Perspective from staff within NHS

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Posted anonymously by an A&E doctor:

Im writing this because I’m angry. Actually more than that, I’m fu*king livid.

I’m an A&E reg with 9+ years experience in A&E both here and overseas. This morning was the first time EVER that I cried in my car after a shift.

I was on nights over this New Years period, but New Year was not the issue, every shift is like this now.

Where 5 years ago we had 50 patients in the department on handover at night, we now have 180. It used to be around 20 patients to see with a 1-2 hour wait for clinician, it’s now 60-70 with a 10 hour wait.

People used to lose their minds if patients were coming up to 4 hour breaches. Last night 60% of the patients in A&E had been there for more than 12 hours, some for more than 40. Many I saw the night before, still in the same place when I came on.

No triage or obs after 2 hours of arrival, no bloods or ECGs or gas for 4 hours. Regularly finding people in the waiting room after 4 hours with initial gases showing hyperkalamia or severe acidosis or hypoglycaemia.

87 year olds coming in after falls sitting on chairs for 18 hours. Other elderly patients lying in their own urine for hours because there’s no staff, or even room to change them into something dry. As the reg in charge of the shift, Ive had (on multiple occasions) to help the sole nurse in the area change patients by holding a sheet around the bed because we have to do it in the middle of a corridor. People lying on the floor because there’s no chairs left, trolleys parked literally wherever we can put them.

Things have been getting even worse for the last 3 months. 5 weeks I came home raging to my wife that people are sitting in their own piss for hours and it’s so inhumane. Now we’ve got to the point where people are actually dying. People who’ve been in A&E for 2-3 days,

The media and public might blame the A&E nurses and doctors for this, but honestly what the fu*k are we meant to do with 180 people in a department built for 50. With 8 nurses rather than the MINIMUM staffing of 12. 1 or 2 nurses per area, giving meds, doing obs, trying to provide basic cares to 25-30 people, an absolute impossibility. And there’s less nurses every week, because honestly why would you put yourself through this day after day?

Resus patients are quickly assessed and stepped down to make room for the next pre-alert, going to the area with those same poor nurses, already overstretched, now inheriting an severely unwell patient.

We need to accept the truth, the NHS isn’t breaking, it’s broken. And the same bastards who broke it are doing reality TV shows and writing books about how they saved the NHS whilst refusing to increase nursing pay. We try and shovel shit with spoons whilst they pour it in with dump trucks

The NHS as we knew it is dead, and it breaks my heart, because it’s a beautiful system. It shouldn’t be like this, and those of us who have been around for longer than 5 years know it wasn’t always like this.

The public have no idea, they don’t really know how dangerous this all is. When they come in they’re horrified, but most of the population don’t know how bad it is. This could be their mum on a trolley for 17 hours, or their wife or son or daughter.

I genuinely feel it’s now our responsibility to speak out. We don’t for fear that it will make our hospital look bad or harm our careers. But it’s not a hospital problem, it’s a national problem, and it’s a problem brought about by the politics of the people in power.

We need to shine a light on what they’ve done, make the public so angry that they demand a change. Massive recruitment of nurses through a proper wage/paid uni/free parking/free Nando’s if that’s what it takes would be a start.

If anyone has any idea how we could coordinate some kind of campaign to show the state of emergency departments in the UK right now please write a response, because I can’t work in this much longer, and more importantly I’m not sure the patients can survive it.

Yes we are different to big cities but on the other hand we have a very elderly population I think, lots of people retiring here. We also have towns with severe deprivation, lots of homelessness and problems with drugs. People are often surprised at how much deprivation there is in the old "bucket and spade" seaside towns.

I don't know about NHS funding but I have read that we don't do well with funding compared to the big cities so I do think the system is a credit to the local trust. If it isn't common I think it is worth looking at, I mean why would you go to A&E with a long waiting time if your condition is suitable for the urgent care centre with a 25minute wait? I didn't even see a doctor with my broken bone, a nurse practitioner dealt with it all and I imagine she was taking a lot of pressure off the A&E doctors in the adjoining town.

