A&E crisis

[mumsthewordi]

i am shocked to see the images from the wards, particularly impact on most vulnerable. Is this just the reality of a health crisis under any government, or do we think Labour have something to answer for?

What is a your level of acceptance at what's happening, and it's being reported to be worse year on year in the wards.

Will it take Labour another 14 years to undo the Tory underfunding ?

I'm a Labour voter.

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I had a good A&E experience the other day at Aintree hospital in Liverpool - went in with an infection and was x-rayed, given meds and out of there within 5 hours, which was much better than expected. I don't know enough about how the NHS works to know why it was so different to the Royal which is the Liverpool hospital currently in the news for dire waiting times. Maybe it is different if you don't need to be admitted?

I’m pretty sure they’ll need that growth they talked about for this and that’s up in the air rn.

Good you got a quick diagnosis, but sorry about the path required to get there. I'm an anxious wreck and whilst I hope it's not MS, it's frustrating that I may spend 18 months living with this anxiety to find out it's nothing (though I suspect there's something going on). It's sad we've reached a point in the NHS that this is now the norm and we simply have to accept it for now.

Wait let me guess - you also don't like the idea of having to pay more tax. Am I right?

The NHS won't be fixed in five years let alone six months. But you know that of course.

All I've ever heard my whole life is what a shit job nursing is. As a teenager I wanted to be a nurse, until I looked into it properly and was told by everyone at every turn, don't do it it's a shit job. So I didn't. I'm not young either.

I don't think decades of that has helped recruitment.

Tbh I think it everyone’s fault - the decades of underfunding by multiple governments; the entitlement of the tax payer whilst not wanting to pay more in taxes to fund it; the 100s of thousands of DNAs, that waste at least a £billion a year; the toxic work environment that drive thousands of NHS staff out of their respective professions and/or into private practoce; the loss of overseas staff post Brexit; the increased running costs post Brexit/Ukraine/etc; yes, the farming out of contracts under the tories to “ mates’ ’’ companies [people should be standing trial for the PPE swindle]; the increased reliance on the NHS whilst simultaneously refusing to take responsibility for our own health; the toxic environment around medications such as Mounjaro/Wegovy which have the potential to reduce NHS costs/improve the health of millions; the demands of difficult employers who insist on doctors ‘notes’ (requiring appointments) rather than operate a system of trust because past employees have gamed the system; the over-reliance on management/DEI/HR/etc staff over clinical staff…. I could go on. The NHS is broken and yet we are not willing to stump up additional taxes to pay for it. The time for it being free at the point of service for anything beyond emergency care is past.

I followed a link for a private appointment on my own NHS GP practice website this week. They are not even allowing access to their eConsult system until 21st Jan due to rolling out a new system (21st Jan is going to be a crap day for their staff). Cost me £45, but I was seen on-line within 2.5hrs and was in Boots with a prescription 30mins later. Pissed off that I have to pay, but the issue was assessed/resolved/treatment offered in the same timescale we USED to able to be seen and treated under the NHS.

Yes. Go and get it today.

I don't think we should underestimate the long term impact of austerity and the faiulure to invest in NHS equipment and estate over 2010-2019.
We have fewer beds, CT and MRI scanners per capita than say France - this leads to significant delays. As well as gaps in the medical workforce and crucially in social care.

Read the OP and was like yep, it’s a mess, has been for several years and gets progressively worse each winter. Then I saw the line about Labour being somehow to blame despite them not being in power for the 14 previous years and my eyes rolled all the way to the back of my head because of course it’s one of those threads- started by either someone who believes everything Tory HQ tells them or Tory HQ themselves.

3 winters ago my dad was trapped in A+E for about 4 days on a trolley in a corridor waiting for a bed to become available on a ward. This was after a 7ish hour wait for an ambulance outside in the cold unable to move. And then a hours long wait in the actual ambulance waiting to be triaged. Someone on a trolley next to his died. He couldn’t vacate the area himself and the staff were all hands on deck trying to save the life of the other patient so my dad was forced to lie there while they tried and failed to save their life. I’m not saying Labour are perfect but they need a bit longer to fix this stuff.

