To think the NHS is in meltdown?

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Just had a horrendous experience. Had an accident at home in the evening - lots of blood (head wound). Went to my local A&E as there are no alternatives (no minor injuries walk in clinic or similar). Was told it would be 5 hour wait. Waited for nearly 6 hours only to be told it would be another few hours wait. About 30 people waiting and only two doctors on duty. Central London so very busy. The people doing the triage were referred to as nurses but I don’t think they were - the woman who saw me said she wasn’t qualified to provide an opinion on the severity of it or to put a dressing on. I had to leave without being attended to as I was close to fainting and the environment was terrible - not enough seats, drunk people lying on the floor, etc.

Agreed, OP. Was thinking about this yesterday- I’ve been diagnosed with a stress fracture in my foot. I accept that this isn’t a huge deal in terms of stuff the NHS deals with, but regardless- I am in agony and can barely walk.

The GP went out of her way to avoid prescribing painkillers, gave no advice on bandages except that I ‘absolutely’ need one, and that I should ask in the pharmacy for advice and buy one- predictably, the pharmacy assistant didn’t know what I should be using. I think I might have to go back and ask for painkillers, or maybe even a crutch- I am struggling to parent effectively like this and I’m worried that I’ll do more lasting damage.

I’m fairly certain that 10 years ago, I would’ve been given a dressing, prescribed painkillers, etc...

I’ve really noticed that an ‘unwillingness to prescribe’ in the last year or so, even when (like now) I’ve bought stuff OTC, done all the self-care advised, and am still struggling.

And then there is Brexit when we will lose a very high percentage of nurses and won’t be able to replace with homegrown nurses due to the loss of bursary.
I have though had good ED experiences recently including admission for a head injury.

Yes it is, yes we are and no I don't think that's going to change.

OP, sorry to hear about your experience. I hope you're able to get seen at an OOH practice today.

@Collectingcpd you are spot on.

In addition, I think there needs to be better education or thought going in before deciding whether to go to A&E, that way, people like OP, with a head injury or other life threatening cases could potentially be seen more quickly. I know some people who have called ambulances or gone to A&E for minor ailments, such as tonsillitis or a fever, which should/could be sorted by a visit to a GP/OOH.

MarieG there was a short thread about exactly that the other day.....but it didn’t last long as no-one cares about the ‘rich’ consultants getting tax bills. As one poster pointed out it will be this that ends the NHS. No consultant working in the NHS who has already worked thousands of hours of overtime for free (because we all do)is going to start doing extra shifts/lists/clinics for free. The shifts in A&E will go unfilled (so the wait will get longer), the additional operating lists /clinic lists will be cancelled so patients will wait longer for those too. If every consultant stops doing one extra session a week the NHS will collapse.

^all of these issues are real. But they are not the cause of this situation and some of them are consequences of chronic underfunding and lack of appropriate resources.

Yes it’s on it’s knees. In my job I see the bed state emails of a large teaching hospital and at the moment there’s an alert every day, with tens of people waiting in the emergency department, and over a hundred discharges needed every day. It’s critically under funded for the job we all need it to do, and the crisis in social care causes the system to back up.

Walk in centres have been closed and there’s a crisis in primary care, so everyone ends up in ED, including OP, who seems not to have been an emergency, but had no realistic alternative. Minor scalp wounds can bleed dramatically so it must have been frightening and no wonder you felt faint.

To the PP who said the continuation of the NHS as a free at the point of delivery service is unreasonable, how should healthcare be funded? If we go down the privatisation and/or insurance route this will increase the overall cost, not reduce it, as there will be shareholders and a whole additonal bureaucracy to feed.

Whatever we do, people will end up paying much more either in tax or in insurance premiums. Or they will go bankrupt like in the USA, and die because they can’t afford their medicines.

Yes, I know the US model is not the only one out there, but it’s the one we are sleepwalking into because to move to a European model, or to raise taxes, would require a national conversation that none of our politicians dare have.

OP - hope your head is better today.