Nail on the head. When there are limited resources (finances, staffing etc)., then we must concentrate on the greatest need, i.e. A&E, heart wards, ICU, etc.

That isn't the likes of cosmetic surgery, IVF, and other "elective" treatments. They should be the first to be curtailed and resources diverted to life or death situations and then to treatable life-limiting conditions.

Also, for the short term, things like smoking cessation, weight loss, contraception, etc., should be looked at, and where there are staff who are qualified/experienced to be in other "front line" departments, they should be moved. Yes, these services are needed, but aren't as urgently needed as life threatening/life limiting conditions, so could be "put on the shelf" for a short while. After all, lots of other NHS services were side-lined during the pandemic, such as cancer screening, which are far more important. Someone having to wait a bit longer for weight loss advice or stop smoking advice is a price worth paying to keep someone alive in A&E if they aren't getting proper treatment due to staff shortages.

We need to start making these kinds of decisions.

We also have self referral to physio which is useful as it means you don't need to waste a GP appointment to just get referred. Again I don't know if that is normal now but I know where I used to live you had to see and GP, if he agreed he'd do a letter and you might hear about an appointment a week or weeks later. Now I just phone up and generally can get an appointment within days.

I recently moved and come under a new NHS trust. I can order my contraceptive pill online in this new trust, it's brilliant. I answer the usual questions online, they then text me if they need anymore info, and then send out my pills in the post. Much better than using up a nurse appointment every 6 months! We need more things like this in place. I could also go straight to Boots in this new trust for NHS prescription for UTI antibiotics (instead of paying for the private Boots service), again instead of wasting a GP/nurse appointment.

If could keep cost at that level that would be better for everyone working adult as big business would be tempted to include that level of private healthcare as a perk. Heck I'm a poorly paid NHS worker with a side hussle and could afford that

But you are not a doctor or nurse that have trained to look after people so easy for you to jump ship. Doctors and nurses don't have that option unless they leave the country.

Trouble is, especially with GPs, they don't take you seriously until you've had a few appointments and appointments are often hard to come by. So, if you think you've a condition that needs GP attention, you're going to try to get an appointment at the first signs, because you expect to wait several days (or weeks) for a consultation, and you don't want to delay just in case your condition gets worse and you know you're not going to get an appointment quickly. Repeat consultations follow that, as the GP's first "answer" is nearly always to "wait and see" and "come back if it doesn't clear up", so basically fobbing you off, and then on subsequent appointments, they seem to just randomly try things that are unlikely to work, so once you've experienced that, you want to get into the system, so that if and when it gets worse, you're already "on record" and they can't fob you off again and again so easily.

Huge numbers of GP appointments would be saved if they actually bothered to take you seriously the first time you contact them, do a proper diagnosis and proper treatment. I have no doubt at all that lots of people go for the silliest of things which really will clear up themselves with time, but GPs need to learn the difference.

My OH had multiple appointments spanning many months before he was finally referred for ultimately a cancer diagnosis. He knew something was wrong, he had lots of different symptoms, but simply wasn't taken seriously. He was someone who'd not been near a GP surgery for years, so suddenly having multiple symptoms and multiple consultations should have meant something to the GPs as his records showed he wasn't a "time waster", but they still just kept fobbing him off, not even organising tests, just batting back his symptoms as "are you stressed at work", "we're all getting older you know", and other meaningless platitudes! It took a locum to take a proper look at him, look at his symptoms, and do an urgent referral to oncology - all in one appointment! Now we know what he has, it's blindingly obvious - classic text book diagnosis based on his symptoms, virtually line for line, word for word, yet a succession of different GPs over multiple appointments didn't see it and just assumed he was a time waster even though he had no history/record of unwarranted appointments in the past!

