An emergency ambulance was despatched to a small town in Perthshire after a 999 call on Hogmanay. The “patient” was a person with toothache who had phoned A&E directly twice during the evening to be told A&E was not the appropriate place to deal with toothache.

On duty in A&E today, consultant Thakore Shoban, who was also on duty on what is traditionally the busiest night of the year, said staff had to deal with a number of people attending A&E who were “belligerent” when refused transport back home.

“Just because they get an ambulance in to hospital doesn’t mean to say they are entitled to transport back home again. The NHS does not have a taxi service.”

He agreed that when a person dialled 999, their request was taken at face value. No chance can be taken. If the caller claims they require an ambulance as an emergency, one will be despatched. However, once a person arrives in A&E and has been treated, staff there advise those able to make their own way home to do so.

“We had demands for transport, which is a common thing,” said Dr Shoban. “People come to hospital and expect to be taken home again, as if we run a taxi service.

“We had somebody in from somewhere in Fife. He was brought in by ambulance after a 999 call and then proved to be fairly belligerent and not particularly nice to staff around him, being pretty demanding (of their attention) and then demanding transport back to Fife.

“He was found in the street in the middle of Fife and sent to hospital here where he wanted to pick a fight with us because we expected him to make his own way home.”

Dr Shoban said what staff had to deal with “after the bells” was “standard fare” for what is the busiest night of the year in A&E.

“There were a lot of young drunks. They come in and are just very belligerent. They want everything and they want it now and are difficult to manage.”

He explained language was also “offensive” and was particularly difficult to accept when children were attending the department. Staff had to try to manage that and keep abusive people away from other patients who might be offended by bad language. Ultimately, if they could not be “talked down”, they were “ejected” or the police called.

Dr Shoban said the nursing staff were particularly skilled at “de-escalating” fraught situations involving abusive patients and also spent a lot of time trying to arrange for people to get home.

“The nursing staff bend over backwards to try and get people home, trying to contact as many people (friends and family) as possible to get patients home. They put in an awful lot of effort but I have to say it’s not always appreciated.”

He explained that in the case of the Perthshire person who pitched up by ambulance on Hogmanay after being told twice A&E was not the appropriate place to come, arrangements had to be made for a taxi to take the person home via a cash machine as the person turned up claiming to have no money when told no NHS transport would make the journey back home.

Dr Thakore said ambulances had to be kept available for proper emergencies and could not be used as an NHS taxi service. Overall Hogmanay/New Year was busy but not exceptional. Abuse and belligerence is sadly “standard” in A&E.

“Having spoken to other people who were on duty that night, it was no worse than any previous Hogmanay, certainly no worse than a bad Saturday night would be.”