NHS needs urgent care after three Xmas dashes to A&E before 93-year-old mother was given treatment she needed, says Janice Turner

WHAT is an emergency? It is a question I’ve wrestled with lately as my mother’s illness coincided with a tough new NHS edict that only those with “life-threatening” conditions should turn to A&E.

Ours was a very ordinary medical odyssey yet it made me fear that our crisis-stricken primary care system is a self-inflicted mess.

On Boxing Day Paddy, my 93-year-old Yorkshire mother visiting London, falls ill. It is a bank holiday so I call Seldoc, the out-of-hours service.

A doctor is sent, a chest infection diagnosed, and antibiotics prescribed which disagree with her spectacularly.

So two days later I call 111 and a random phone doctor tells her to stop taking them.

A day later she is no worse, has no fever, is breathing fine, eating a little.

But I’m worried: She’s weak and very old. Is she getting better? Does she need different pills? I’ve no idea.

I call my GP surgery: Could a doctor visit? The big-hearted receptionist laughs.

They won’t even register her as a temporary patient and even if she was their patient they never do home visits.

Take her to a walk-in clinic, she says. (But it’s freezing and she can barely walk.) Or call an ambulance.

Now here lies the dilemma. Is my mother an emergency?

My instinct is she just needs a doctor to check her chest, write a prescription, then more bed-rest.

Every ambulance call costs the NHS £300. It seems a stupid waste.

So I ring 111 again which — after a call handler takes me once more through 50 irrelevant questions — suggests I wait until 6.30pm when Seldoc kicks in.

It is 10.30am. How crazy that the out-of-hours service is better than normal care!

So, because I am fortunate, I call a private GP.

Around 10.30pm a suave Harley Street type pitches up and charges me £160 to say my mother isn’t too bad but I should take her to A&E. Couldn’t we wait until morning?

“Well, you could…”, he says, covering his elegant arse from malpractice suits.

We bundle her up and drive to A&E, and at 4am, after a sleepless night of tests, she is sent home frailer than before.

Why would anyone go to A&E unless they are truly ill?

What a scene. An obese woman bucks and screams on a trolley. A father chides his vomiting disabled son. An old, bald woman with dementia paces the corridor.

And yet the patient ahead of us at triage says: “It’s my shoulder. It’s hurt for a few weeks but it’s worse today.”

Wouldn’t you find a hot-water bottle, take ibuprofen — anything but spend a night here?

In 2013, the then NHS England medical director Sir Bruce Keogh declared that the work of an emergency department was “unbounded”.

It was a licence for those with poorly shoulders, sore throats, even (reportedly) broken fingernails to turn up at A&E.

And for surgeries like mine to dump its more costly, time-consuming duties on another health budget: Home visits are at a GP’s discretion.

Now, overwhelmed with patients, the NHS struggles to reverse the Keogh doctrine amid budget cuts and an I-want-it-now culture.

Anyway, three days later my ma got dressed, came downstairs, instructed me to book her return home, drank coffee with her grandson — and collapsed.

She was unconscious for 15 minutes: I thought she was dying in my arms.

Now she really was an emergency. I called 999 and an ambulance took her to hospital.

For 12 hours I sat with her playing A&E snakes and ladders, repeating her story to ten people, slowly moving up from nurse to registrar.

Ambulance crews must stay with patients until they’re booked in, even if that means hanging around for four hours. No wonder emergency call times are so long!

In extremis, a nurse may be put in charge so that crews can leave, but then there may not be enough spare trolleys for every ambulance.

I watched the drunks. “Hello, Manuel,” said a weary nurse to a staggering man flanked by police.

Could Manuel be held in a side ward? The nurse protested, then gave in.

Three in ten A&E admissions are alcohol-related and they are messy, troublesome and often violent.

Police are reluctant to arrest the drunk and disorderly in case they get ill in custody so take them straight to A&E.

Drinkers treat 999 like an Uber app, knowing they will be scooped from the gutter.

Why not create drunk tanks, overseen by nurses and alcohol counsellors, where they can dry out and pay a hefty medical bill to be released?

After 12 hours, the registrar said that my mother had merely fainted and could be discharged.

He prescribed antibiotics — the very drugs to which she’d had the bad ­reaction.

She had scaled the A&E ladders only to be thrown down a snake.

If she collapsed again tomorrow she would be back at the start.

So I insisted she be admitted for observation overnight.

My ma was livid with me: Her generation are deferential to doctors. And true, I’m no medic, administrator or health minister. But even I can spot an illogical system held together with dedication and gaffer tape.

Why can’t GP surgeries — as doctors have suggested — be put in A&E to filter off the poorly shoulder brigade? Why can’t Seldoc perform home visits for vulnerable patients at all times?

My mother collapsed AGAIN on Saturday and was taken to hospital.

Her heartbeat was 200bpm — caused by an underlying infection.

She ended up on a cardiac ward and has spent the last two days FINALLY getting the care she needed.

She came out last night.

Most of us know what “emergency” means. It’s the muddled NHS which can’t decide.

— Janice Turner writes for The Times, which published a previous version of this article.

The Times/News ­Syndication