Sometimes even the most well-intentioned rules should be broken.
Nowhere is this more important than when the interests of a patient in pain are concerned.
The revelation that a woman suffering severe back pain that turned out to be ovarian cancer was turned away from A&E at Ninewells Hospital in Dundee because staff were following a health board policy, is deeply concerning. The health board was at the time, in 2011, operating a pilot scheme aimed at making sure patients were treated in the most appropriate place after being seen by a senior clinician. The scheme, aimed at reducing pressure on A&E departments from non-emergency cases, required patients who had already been seen by their GP and had had symptoms for more than three days, to be referred back to their GP instead of being investigated further in hospital. Since the woman in question fell into that category, she was redirected to her GP, in spite of her increasing pain levels.
This is a very sad case and its implications go beyond NHS Tayside. Since the pilot scheme in question is now being rolled out across Scotland, it raises the possibility that other poor decisions could result.
The system itself does not appear to be inherently flawed. The Scottish Public Services Ombudsman describes it as a "reasonable" process if appropriately applied. It certainly has the potential to ensure patients get quicker treatment and allow A&E departments to focus on the most urgent cases. Around 4,000 out of 80,000 patients coming into A&E in Ninewells and Perth Royal Infirmary each year are signposted to a different service, such as their GP, NHS 24 or an out of hours clinic.
Yet the system must be implemented with common sense. Some serious illnesses are notoriously hard to diagnose and have symptoms that can easily be mistaken for less significant complaints; ovarian cancer is one such disease. One third of women with ovarian cancer are diagnosed after a visit to A&E, according to Target Ovarian Cancer. Often they have previously been to their GP and been misdiagnosed, and turn up to see the emergency medics in acute pain. The charity is understandably alarmed by the thought that the new guidances could cause delay in women with ovarian cancer getting a diagnosis.
The Herald has been running a campaign, NHS: Time for Action, calling for a review of NHS resources at a time when pressures on the system are increasing as a result of the ageing population. Innovative ways of working are required to cope with growing demand for NHS services, particularly in A&E departments, but hospitals must never lose sight of the needs of individual patients. Sometimes sticking to the rules will be the wrong approach. It is now an urgent priority to review the three-day guidance and ensure that staff in A&E departments all over Scotland understand the potential pitfalls. They must have faith that they will have the backing of bosses to depart from official guidance, if circumstances demand, to help a patient in need.
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