By 2020.. that’s one year away there will be a shortfall in nurses by 70,000 across the uk.
This is going to get even worse.
No one in their right mind will take on debts of £28k to be spat at, assaulted, verbally abused, complained about and to have to complete mounds of pointless checklists, paperwork and to complete 12 -14 hour shifts with not even a cup of tea, no time for a wee and having to take pain killers for back and foot pain when they get home... to have to go and do it all again another 4/5/6 times in a row as if you don’t go in there will be absolutely no one else to cover.
Being forced to do on call shifts over and above your allocated shifts because more than likely the shit will hit the fan and you will have to go in.. but hang on, if you don’t go in, the nhs will kindly pay you £1.18 per hour to not go in but be on standby even if you had just worked your 5th night in a row last night...
yep, melt down it is.

kbPOW, please tell me what adequate funding of a healthcare system is? The problem is that it is a bottomless pit, and however you draw the line someone always feels hard done by. The ethics are a minefield.
Should drunk people be charged?
Should limitless IVF attempts be free?
Should we be battling to save a 24 week premature baby who at best is going to have severe brain damage and require life long 24hr care?
Should we be battling to save 95yr olds who live in nursing homes and have dementia?
Should we be spending £100,000 on cancer treatment to give a young mother and extra week of life, most of which will be spent unconscious?
Should the hospital car parks be free?
Should paracetamol be free on prescription?
Should pretty much anyone who claims they have no friends or relatives to collect them get hospital funded transport home?

There is no end to the spending.

It is failing as a system because of abuses, misuses and underfunding.
All the NHS care me and mine have ever received has been magnificent, not just the physical, medical side but the nurture/human support.
But the only way it’s going to survive is if it is able to redefine its purpose, and become an essential health service, dropping all the extra stuff into the private health insurance realm. Able to refuse to deal with non-essential non-emergency demands. With a breathalyser on the door of A&E.
Lack of access to GP appointments is also a huge factor, and has been for years. No effective solution has yet been found and the number of GPs is dropping as numbers of patients rise.
Yet despite this, staff keep going, in the face of ridiculous demands and pressure. At my local hospital, staff pay to park. £1 for every hour. Insane.

My local hosptial is southmead in Bristol and they are literally amazing!! Never been able to fault them especially a&e. Ive never been in the waiting room for more than an our. If it wasnt for a neurological a&e doctor i doubt I'd be here today. Seriously its a great hospital. Even for a less serious problem like my dp fractured ankle he was still in and out in about 3 hours.

Collectingcpd those are the decisions I’m talking about. If the NHS is to survive as a free service, the answer has to be no.

Oh, and what I actually meant to say was that I was in the ED and than AMU at Wythenshawe hospital last weekend with my elderly mum after a fall.

Everyone we saw, and everyone I spoke to on the phone in the subsequent days, was absolutely wonderful. They were all clearly stretched, but completely committed to getting to the bottom of the issue.

They all (HCAs, nurses, juniors, physios and even the transport co-ordinator) treated my slightly confused mum with great patience and kindness, and preserved her dignity at all times.

This has reminded me I must write to them to thank them. I wish everyone’s experience was consistently as good.

This is one of the reasons why I get so cross about the whole Brexit shambles. The amount of time, money and effort that has been spent trying to arrange something that we didn't really need to do anyway is staggering. Why couldn't we invest all those resources into improving the NHS? Or any of the many other things that really need fixing?

I wish a political party would have the guys to say vote for us and we'll put your tax up a bit and put every penny of it into the NHS (and mean it!). I'd vote for them in a heartbeat.

My DH is a Dr who did his time in A&E but thankfully has moved on to specialise.

To be a Dr (depending on specialty) you need impressive grades, which means about 10% of a nationwide A-level year even stand a chance!

These are VERY intelligent kids, who are presented with a bunch of career options like finance, law, tech and the WORST paid of these is medicine (it’s not seen as the ‘best’ choice). But some (like DH) do it anyway because they want to help people.

Then they get hit with 13 hour days, nights, and get moved around hospitals at the drop of a hat regardless on where their house/spouse are, (DH has been dumped a 2 hour drive from us - 😡 whilst we live opposite his preferred hospital) so settling down/having children is a bloody nightmare.

Meanwhile they watch their peers/ uni friends earn 5x their salary but yet the daily mail (and half the country) winge about the amount Dr’s earn and they get daily abuse from patients who are unhappy with the NHS 🙄🤔 - so people want the ‘best and brightest’ saving your life on an opperating table...as long as they’ll do it for bargain basement prices? 😒

So then they hit 30, wonder why they’re bothering and head abroad to be paid at least 2x as much (often more) and live a family friendly lifestyle of non crazy hours and compulsory moving around.
Fair enough.

