and foremost, my role is as a hands-on senior nurse leader, guiding and developing the role of nurses within the A&E department to ensure that they have the right skills, attributes and resources to support patients and provide safe and high quality care. There are also other important elements to my job, for example overseeing matters around patient experience, privacy and dignity, infection control, cleanliness and nutrition.

Empathy and remembering to see it from the patient’s point of view is essential – how frightening must it be for an elderly person to arrive at A&E in the middle of night feeling sick and vulnerable? If that was your relative or friend you would want somebody to take a minute, however busy there were, to reassure them. This is certainly what we expect our nurses to do.


Dr Helen Cannon, Clinical Lead

As Clinical Lead for A&E, I oversee the clinical care provided by doctors in the department and manage the quality of patient experience. We are a good, cohesive team and I feel it’s important to try and get the best out of every consultant and doctor in the department.

Recently we’ve invested more time and resources into training our junior doctors, through simulation with mannequins to try and recreate real-life patient scenarios within the department.

In terms of the national picture, the number of patients coming into A&E departments is increasing, but the reality is that we only have a finite number of resources, space and beds. We have to find better and more efficient ways of working without compromising the standard of care patients receive.

One thing we have done is to increase the number of consultants within the department seven days a week, to enable treatment decisions to be made more quickly.

We have also looked at the flow of our medical patients, many of which are frail and elderly and may have been referred to hospital by their GP. These patients now go straight to the Medical Assessment Unit, bypassing A&E, where they can receive specialist assessment and treatment more quickly. Clearly this is a better experience for our patients and also reduces the number of ‘handovers’ from one area to another.

Moving forward we are now looking at creating more space in our paediatric A&E department and also at expanding our Surgical Assessment Unit.



Debbie Morgan, Administration Manager

Debbie says: “Being an A&E receptionist is a tough job – we are are often the first person somebody sees when they come into the department, feeling sick, frightened, shocked, upset and sometimes angry. This first impression is carried with the patient through their journey at our hospital and I feel like we are ambassadors for the Trust. The small things we do can make a big difference – a cup of tea for an upset relative or just a friendly smile for somebody in the waiting room.”


Facts and Figures

  • Last year our A&E department saw a total of 92,000 patients
  • This compares to just 56,000 in 2002
  • On average we see around 250 patients a day
  • This peaked at 308 in one day earlier this summer, proving it’s not just winter that can be busy



Philip Kemp, Head of A&E

It can sound cliché, but team working is so essential in a busy A&E department. Every member of staff plays their part in keeping the service running 24/7.Yet A&E is only the ‘front door’ to the hospital and we could not function without working closely with other teams across the Trust and in the community.

Whilst I feel the media can ‘overegg’ things and sometimes create unnecessary panic, we are seeing and admitting more patients every year. However, I think it is important to recognise that we are performing well and feedback from our recent Friends and Family tests reflect this.

The challenge going forward is to get patients to the right place to receive the right care more quickly. Many patients do not benefit from long stays in hospital, particularly elderly people, and can often receive more appropriate care in the community or at home and avoid being admitted to hospital.

Rising to this challenge, we are working closely with NW Surrey CCG and our community care and social services partners on several projects to help keep people out of hospital as much as possible.


Keeping frail, elderly patients out of hospital

We are planning a new Ambulatory Care Unit at St Peter’s Hospital to take patients - from A&E and our Medical Assessment Unit – who don’t need to be admitted to hospital and who are likely to only need a short assessment (e.g. a quick x-ray or scan). This will help speed up the time it takes for these patients to be discharged and give a much better experience.

Frail Elderly Pathway – we are developing a skilled multi-professional team to look after our frail, elderly patients. The team will work from our Medical Assessment Unit with good links to community teams to ensure we discharge patients as quickly as we can, with the right support.

Recruitment – we are continuing to expand our consultant team, advertising for our first two dedicated paediatric A&E consultants, and for additional adult A&E consultants.