- guardian.co.uk, Sunday May 11 2003 09.42 BST
For staff in the accident and emergency department of Chase Farm hospital in north London, life is never dull. Each day between 120 and 240 people may walk through the door seeking treatment. Last year the Potters Bar train crash happened near by.
Patients get frustrated sitting in waiting rooms, hopes raised as they are moved into the next room only to be met with yet another wait. And like all the other doctors and nurses working in casualties across the country, they also have to contend with the pressures produced by government targets.
At Chase Farm the aim is for patients to be seen by a doctor soon after arrival before waiting for fuller treatment. It is an initiative called 'see and treat' and is one suggested way to help the hospital meet the goal of getting nine out of 10 patients through A&E in four hours.
In the last week of March, when every casualty department in Britain was under pressure to ensure that patients waited four hours or less, Chase Farm managed to hit the 90 per cent target. Since then, they have slipped back by a couple of percentage points. Next year, however, the Government wants to see this target raised to 100 per cent, an unfair demand according to staff in a department already strained for resources.
'People are motivated, but that is not the problem,' said Karen Kawase, a staff nurse at the A&E. 'To hit targets you have to address bottlenecks. There is the shortage of beds, the lack of support in the community and the portering and X-ray services are all pushed to the limit.'
Despite the pressures on the emergency rooms, the patients sitting in pain, tired and fed up were all quick to praise the efforts of the staff. 'They work so hard' said Mary O'Connor, whose two-year-old daughter Eva needed stitches after jumping off a couch and hitting her head. 'I appreciate there are far more serious things to deal with.'
For a hospital that received a government rating of zero stars, the care from the medical staff appears very high. The outcomes of such testing can be disheartening for some doctors. 'I think the Government would admit that its star ratings are based on targets that are management orientated,' said consultant Dr Kilian Hynes.
'It is very hard to measure clinical care and it is demoralising when you work exceptionally hard, then see your trust criticised.'
The time of year the trust comes under most scrutiny is during the spring, when all hospitals know to prepare for their annual check-up.
'As I understood it, there was an experiment in March,' said one member of staff. 'They gave the department extra money to prove that with the resources we would hit targets. It worked like clockwork. There were more staff and all patients were seen within four hours.'
With a busy day in casualty being described as a 'war zone' by some and a 'madhouse' by others, it seems unlikely that running like clockwork is a daily experience, but Hynes is optimistic about results.
'I think it is obvious that if everyone has exact notice of days of measurement it will improve the reported results. But I do not think any trust would be able to improve that much within a week if they had not been approaching targets.'
One elderly lady, who had come into casualty after falling, felt sorry for the staff on duty: 'The nurses are run off their feet. The girls are wonderful and really do their best, but I think they are understaffed. There are always terribly long waits in casualty.'
Manuel Gilbert, 50, had been in the department for three hours and was assured he would be able to leave soon. He was lucky, having come into casualty in the late afternoon. Staff expect the numbers to increase after midnight.
Word came in of a stabbing in the area and doctors and nurses flooded into the trauma room to prepare. Whatever happens elsewhere, there is always someone on duty for major incidents and as the injured 18-year-old man was wheeled in, straight towards treatment, those with lesser injuries would have to wait their turn.
