Christmas in A&E is a time like any other. Just take off the deely-boppers when giving bad news

If you’re the kind of person who thinks, “It’s Christmas – A&E will be empty,” and comes in to have their verruca treated, you are wrong.

Merry Christmas. It’s that special time of year. For 18 years I’ve worked in A&E, on the ambulances and at an urgent care centre, and been at work plenty of Christmases. It’s a busy time, with the normal injuries and illnesses joined by “seasonal” problems such as drunken behaviour and more wounds caused by partying.

Most of the NHS works over Christmas and this year we’d like a nice, quiet one. So, in an effort to reduce the strain on the service, let me give you a few tips, based on my experience, for avoiding heartache, injury and ill-health over the holiday.

1) If you have children and have bought them toys, I would recommend that you forgo bare feet and wear some sort of boot with thick soles instead. Small toys are not always the best thing to step on in bare feet. I don’t mind pulling a bit of shattered plastic from your foot, but it might be a bit painful for you.

2) If you are 19 and have wolfed down a huge dinner, topped it up with booze and then jumped around on your brand new pogo stick . . . it’s probably indigestion and not a heart attack. If Dad does the same and feels “funny”, it might be.

3) Alcohol: I know people like a drink, but if Uncle John turns into a bit of a daredevil when he’s tipsy, it might be best to keep him away from the strong lager. And the sledge. If Gran gets a bit punchy on the sherry, best keep it out of her reach.

4) When the usual family arguments start just walk away. It will stop you punching a wall in anger or frustration and fracturing your hand. It’s no secret that A&E staff can easily spot when someone has punched a wall. We know you haven’t “fallen”.

5) If you’re the kind of person who thinks, “It’s Christmas – A&E will be empty,” and comes in to have their verruca treated, you are wrong. Here’s a hint: many of the alternatives to A&E are closed at Christmas, so if you find it hard getting a GP appointment normally it’s not going to be any easier over the holiday period.

If you follow these simple rules you should have a nice Christmas. Except, of course, that there’s no escaping bad luck. Maybe the dog trips you up as it chases a wayward Brussels sprout, maybe you come out in a huge rash from an unexpected allergy to tinsel.

What should you expect when you end up in hospital?

First, hope that you haven’t actually developed an allergy to tinsel, because you’ll meet a lot of people wearing uniforms that have been modified with the stuff (please don’t tell the infection control team). Sometimes it’s subtle – a little piece wrapped around the end of a pen – but there are those who go to seasonal extremes and turn out in a necklace of tinsel, tinsel round the glasses, bauble earrings and reindeer antlers on their head.

Christmas bauble deely-boppers should be outlawed, I’m afraid. It’s very distracting to see a nurse giving chest compressions with a pair bouncing around on her head. We should always, always, take them off when breaking bad news to relatives.

For the staff, things are often a little bit more relaxed, mainly because most of the managers and other folk with clipboards just happen to have Christmas off. But beware the manager who comes in for a stealthy unsocial-hours bonus payment. The only time I ever saw the upper management of my old hospital was when they “worked” the millennium and all vanished ten minutes after midnight.

There are a lot of staff who have a love of Christmas (the ones wearing tinsel) and they’ll bring in food and sweets and fizzy drinks and turn the staffroom into a little party zone. It’s a weird party, though, as people rotate in and out in order to keep up staffing levels, and the food lasts for at least two weeks because most of the staff are too busy to do anything but run in and pop a solitary fig roll in their mouth before dashing off again.

Once upon a time, a national supermarket chain would give the local ambulance station a little hamper. This is a tradition that I’d like to see continued.

One of the more surprising reasons for pressures on A&E departments is that of street sleepers. Over the Christmas period, homeless organisations like to gather them all in one place to keep them warm and fed. Although they often provide health services at their shelters, it still increases the burden of work on local hospitals and the ambulance service, which has to transport them between shelter and hospital. On the positive side, it does give the hospitals a chance to catch some rather nasty stuff early on.

In the run-up to Christmas, about three months in advance, staffing rotas will be inspected to find out who gets to see their family and who gets to work (the staffing is the same as at any other time of year). You’ll find previously warm-hearted nurses capable of the most Machiavellian manoeuvring in an effort to get the “big day” off and spend some time with their family.

For those who work, it will be a day much like any other. Doctors will doctor, nurses will nurse and radiographers will take pictures of bones. Ambulance crews will pick up patients while cleaners sweep the floor and HCAs do the mucky work. The NHS is staffed by people who are willing to work on Christmas Day – for them it’s just another day of the year. But even for those working, there will be one consolation: at least we aren’t a patient.

Photo: Getty

This article first appeared in the 19 December 2013 issue of the New Statesman, Christmas Triple Issue

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Oxbridge’s diversity failure is so severe it’s time to ask if it’s wilful

If Oxford and Cambridge are to become the diverse institutions they claim to want to be, they must address the systemic problems inherit in their admissions systems.

“We’re not the best”.

It’s the open secret that every Oxbridge student eventually comes to accept. Some realise it during their first term, informed by the mundanity of their year group’s Received Pronunciation-dominated conversations. Others learn the humbling fact mid-way through a tutorial, or when first entering employment. For a remaining few, it took the allegation that their peers amuse themselves with porcine-related debauchery for them to question whether the Oxbridge cohort really does encompass the brightest and best.

Yet it remains almost sacrilege to voice anything other than self-deserving grandeur when it comes to Oxbridge’s student intake. Admissions tutors maintain the infallibility of their interview technique in selecting the country’s most promising students but still, admission figures show an unrelenting bias to a white, middle-class population. Pupils from independent schools dominate 43.7 per cent and 37.8 per cent of the intake at Oxford and Cambridge respectively, black students are half as likely to be awarded a place than white applicants and students on free school meals are under-represented by a factor of more than ten to one at the universities.

