The government has announced a Patient's Charter, which includes an understanding that 'authorities will increasingly set and publicise clear Local Charter Standards, including waiting times in accident and emergency departments, after initial assessment.' This is all to the good as far as it goes. But many other improvements are urgently needed:
- Increasing the number of doctors in casualty departments up to levels recommended by the British Association for Accident & Emergency Medicine;
- Reducing the proportion of junior, inexperienced doctors working in casualty departments, given that they are attempting to deal with many of the hospital's most seriously ill and injured patients;
- Independent consumer bodies such as 'Which Way to Health?' or the College of Health publicising details of the best and worst casualty departments and their own comparative listings of waiting times (a) for those with serious disorders (b) for those with minor self-limiting injuries;
- Financial incentives to hospitals to lessen waiting times. At present hospitals receive a 'block grant' to run their accident and emergency service, a grant which is not dependent on the number of patients seen. They therefore at present may be tempted to conserve their grant by rationing use of the system through increased waiting times. There could be new scaled incentives based partly on any increases in the number of patients seen in categories (a) and (b) above, and partly on any lessening in waiting times in these categories;
- Assigning volunteers or counsellors to talk with people waiting in casualty, to help sort out non-medical problems, to make phone calls for the patient, to liaise with the nurse in charge, etc;
- Airport-type TV monitors to let people know likely waiting times for non-urgent cases or other developments;
- Transport to take patients to neighbouring hospitals if they are not so over-stretched;
- Prominently advertised suggestion schemes so that patients can add their ideas.