I've well managed diabetes. Medication hasn't changed in over a decade. Yet, still I apparently "need" a consultation with either a GP or the diabetic nurse every year (used to be twice a year before covid). We have a lovely chat, but that's basically it! What's the point? I know my HBA1C levels because I test blood sugars daily and my HBA1C literally never changes from one year to the next. I have a blood pressure monitor, so know my blood pressure is fine. I can check my feet myself.

So, the yearly "chat" comes down to answering the same questions on their screen. Do I smoke, Do I drink? What exercise do I take, etc! I know it word for word. My answers havn't changed since I was first diagnosed 20 years ago. I didn't smoke or drink then, and have no intention of starting, yet they ask the same questions every year, taking up their valuable time to tick the same boxes.

We all know that the GP surgery do it to claim the extra funding for "managing" my diabetes. During covid, they phoned me up to ask those same questions, tick their boxes, and "kerr-ching" money into their bank account.

That's the kind of thing that needs to be changed. Concentrate on things that matter, i.e. providing relevant advice to people who need it, and not having a 20 minute appointment for no other reason that to tick boxes just to get the funding!

I know it's not the cure, as the NHS is fundamentally broken at this stage, but I strongly believe that brining back the walk-in GPs services would greatly alleviate the pressure on A&E. People are attending A&E as they have no other option in obtaining treatment. I'm sure no one wants to have to wait in an overcrowded waiting area for 12+ hours just to get a prescription for antibiotics.

The number of health care workers in the community needs to be greatly increased as well as the staffing levels in hospitals. The services are crying out for staff in my local area but are unable to fill the vacancies. Care in the community only works when there's enough staff to provide a safe level of care. It's such a shame that Brexit greatly increased the pressure on that sector as well.

I think this is a brilliant idea and will write to my MP and local newspaper about this.

At the moment, MPs have no reason to sort this out because they can opt out and on their salary that is easy. It would also get rid of rich toffs in safe seats who have no real interest in doing the job of an MP because they'd choose the private schools / healthcare over being an MP.

Though maybe it would be a bit punitive to say 'ban the families' as it's not their children's fault, however, I don't think it's unreasonable to expect MPs who make decisions about the NHS to use the NHS alone so they can fully appreciate the problems.

This, there are more GP patient consultations than ever. It’s just increased demand, sicker patients as cancelled outpatients and surgeries during the pandemic, people going to see someone with just a cold and then making everyone else Ill etc

Australia has a fully functional public hospital system as well, you don’t need to pay for private.

Some people choose to because it’s sometimes (but not always) faster, they can choose who they see and they see the same person every time. Scans, blood tests are done “for free” through the public system as well.

The hybrid public/private system works because the government helps fund the private system. Private Providers (doctors, therapists, labs, radiology groups) are given a fee by the government. Some bill on top of that, others “bulk bill” so are free to the patient. A low income patient has a health care card, bringing costs down.

There is a National Disability Insurance Service funded by the government that pays for private community services for individuals with a recognised disability/disorder.

I’ve used this example before, but a 7 year old with ASD/ADHD and a physical disability would be able to see a paed through public hospital (no cost), a bulk billing GP (no cost), have blood tests done in a private lab (bulk billed, no cost), X-ray to diagnose a fracture with a private radiology group (usually no cost for a plain X-ray). They could go to a public ED to have their fracture treated and for their pneumonia a year later, where they may be admitted to the public paeds ward (no cost). The NDIS would find fortnightly psychology, speech , OT (no cost).

Their medication for ADHD would have a cost, but even the more expensive long acting ones would be about 7 dollars/month because the had a chronic health condition.

I disagree, if the NHS and state school education- both of which are designed, budgeted for, controlled and maintained by MPs- are good enough for my kids then it should be good enough for their kids too.

Remove privilege and increase incentives for them to work to the benefit of all of society rather than just lining their pockets and opting out of the systems. They can still have nice, quality healthcare and education- they just need to make sure everyone else does as well.

