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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Perspective from staff within NHS

314 replies

lowercaseletter · 04/01/2023 04:44

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.

OP posts:
Morielle · 04/01/2023 13:02

I see you OP. My heart breaks for you and your colleagues. It's a travesty, it makes my piss boil. I'm scared for my family. We should all be marching in the streets of London for you.

XingMing · 04/01/2023 13:05

A European system will force people to associate the deductions for healthcare with the costs and their entitlement rather that thinking it's all "free". Germany has a cut off point at about €65k of earnings above which a person is required to join the mutual insurance system. From that, the patient (and dependent family) can access a slightly wider choice of services and specialisms. It's not just working people either; better off pensioners have to contribute too, regardless of their age.

dollybird · 04/01/2023 13:12

Badbadbunny · 04/01/2023 13:01

@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!

I worked in primary care finance until quite recently, and not aware of any incentive for having patients with depression. There are payments for health checks on patients with severe mental illness or learning disabilities, but that's not the same thing.

RethinkingLife · 04/01/2023 13:20

Orangesandlemons77 · 04/01/2023 12:55

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

It's limited in area but it's this for finding out where to go.

nhsquicker.co.uk/

There are areas with a WaitLess app like this that will tell you about probable wait times in A&E.

www.waittimes.uhnm.nhs.uk/

However, a number of areas did it as a pilot but didn't continue it. Wales has come up with a version (see below) but there are areas with different systems.

www.waittimes.uhnm.nhs.uk/

RethinkingLife · 04/01/2023 13:34

RethinkingLife · 04/01/2023 13:20

It's limited in area but it's this for finding out where to go.

nhsquicker.co.uk/

There are areas with a WaitLess app like this that will tell you about probable wait times in A&E.

www.waittimes.uhnm.nhs.uk/

However, a number of areas did it as a pilot but didn't continue it. Wales has come up with a version (see below) but there are areas with different systems.

www.waittimes.uhnm.nhs.uk/

Wales is here

aeinfo.nhs.wales/

Becas4 · 04/01/2023 14:09

Its heartbreaking.

I think the 2 main reasons the nhs is broken is chronic underfunding for years by the Tory party and staff shortages across the board, 40,000 in nurses alone I read the other day.

With regards to the shortages - Theresa may scrapped nurses bursaries, so now to become a nurse you have to study for 3 years (mainly working in hospitals) and be able to finance yourself to do so, most people I know can’t afford to work 40 hours a week unpaid for 3 years , at the end of which you enter a profession where you may need to use a food bank to supplement your income, you will be overworked, undervalued & risk burnout. Not an attractive prospect.
The nhs also lost a lot of staff after brexit when they decided to go back to their home countries, leaving even more of a shortfall. The ones that are left are at greater risk of burnout due to this lack of staff and are also leaving because to this.

Now I think we are in a position where what we are seeing is the result of staff shortages, years of underfunding, a bad flu season, and a backlog of medical issues that weren’t dealt with during the pandemic. it’s very easy to blame the public for wasting resources, but when people can’t see a doctor and don’t know what else to do so they turn up at a&e. issues that could have been treated by a gp become urgent. There are no clear public health messages about how to access care. Underfunding in mental health services also means people in mental distress also turning up at a&e. lack of social care leads to bed blocking when there is nowhere to discharge patients.

These are not quick fix issues. I don’t know what the answers are, but addressing staffing shortages and paying nhs staff fairly is a good start. I fear that this is deliberate and the tories will announce that the only way to fix it is to introduce American style insurance, we really will be in a bad place if that is allowed to happen,

ancientgran · 04/01/2023 14:13

Orangesandlemons77 · 04/01/2023 12:55

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

This is where we check for my area www.torbayandsouthdevon.nhs.uk/services/urgent-and-emergency-care/ed-miu-waiting-times/

The main hospital is Torbay, the urgent care is in Newton Abbot and then there is the minor injuries in Totnes. Dawlish is closed at the moment.