But by that point the NHS has ‘invested’ an obscene amount on money in training them up, and it’s gone in an instant because they don’t treat them better 🙄 and they have to start all over again with a graduate who may end up doing the exact same thing!

It seems insane to me, DH has always been loyal as a dog to the NHS, but now we want to have a baby and are both terrified of them dropping him at a hospital 3 hours drive away when we have a tiny baby and my career/our family are all in our home town! (This happened to two of his friends!!!)

He used to work at the hospital opposite us but now they say they say he’s not a ‘priority’ to work there are doesn’t have school aged children 🙄😡 we’re seriously considering a move abroad atm!

People like the OP have one bad experience and have a mini melt down that the whole system is in chaos. In short, you are seen in accordance with severity - there were worse people in front of you. People who really were close to or were dying.

Head wounds bleed copiously. They are frightening but cuts are rarely fatal. Unless you were walloped with a lump hammer of course but then you wouldn't be looking at a walk in centre for first choice.

collectingcpd This is the conversation that must be had, that we aren’t having. It is an ethical minefield, but I don’t think it can be shirked. I have my views about each on your list and I suspect we’d agree on most of them, but for ethical reasons as much as financial.

Interestingly, on the transport question, my mum went back to her care home in patient transport when she was ready for discharge 2 days earlier than originally planned. I couldn’t get there quickly enough for the ward (I live and work some tens of miles away and was on public transport that day) and they needed the bed. So it’s really complicated.

*People like the OP have one bad experience and have a mini melt down that the whole system is in chaos. In short, you are seen in accordance with severity - there were worse people in front of you. People who really were close to or were dying.

Head wounds bleed copiously. They are frightening but cuts are rarely fatal. Unless you were walloped with a lump hammer of course but then you wouldn't be looking at a walk in centre for first choice*

This is all true, but the system is also in meltdown.

There should be private accident and emergency clinics that are 24-7, for cases like this. I am sure with these types of queues they would get used, alleviating the NHS a bit. Better still maybe the NHS could have a fast track you pay for to put money back in. It is appalling that people don't have a choice but to sit in this.

There are certainly pressures but OP was unlucky or it was a very minor issue. Only 12% of people spend longer than four hours in any accident and emergency department nationally.

That is the time from booking in to the time they are discharged. Twelve percent isn’t ideal but most of those have already been stabilised and treated, are on a trolley designed for up to sixteen hours and are just awaiting a bed.

www.kingsfund.org.uk/sites/default/files/styles/media_large/public/2017-12/Figure%201%20Attendances%20by%20total%20time%20spent%20in%20A%26E%2C%202016-17%2C%20England_1.png?itok=YIeR51cs

@WiseUp - I suppose it would depend on the Trust and area.

My DH is waiting for a heart transplant, if he feels unwell he's blue lighted into RBHT no matter where he is in the country; people we've met have been air ambulanced in from holiday, because they feel a bit under the weather; the NHS has installed a special fridge in my kitchen for his drugs. When he's in hospital, in his single room, with TV and fridge and al a carte menu, I'm allowed to sleep with him.

Your experience of the NHS and mine are very different

Some people will say "what, he gets all that, that's unfair" - well I'd trade his death sentence for your 5 hour wait with a bang on the head.

Those are figures from 2016/17. Current figures are worse and clearly showing a downward trend.

www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2019/04/Quarterly-timeseries-March-2019-GRyQD-1.xls

It will be even worse after Brexit...

Part of the problem is that people will happy pay a painter and decorater/plumber/electrician more than a nurse/junior doctor. It's a mind set that is hard to shift. People would be horrified to pay 50 quid to be seen quickly in a private clinic but will.pay someone 200 quid to paint their living room - something many people could do on their own quite easily. (Note many - not all).

The NHS has changed massively since it's inception - new drugs, people living much longer therefore more dementia, long term care, technology......we need a culture shift in what should be "free" to support the change. We get free prescriptions in Scotland where I could easily (and happily) pay for mine....that money could be better spent on more deserving issues.

Crosser62 agree with you absolutely. I would just add having to do loads of bloody internet training courses - hours of them literally - of no use whatsoever just to tick a box. And if you don't manage in the requisite time because you're too busy or no free computers you can end up potentially not getting your increment !