The elephant in the room are the sheer numbers.

We need to pause all in coming immigration for two years(unless it is qualified medics and health care professionals). We need housing for the Afghans and Ukrainians and tens of thousands of families already living in cramped hotels and b&bs first and foremost. We can’t even currently look after the people that are actually living here, taking refuge.

We need to get a grip seriously.
The jug is literally overflowing now and people are needlessly dying as a result.

Whilst maybe there are disaster capitalists (Rees Mogg) in the Tories who just want to make money and run from the death and destruction they leave behind, in the longer term it makes no sense to leave the NHS as it is. Moving to a health insurance model will cause massive wage inflation and costs to business.

I've read in a number of places (link below just one) that increased disability / chronic illness in the working age population is part of the reason why the UK is not seeing the same level of economic growth as other economies. (other reasons are available: e.g Brexit).

With the NHS on its knees and public health measures basically non existent, this will damage the economy. So the party which is pro-economic growth should really care, but they're just incompetent I think.

A lot of the people in the cohort seeing massive increases in disability and not being able to work as a result are parents of secondary aged kids. Surely, ventilation and air filtration in schools would be worth it just to improve this? It would also save money in terms of those children then relying on free school meals etc once their parents can't afford to pay and are out of work.

www.health.org.uk/news-and-comment/charts-and-infographics/is-poor-health-driving-a-rise-in-economic-inactivity

I wrote a long post but deleted it. In summary, IMO,
Nobody wants to pay what is required.
It is far too easy for the very rich to avoid paying tax.
There is a lot of waste - the procurement system is ridiculous.
PFI is extortionate.
We need to move to a European system.

Luckily, as per my post above, Australia also has a public health system where scans and gynaecology appts are free at the point of use, just like the NHS.

You are right in tick boxes is how the Gps get paid. How else would they do it? They want change too? They get the same for a patient who sees them once a decade as they do someone requesting an appointment every day.
They have to meet targets to get funding to you know, pay the heating bills and staff. Trouble is they hit these targets and to get the same money next year they have to hit a higher target. Practices sit and decided at the beginning of the year not to try for some things as they need to focus on patient care.

You can’t magically know your HBA1C without that blood test, and that’s what the funding is for. You might stay stable until you die, but what about the other diabetics who would get missed if not seen?

I work in maternity on a busy city delivery suite, so slightly different to many of the comments up-thread about primary and emergency care, but similarly to other acute services many of our shifts are unsafe and more and more shifts feel unworkable.

Care in labour should be 1:1 but so often we don't have the staff for this. Our midwifery led unit is almost permanently closed in order to staff the obstetric unit but even this is usually running at capacity, not because we don't have the physical space but because we don't have the staff. Our triage service tries to put women off from coming in for as long as possible, or sends them home when they perhaps should be admitted which increases the numbers delivering before arrival. It feels like we've had so many more babies unintentionally born at home or in the car park recently which can be an intensely scary experience for those women and their partners. We're meant to send women to other hospitals if we're full but usually if we're closed so are the surrounding units, nowhere has the capacity to accept patients and how far can we reasonably expect someone in labour to travel?

I know many community midwives who feel uneasy attending home births just in case they need to call an ambulance and none are available, who now counsel women about the possibility of there being a delay if transfer to hospital was required. These are midwives who are passionate about supporting women's choice, but who also don't want to be the person managing an emergency with no backup available.

We have a safety huddle every shift and on every single shift staffing is a safety issue. We're so used to being understaffed and managing it we don't even realise, the numbers we're running at have become the norm. On some shifts though I live in fear of pulling the emergency buzzer and nobody coming, there are times this has been a real possibility.