How on earth do you think Labour could turn it around in 6 months? Genuinely.

@mumsthewordi I said have they some responsibility and something to answer

But how????

More worryingly, Jenrick claims that it will all be sorted out without training and employing more medical staff (nurses, doctors etc)

This is a really interesting article regarding the lack of investment -

Two key pieces of analysis by the Institute for Government and the Institute for Fiscal Studies have identified capital underinvestment as one of the key areas contributing to lower-than-desired NHS productivity. In 2019, the UK spent 0.33% of GDP on capital investment in health care, compared to an average of 0.48% for comparable countries, and this trend of underinvestment has been consistent for nearly 20 years. The trend was exacerbated by the siphoning of £4.3 billion from capital budgets into revenue as a response to the lack of resource in core day-to-day NHS budgets between 2014/15 and 2018/19. This short termism is likely contributing to the lower-than-expected hospital productivity seen since the Covid-19 pandemic, as staff try to work with less equipment and outdated technology in deteriorating buildings. The Institute for Government put it well saying, ‘Ultimately, if large increases in the workforce are not matched in capital almost any system will get less productive.’ The idea of spending money on buildings and equipment might have seemed less important than directing it to ‘the front line’ but now staff are facing additional operational pressures ‘generated by the level of backlog maintenance’.

Therein lies a critical piece of the problem: "It's not my job to come up with ideas". Why not?

Edited to say, the above was in reference to the OPs comment.

You’re absolutely correct. It’s not so much the physical aspect, it’s the mental damage it does wondering and waiting. I hope for your sake that it’s not (lots of things have crossover symptoms with MS, many of them extremely minor-like b12 deficiency)
I was lucky in a weird way, my initial symptoms weren’t that bad in the grand scheme, it’s just that they were red flag symptoms for cauda equina, so they had to do an emergency MRI which led to me being admitted. When you’re an inpatient, tests happen at rapid pace.

I agree with this.

Why would anyone think Labour are to blame? The Conservatives have all but destroyed the NHS. People need to remember this.

Because I am not an elected representative who's committed to sorting the nhs out as one of their key manifesto pledges

Having taken power they should have already assessed the state of play, developed a plan, funded a plan, implemented a plan and reviewed the outcome of the plan?
How far do you think they could reasonably be expected to have got with that in the time they have had so far?

Bizarrely I read this post and knew exactly who this patient was, and if it is, then that was a very quick dx, surgical intervention and recovery jobbie, I suppose we don't have many of those in reality and also Paeds is a lot more palatable in terms of wait times compared to Adults.

Incredibly despite it being winter we still have some beds in Paeds, November and December was hellish though.

Your elected representative represents YOU. How do you think things like Martha's Rule came into being? You can't sit back and be a lazy citizen expecting a "fix" to something you're unwilling to even think about yourself.

It is also incredibly naive to be "shocked" at the state of A&E wards. Why are you so shocked? Where have you been living for 30+ years?

There is a huge emphasis on the 4hr waits in Paeds ED at least, more so that there will be a fine, less so about the fact the patient has had to hang around waiting for a bed!
It's par for the course in Adults though, I work there sometimes and the amount of patients whose first words are "I couldn't get a GP appt" ... we do stream as many as we can to our onsite GP service but still.

Thank you. Genuinely. I have been saying this for years. For the record, I don't work for the NHS but do use their services.

Nothing can ever be truly free. If we as an electorate want "free" public services, health care, schools, policing, fire departments, etc, to actually work, we need to need to pay more taxes. The money that has been allocated to public services is shamefully low and has been decreasing under the last government. By increasing taxation, we can hope that more money will be adequately allocated to where it's needed most and the people who deliver these services should be paid accordingly and appropriately for the service and work that they provide. Not mention given respect, which, by the way, is actually free. No one becomes a nurse, midwife, or police because it's easy money.

