Hourly dramas in a real-life `Casualty'

THERE IS no coffee brewing in the staff rest room at the Manor Hospital in Walsall, near Birmingham. No magazines or newspapers scattered around the tables.

The idea that the nurses in the intensive care unit might have time for a break provokes a hollow laugh from the sister in charge. They have been operating over-capacity since Christmas, and forced to rely heavily on agency nurses. And the pressure is showing no signs of letting up.

The picture has been similar at casualty. On New Year's Day the cases were mounting so fast the A&E had to close briefly, something that rarely happens at The Manor. John Rostill, the chief executive, said: "We can predict there will be excess and take precautions to cope with it. But we cannot predict when or where the excess is going to come. There is always somewhere somebody under pressure."

Indeed. On Saturday morning A&E staff were enjoying a lull but by noon it evaporated as several patients come in at once. Dave Hales, 36, arrives strapped into a head brace after suffering whiplash in a car accident. Four nurses are required to help turn him while the doctor examines him. Careless handling in his condition could leave him paralysed. By 1pm he is ready for X-rays and the casualty staff are optimistic about his chances.

Meanwhile, Priscilla Lees, 86, is bleeding from a head wound after a man had an apparent epileptic fit in a shopping precinct and accidentally knocked her over on to the concrete. Closer examination reveals a superficial injury, but because of her age she is given oxygen.

Shortly afterwards, Shaun Painter is brought into the trauma area cradling his three-year-old son, Jack, also spurting blood from his head. "I don't know what happened: my girlfriend came in screaming, with Jack in her arms," said Mr Painter, "I was in the car with him before I had time to stop and ask." The prognosis looked better after Jack was cleaned up. He would need a few stitches, but probably nothing more.

At the Manor some pressure is taken off casualty by having a separate ward for medical admissions referred by GPs. But this means Carol Osbourne, the sister at medical admissions, endured a similarly gruelling holiday season as the flu cases mounted up. On Saturday a woman came in with suspected meningitis.

Unlike many hospitals hit by the flu crisis, the Manor has managed to avoid leaving patients on trolleys in the corridor. But only by expecting superhuman efforts from its staff. "We were hanging on by our thumbnails last week," said Ziggy Ezikwa, the staff physician on the ward.

Patients were on their way to hospital before beds in the ward had been cleared. At the height of the crisis, medical admissions were forced to commandeer two surgical wards to cope with their overspill. "Elective surgery collapsed, because we stole their beds," said Dr Ezikwa. Managers mucked in,making beds to help clear the backlog. The Manor has a better reputation for efficiency than most hospitals in the area.

But after nine years in nursing, Sister Osbourne has had enough: she handed in her notice last week. Nurses with her skills and experience are at a premium in the NHS and managers are trying to persuade her to stay by offering a new timetabling arrangement.

"The bed crisis is nothing new," she said, "We have an ageing population and there aren't enough beds for them. There are certainly not enough nurses." Violence also plays a part. Janet Brookes, overseeing the night shift in casualty, said: "When I first started 20 years ago, stabbings were rare. Now we get gunshot wounds about once a month."

Shortening the hours of junior doctors has also put pressure on nurses, because the extra work has largely fallen to them. All this for very little money. "I have a friend who qualified as a teacher about the same time as I did and her pay is a lot better," said Sister Brookes. "She once said `I've had such a stressful time, we had to spend the whole week preparing for a visit from the Bishop.' I told her that in one day that week I'd had to deal with two cardiac arrests, one death and a schizophrenic who had to be sectioned. I think my day beat her week."