It is a good system as it helps the patient and it must reduce numbers just going to A&E because they don't realise the help they can get elsewhere.

LeccyBillShill · 04/01/2023 14:20

@Becas4

“I think the 2 main reasons the nhs is broken is chronic underfunding for years by the Tory party“

www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget

Perspective from staff within NHS
ancientgran · 04/01/2023 14:20

Becas4 · 04/01/2023 14:09

Its heartbreaking.

I think the 2 main reasons the nhs is broken is chronic underfunding for years by the Tory party and staff shortages across the board, 40,000 in nurses alone I read the other day.

With regards to the shortages - Theresa may scrapped nurses bursaries, so now to become a nurse you have to study for 3 years (mainly working in hospitals) and be able to finance yourself to do so, most people I know can’t afford to work 40 hours a week unpaid for 3 years , at the end of which you enter a profession where you may need to use a food bank to supplement your income, you will be overworked, undervalued & risk burnout. Not an attractive prospect.
The nhs also lost a lot of staff after brexit when they decided to go back to their home countries, leaving even more of a shortfall. The ones that are left are at greater risk of burnout due to this lack of staff and are also leaving because to this.

Now I think we are in a position where what we are seeing is the result of staff shortages, years of underfunding, a bad flu season, and a backlog of medical issues that weren’t dealt with during the pandemic. it’s very easy to blame the public for wasting resources, but when people can’t see a doctor and don’t know what else to do so they turn up at a&e. issues that could have been treated by a gp become urgent. There are no clear public health messages about how to access care. Underfunding in mental health services also means people in mental distress also turning up at a&e. lack of social care leads to bed blocking when there is nowhere to discharge patients.

These are not quick fix issues. I don’t know what the answers are, but addressing staffing shortages and paying nhs staff fairly is a good start. I fear that this is deliberate and the tories will announce that the only way to fix it is to introduce American style insurance, we really will be in a bad place if that is allowed to happen,

I believe bursaries have been reintroduced, a friend whose daughter has started her nursing degree told me she gets £5k, I don't know if everyone gets it but she says her DD definitely does.

Merrymouse · 04/01/2023 14:24

The sheer size and scale of the population is the elephant in the room.

The main problem is the age distribution. The birth rate is decreasing but people are living longer in poor health, so the working population becomes proportionately smaller.

RethinkingLife · 04/01/2023 14:25

ancientgran · 04/01/2023 14:20

I believe bursaries have been reintroduced, a friend whose daughter has started her nursing degree told me she gets £5k, I don't know if everyone gets it but she says her DD definitely does.

Details of the bursary and terms & conditions.

www.nurses.co.uk/blog/do-student-nurses-get-an-nhs-bursary-and-how-you-can-apply-for-it/

Becas4 · 04/01/2023 14:25

That’s great if they have. It will take a while to take an effect thou

Everanewbie · 04/01/2023 14:28

LeccyBillShill · 04/01/2023 14:20

@Becas4

“I think the 2 main reasons the nhs is broken is chronic underfunding for years by the Tory party“

www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget

This. I know that blaming those evil tories and their rich pals is a great soundbite, but the reality is that more and more money is going in, and the experience is getting worse and worse.

ancientgran · 04/01/2023 14:31

Becas4 · 04/01/2023 14:25

That’s great if they have. It will take a while to take an effect thou

Yes I thought it was good when my friend told me. Funny there didn't seem to be any big announcement about it, maybe they didn't want to announce another U turn.

Becas4 · 04/01/2023 14:34

I have a graph too

Perspective from staff within NHS
Ihavedogs · 04/01/2023 14:48

Blondewithredlips · 04/01/2023 11:43

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.

