• skillmix

Over the past five years there have been many changes in the way that emergency medicine departments work. This has been given recent prominence and encouragement by the recognition of the government—finally—that emergency medicine was in difficulty. There is also the recognition that the A&E department is the shop window of the NHS. A long trolley wait today is a newspaper headline tomorrow—particularly in London and the south east.

So why do we have a problem? Much is historical. Many A&E departments changed little for several decades after the birth of the NHS. A large, unattractive waiting room was the norm with all sorts of patients mixed in together. There was tacit acceptance that one would wait—sometimes for several hours. A&E had neither the glamour of surgery nor the academic backup of internal medicine. It was looked on as a necessary evil—a carbuncle on the side of the hospital. A&E consultants and SHOs worked hard and well, as did the A&E nursing staff, but opportunities to change practice were in short supply.

The past two …