Use of chaperones in clinics for genitourinary medicine: survey of consultants.

This study shows that, whatever else is causing a real or perceived crisis in the NHS, an increase in the number of people requiring or demanding emergency treatment is not the explanation. The supposed rise in emergency admissions is almost entirely attributable to the increased reporting of internal transfers of patients after admission. For example, if someone with a stroke is transferred from an assessment ward to the care of a neurologist, then referred for computed tomography, and subsequently moved to a geriatric rehabilitation ward, this single admission may be recorded as three or even four episodes. Costs are attributed according to episodes, not admissions. The cost of emergency care has thus risen dramatically during a period when capacity and demand have changed little. The main evidence to support the view that the current rise in emergency admissions may be a genuine reflection of population changes comes from the analysis of linked Scottish data for the period 1981-94. Our study shows how extrapolation from that period may be seriously misleading for the interpretation of more recent trends in other geographical areas. There is no doubt that many individual patients and their carers have deeply unsatisfactory experiences when seeking access to emergency care. It will be important to replicate this study in other localities to decide whether the problem in emergency care is really one of changing demand, or more a matter of the quality and accessibility of the capacity that is currently available.