I have never said what my job was or what I was trained in. Doctors and nurses and other healthcare professionals do have the option to jump ship. They can and do move to different areas within the NHS such as advisory roles, management, commissioning, they also move into the private sector, or move into a completely different field which may, or may not be in healthcare. Over the years I know plenty who have all done that sort of thing with some of them moving back to a similar role to the one they originally left because the grass wasn’t as green as they thought it was. There are also many, especially younger healthcare professionals, who have a portfolio career and work in various areas and fields. It wasn’t the pay that drove them to make changes.

There are options beside leaving the country.

Nameneeded · 04/01/2023 14:51

Kathai · 04/01/2023 10:21

Other countries have specialists on tab. Women visit the gyno for anything related to women's health, kids and young teens are looked after by paediatricians, if you have issues with your skin, you go to the dermatologist. All as out patients so in private's practices not hospitals. It's great. More interesting professional opportunities for medics too. The uk has a very strange health system and GPs are often totally out of their depth useless.

That makes so much more sense than GP's who cannot diagnose anyone with a 6 minute appointment. Let's invest in specialists who are experts and give patients direct access to the experts without having to beg for a GP appointment and then a referral. I do believe the terrible outcomes cancer patients have due to late diagnosis is due to our outdated GP system.

Merrymouse · 04/01/2023 14:55

I know that blaming those evil tories and their rich pals is a great soundbite, but the reality is that more and more money is going in, and the experience is getting worse and worse.

More and more money is needed to meet the needs of an ageing population. Better treatment options may also incur more expense (although equally better treatment may enable more people to work or may be cheaper n tbe long run). But there is no treatment that can currently treat Alzheimer’s or reverse the impact of age on joints.

Under successive Tory governments NHS expenditure fell as a % of GDP. Johnson did increase expenditure but not enough to keep up.

None of these problems are easy to solve, and as others have said the choice is not NHS or American healthcare. However it’s very obvious that the government’s concerns have been elsewhere for at-least the last 7 years.

healthadvice123 · 04/01/2023 15:05

But surely the issue is also they used to see 50 people now its 120 ? Thats double the amount arriving , why ?

MumsPencil · 04/01/2023 15:07

no access to GP, that's why

healthadvice123 · 04/01/2023 15:16

@MumsPencil thats what I think we clearly do not have enough gp's
In my surgery 10'years ago we had about 5 full time Gp's and a couple part time
Now i think we have 2/3 and a paramedic but now running two surgeries and probably double the patients as lots of new houses gone up in my area
The GP's we have to their best but its often not possible to get an appt
You ring at 8.30 you can't get through and when you do appts are all taken
But as this a &e dr describes double the amount coming through its not gong to cope
The nhs needs more than just money , it needs a complete overhaul

cptartapp · 04/01/2023 15:18

GP's clinics are also full. Week after week. But less GP's and other staff to run them.
Millions of practice nurses and ANP's are also retiring about now. The RCN warned of this timebomb for years. We have two going next month. No replacements.

elephantcandle · 04/01/2023 15:24

I'm genuinely terrified to get sick

Rabbitsandhabits · 04/01/2023 15:35

Nameneeded · 04/01/2023 14:51

That makes so much more sense than GP's who cannot diagnose anyone with a 6 minute appointment. Let's invest in specialists who are experts and give patients direct access to the experts without having to beg for a GP appointment and then a referral. I do believe the terrible outcomes cancer patients have due to late diagnosis is due to our outdated GP system.

Absolute rubbish. Completely undifferentiated patient access to specialist would not improve cancer outcomes. Patients are less likely to think cancer with vague symptoms not more.

GPs ARE specialists- they are specialist generalists.

sadly even ‘2 week wait’ cancer referrals are no longer being seen within two weeks- nowhere near. And many get bounced back to the GP.

Rabbitsandhabits · 04/01/2023 15:38

Badbadbunny · 04/01/2023 13:01

@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!

Depression is much more common in those with chronic diseases like diabetes and it is considered good practice to screen for it at routine visits by asking and opening up the conversation. It would be much quicker and easier not to bother.

seems you can’t do right for trying in GP anymore