Our services are broken and on their knees. The NHS is struggling and do the best they can with what they have. This situation is due to a high level of flu, sickness bugs, people who have not sought treatment when they should have, massively underfunded services, with over worked-under paid staff.

To those that provide these services to us. Thank you from the bottom of my heart. I know it means very little, but myself and family value all that you do.

Issues as I see it - for clarity I work for the NHS in a community trust - not acute.

Recruitment - lack of appointable staff (covid has had an impact on this - I trained during the pandemic and our course drop out rate was much higher than normal years because online learning was so shit) and the fact that NHS HR has two speeds when there IS an appointable person - slow and glacially slow.

Too many managers - we're told constantly there's no money, recruitment has been slashed down and everything has to be justified at multiple levels before a post even goes out to advert - but they can find cash for multiple new very well paid management posts. It's bollocks and it's not improved patient care at all.

Closing the walk-in centres - happened a lot around here, just offloaded everything onto A+E. Upping the capacity at our urgent care centre or opening that overnight would reduce things as well - they have things like access to X-rays and A+E do signpost people there during the opening hours.

Social care is fucked - we have people in hospital due to placement breakdowns or placements not being available, and we have people who become unwell because of medical needs and care plans not being followed - social care is at the bottom of this house of cards and needs shoring up and staff ups killing and up-statusing before the whole thing falls completely.

Morale - people say it's toxic to work in. I don't get that with my colleagues - I love who I work with - both colleagues and client group (which is why I'm determined to stay put) - but morale in general is absolutely battered and endless funding issues really don't help that. I'm lucky that I have incredible management at most levels who appreciate good staff and will try to hang onto them and develop them - but even then, there's minimal money for training so you have to push and consider leaving to get developed further as a professional.

Access to GPs - also things like district nursing and GP home visits - I know of many many incidents where, as the GP wouldn't do a home visit or offer an appointment - my clients have ended up needing to be taken to A+E and they really didn't need to be there. Likewise district nursing - more resources into community healthcare would take so much of the burden off A+Es - but it needs joined up thinking across multiple providers and that's not going to happen.

And last - shitty NHS IT. We still have different trusts on different IT systems which can't talk to each other and that means people (cough me) spend bloody hours having to phone up GP surgeries for information that should be checkable at the click of a mouse button. And then the GP surgery needs to provide this information which takes admin time that could be used manning the phones or whatever. And that's when the IT works - we had a week the other week where we couldn't send emails to a different form of NHS email address - so everything was having to go to phonecalls and chaos ensued. Working printers would also reduce a hell of a lot of staff time spent trying to printer-whisper things into cooperation (my client group often can't access digital resources) and functioning wifi at times would help. When I last spent time shadowing my acute counterparts, they were still writing in paper MDT notes, then going and waiting for a free computer to type up the same notes digitally and the waste of time doing things twice was fucking nuts!

Winter is going to winter. The issue is that for about the last decade - it's become so normalised to see queues of ambulances waiting to offload and horror stories about A+E waits and journalists hanging around to report on the horror - that we've lost sight of the fact that we should have an NHS funded and staffed based on the WORST, rather than one that is funded and staffed to just about cover the BEST days in the summer where things are (and I know never to utter this word in NHS terms - it's like the Healthcare equivalent of saying Macbeth in a theatre)... "quiet"

We've been running at 50% capacity in my area for most of the last year. We've managed just about to keep to our waiting time targets (which is 8 weeks to be allocated and contacted with an initial appointment) - but the only way we've done this is to absolutely ignore every other element of our role (we do lots of care team training and the like which invests in future proofing our service users) and by the remaining staff putting in massive amounts of unpaid overtime. People burn out when treated like that as the norm - and if management respond by saying "oh you don't need that post filled as you're managing" they stop giving a shit at work - thankfully our management haven't done that - it's just finding an appointable candidate that's been the issue.