"Accident and Emergency - Easy Ways to Improve"

I spent much of a night in A&E supporting an elderly relative. There are a lot of little things that could be remedied at minimal cost:

* I spent about an hour in the ambulance arrival area, 10pm-11pm. In that time several members of the public failed to find the pedestrian entrance. Yes there are signs, but they are not adequate. Sign the entrance properly.

* From the entrance there is no sign for the A&E short-stay ward (nor is there a sign for the turn off the corridor. Put signs up.

* As a university lecturer I'm aware of the requirement for fire signage in public buildings. The A&E area is clearly in breach. Make sure fire signage is correct.

* The public door to A&E general clonks when it closes. Get a jobber to fix it. It disturbs people in the waiting area.

* Patients leave A&E either via mortuary, admission to hospital or car/taxi pick-up. The pick-up for taxi is in the ambulance arrival area. There is no park bench or similar to sit on. There seems to be no understanding that very unwell people wait here for a taxi. There is no shelter whatsoever.

* My relative was "lost" in the system. The ambulance arrived just before I did, but there was no record of her arrival. I spent an hour watching ambulances arrive (with several trips back to reception to be told she hadn't arrived.) There has to be a solution where the arrival of patients by ambulance is noted.

* Entering name of system - was an hour after arrival. Presumably paramedics had indicated not urgent, but there's an issue here notwithstanding. My impression is that I saw the triage process more than an hour after arrival.

* A&E does not provide seats for relatives. Standing for hours isn't nice.

* More needs to be done to provide water for patients and accompanying relatives. Yes I know there is some provision of tea/coffee - it isn't adequate.

There didn't seem to be any concept of promptly clearing out of A&E those patients who were able to be kicked out. While I recognise that these are the less serious cases, there was a real need to get them out to clear space. My relative was told at 3am that A&E would find a short stay ward bed as it was too late to go home; had she been kicked out before midnight (when results were in) this inconvenience for her and cost for NHS could have been avoided. (The test results were through about midnight - it took about three hours for a doctor to look at them). 15 beds in the corridor was primarily an admin failure.

I suggest A&E needs an administrator who is a fire-breathing dragon to sort these issues.