I’ve spent the past six months researching the under-representation of disadvantaged demographics for OxPolicy, an independent think-tank comprised of postgraduate and undergraduate researchers. Our report, published tomorrow, reveals an even bleaker picture. Statistics obtained by Freedom of Information requests show the universities’ own efforts to support applicants from under-represented demographics are consistently failing.

Consider Cambridge’s admissions last year. Applicants from schools flagged by the university as having a poor record of sending students to Oxbridge had a success rate of just 18.6 per cent, compared to 28.5 per cent for unflagged students. This trend was replicated for an array of markers recorded by both universities, including living in a deprived area and attending a school with poor academic attainment. The discrepancy translates into a statistical equivalent of 275 applicants from disadvantaged backgrounds missing out on places at the University each year.

When we approached admissions tutors to discuss the topic, we were met with a general sense of denial. “It would of course be good to have more students from disadvantaged backgrounds,” commented one, “but factors substantially outside the control of universities make this difficult”. Others were blunter. “I don’t think there is a problem” was one tutor’s only response to our question about under-represented demographics. “It is self-evident that the University is not to blame” asserted another.

The universities’ senior staff offered similar retorts. In January of this year, Oxford’s Head of Admissions, Dr Samina Khan, claimed that applicants were “more likely” to be shortlisted for interview if they came from disadvantaged backgrounds. The figures in our report show this to be statistically untrue. When I presented our findings to Khan she was unavailable for comment, although she referred me to the University Press Office. A spokesperson insisted that our statistics “did not suggest a bias on the part of the selection system,” attributing the discrepancy instead to the “lower prior attainment” of candidates from disadvantaged backgrounds.

But this confidence was not shared by everyone we spoke to. One tutor told us that “more could be done” in terms of the “implicit biases [that] play a role in the problem,” while others expressed concern that “not all tutors [were taking] contextual information into account”. “I use contextual data, but it's limited. I'd like to get more” suggested multiple respondents.

Other replies were more concerning. “A lottery would be fairer than the current system” was a sentiment expressed on more than one occasion. Another tutor who had more than twenty years of experience of handling admissions blamed the universities’ senior staff for a “defensive ‘arse-covering mentality’ which refuses to admit they have a serious problem”. “There is a stark refusal to allow evidence to impinge on decision-making. Anyone looking in from the outside would think we were deliberately hostile to widening access”.

A 2012 report by the Supporting Profession in Admissions programme analysed the kind of evidence this tutor was alluding to. The document summarises the policies of UK Higher Education Institutions which have used contextual data in their admissions processes. Policies include offering students from under-represented demographics lower entrance offers, being more likely to invite these applicants to interview, or giving their applications extra weight in borderline decisions. While 40% of these institutions reported that students admitted because of their contextual data out-performed their peers, not a single one concluded that these students performed worse than the rest of their cohort. One study, carried out at the University of Bristol, revealed that contextually-admitted students were outperforming their peers by such a margin that reducing offers by up to three A level grades was justified. In other words, when universities gave a selective advantage to applicants from disadvantaged backgrounds, they were rewarded with a higher calibre of applicant.

This evidence from universities across the UK clearly suggests that Oxbridge should rely more heavily on contextual information in admissions. However despite officially recommending that demographic data be considered in decision-making, neither university provides obligations nor incentives for its admissions tutors to do so.

In fact, not only are tutors not obliged to consider contextual data, but the funding arrangements at Oxbridge mean that colleges are actively discouraged from admitting students from disadvantaged backgrounds. In each of the years I studied at Oxford, my parents would receive letters requesting donations; to support learning opportunities, teaching resources or construction projects. They were invited to countless drinks events and fundraising dinners to the same effect. It was symptomatic of a culture that pervades the collegiate system at Oxbridge - we will educate your son or daughter, and in return you will support us financially.

Oxbridge colleges operate in networks dominated by white, middle-class and southern-dwelling families. Fixated with the idea that they are short of money, the stakes are too high for colleges to risk losing the hundreds of thousands of pounds they receive in annual donations by pioneering a new access policy. Their reluctance to diversify their student intake is as much about preserving capital – whether financial or cultural - as it is an unwillingness to admit applicants from disadvantaged backgrounds.

The admissions tutors we spoke to in our investigation openly discussed the existence of “an unconsciously corrupt relationship between many colleges and independent schools”. No surprise then, that many tutors expressed a desire for admissions to be dealt with by the central university. “Decisions are left almost entirely to a college’s discretion, there is no way that the University can exercise any oversight over the representation of different demographics” they warned.

If Oxford and Cambridge are to become the diverse institutions they claim to want to be, they must address the systemic problems inherit in their admissions systems. Their admissions officers should stop telling the press that disadvantaged applicants are more likely to be shortlisted for interview when the opposite is true. They should follow the lead from other UK universities whose contextual data initiatives have led to almost universal success. And they should encourage all their admissions tutors, by either obligation or incentive, to follow the evidence and give a bias towards, not against, applicants from disadvantaged backgrounds.

No longer can we believe the myth that Oxbridge’s diversity crisis is a result of incompetence alone. The universities’ failure on admissions is so stark and longstanding that even its own students are wondering if it’s wilful.

OxPolicy is a think-tank set up by Oxford University researchers in 2013. It produces regular policy papers on a variety of issues from a non-aligned stance. You can access their reports at their website, www.oxpolicy.co.uk.

George Gillett is a freelance journalist and medical student. He is on Twitter @george_gillett and blogs here.