The service continues to run on good will, midwives and doctors not having breaks, picking up additional shifts to provide cover, and staying beyond their shift to provide care or complete documentation. We often end up pulling midwives from other areas like postnatal care or the home birth team to ensure our delivery unit can stay open but this just pushes the problem into other areas and creates a bed block further along. We try to get new mums out the door as quickly as possible after birth, it feels like a production line, it isn't the level of care any of us want to provide.

I don't know what the immediate answer is. It's easy enough to say hire more midwives but we need to train them first and there isn't capacity for this. So many midwives leaving the profession because they are fed up, and it's not just those nearing the end of their careers but newly qualified midwives who have already had enough. We have a ridiculous number of staff on long term sick with stress who we obviously can't replace, but who without making changes to the way the service is run can't reasonably come back to work and be okay.

The conditions we work in have been gradually chipped away at and we've adapted to work in them, but it has reached a point where adaptation is no longer possible and care is being impacted.

We try our best for everyone who walks through that door, to keep them safe and provide a good experience but we are only human and there are a finite number of us. Increasingly shifts are stressful and disheartening, many of us are becoming compassion fatigued, and the longer it continues to spiral down like this the less safe it becomes for everyone

The sheer size and scale of the population is the elephant in the room. The supermarkets' data suggests that the population is actually closer to 90 million than 70 million. Which explains why there's such pressure on housing, education and health. An ID card system and database needs to exist to access public services legitimately.

If the NHS is to keep going, then I think there has to be a tiered system, like the difference between the basic fixed price restaurant menu and an a la carte menu where the luxury and more complicated dishes are shown separately. So everyone qualifies for and basic emergency care, including tests, x-rays and scans and generic/off-patent pharmaceuticals. Everything else from IVF, cosmetic and gender reallocation surgery comes with a price and from specialist private providers.

Also agree with the PP who suggested that GP referrals should not be needed for access to specialists like OB/Gyn or paediatric care or physio. Leaving GPs a bit more time to do proper consultations and reach considered diagnoses. And FFS, get rid of all the blinking quota payments for hitting targets.

Please could you share where you can check this? many thanks, sounds very useful

How about moving to a model where they get paid for appointments and work done, rather than a fixed amount paid "per patient" with add-ons for those with chronic conditions which may or may not need much attention?

Where longer appts are needed, they get paid more. You know, just like most other "businesses" where the more you do, the more you're paid. The idea was fine to pay "per patient" to encourage a more holistic approach, but it just hasn't worked. Why should the GP get paid the same for someone who goes monthly compared with someone who goes once a decade.

Why should a GP "waste" an appointment just to tick boxes to get funding when they could use that appointment to actually do a consultation with someone who needs it?

It is far too easy for the very rich to avoid paying tax.
There is a lot of waste - the procurement system is ridiculous.
PFI is extortionate.
We need to move to a European system.
The rich avoiding tax will never change particularly whilst 'the rich 'are inextricably linked with the majority governing party. And actually I think you mean the super rich..
PFI was created to meet a specific need at the time (read up on Maastricht).
Amount spent on PFI has been over exaggerated (not ideal though).
How will a European system magic up thousands of medics, nurses, pharmacists, physios ? Will it be for profit or non profit ? Not happy to 'pour ' money in to the current system but presumably happy to hand it over to Kaiser Permanente or likely Serco whose share holders take priority ?
When folk talk about 'streamlining' 'efficiency savings' 'stripping back on managers 'etc the wards cannot get any more streamlined 😂 and 70% of managers are clinically based.

@WeNeedMoreFairyLights

It sounds like you work in GP surgery? Would I be right in thinking GPs get paid more for patients with depression? My GPs and diabetic nurses constantly ask me if I'm depressed and look slightly disappointed when I say no, and I've always wondered why. I've never presented with depression problems, so they must have a reason for asking. It's not as if they ever ask me if I have any other random ailments/conditions. Not just in the annual diabetic check up either. They'll ask when I go for other things, even asked me if I was depressed when I first went to get a referral for hearing aids which I thought was particularly strange!