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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:
healthadvice123 · 04/01/2023 15:39

@ancientgran im also i the sw and we only have a&e to go to so when we have broken bones etc we have to go to a&e
Miu seem the way forward to me and we used to have one in the next town, this is now appt only through 111 and even when it was open it was only 9-6 mon- fr 10-4 weekends or something and at one time was not being used as not well advertised
I was always shocked that our a &e didn't divert people there for minor ailments
It always annoys me on here when people say a&e is for life threatening only , well if you have broke your leg where I live you also have to go to the a&e dept , there they filter you off into a MIU type scale
We also used to have a 24/7 every day of the year drs surgery but it got shut down supposedly as people were misusing it ?? I think the real issue is people were going there on sat for non urgent matters as didn't want to take time off work or couldn't to see own dr
But it was great used it for my kids several times when needed antibiotics for severe tonsillitis and ear infection
Now if happened at a weekend i would end up most likely being sent to a & e for even matters such as fhis
When i was in recently there was also a fair few in with dental issues as you can't get an nhs dentist where I am and even the private ones many have waiting lists
The whole system from top to bottom is broken

ElizabethBest · 04/01/2023 15:43

I’m exhausted. I can’t actually face much more of this. I’m so bloody tired and we are just letting people down left right and centre because we have no time, no staff, no money, no space and the government are doing fuck all to support us. I am so fucking tired.

Kazzyhoward · 04/01/2023 15:43

Rabbitsandhabits · 04/01/2023 15:38

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

So are you saying that GPs don't get extra funding for patients with diagnosed depression then? They don't get more funding for earning extra "points" with each extra diagnosed patient towards targets which trigger extra funding?

LeccyBillShill · 04/01/2023 16:03

Becas4 · 04/01/2023 14:25

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

I don’t think it will take effect so long as the number of non productive citizens (non tax payers) keeps on increasing. Too many people aren’t paying their way and the sums do not add up to keep the NHS going.

LeccyBillShill · 04/01/2023 16:05

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.

Exactly. GPs are just an inefficient additional level of bureaucracy and gate keeping in order to get access to consultants who do the real diagnosing and treatment.

ElephantInTheKitchen · 04/01/2023 16:13

Question for NHS staff - in a theoretical world where nothing changed except for there being more than adequate amounts of social care available, how much of the problem would this solve?

I'm thinking in terms of bed blocking no longer being an issue and a modest reduction in the number of preventable admissions caused by things like confused elderly forgetting to take meds and avoidable falls.

Obviously there are enormous practical and financial barriers to this actually happening - but would that be the single best intervention possible for the NHS, or would it be something else like zillions of GP appointments?

dollybird · 04/01/2023 16:34

Kazzyhoward · 04/01/2023 15:43

So are you saying that GPs don't get extra funding for patients with diagnosed depression then? They don't get more funding for earning extra "points" with each extra diagnosed patient towards targets which trigger extra funding?

See my PP. No they don't.

FangedFrisbee · 04/01/2023 16:45

ElephantInTheKitchen · 04/01/2023 16:13

Question for NHS staff - in a theoretical world where nothing changed except for there being more than adequate amounts of social care available, how much of the problem would this solve?

I'm thinking in terms of bed blocking no longer being an issue and a modest reduction in the number of preventable admissions caused by things like confused elderly forgetting to take meds and avoidable falls.

Obviously there are enormous practical and financial barriers to this actually happening - but would that be the single best intervention possible for the NHS, or would it be something else like zillions of GP appointments?

Well we'd have somewhere to put all the a&e admissions and the people who are borderline but we send home because of lack of beds. We'd be able to do planned surgery because there would be beds, therefore less on the waiting lists, better quality of life and more inclined to take care of themselves because they're not in pain etc

Because of the leeway in a&e we'd be able to take more into the department and the ambulances could go back out and treat more patients

It would make a massive difference

olympicsrock · 04/01/2023 16:51

ElephantInTheKitchen · 04/01/2023 16:13

Question for NHS staff - in a theoretical world where nothing changed except for there being more than adequate amounts of social care available, how much of the problem would this solve?

I'm thinking in terms of bed blocking no longer being an issue and a modest reduction in the number of preventable admissions caused by things like confused elderly forgetting to take meds and avoidable falls.

Obviously there are enormous practical and financial barriers to this actually happening - but would that be the single best intervention possible for the NHS, or would it be something else like zillions of GP appointments?

Yes it would make a huge difference as @FangedFrisbee said .

RethinkingLife · 04/01/2023 16:56

olympicsrock · 04/01/2023 16:51

Yes it would make a huge difference as @FangedFrisbee said .

As per @FangedFrisbee and @olympicsrock it would not only reduce the ongoing moral injury for HCPs also have a remarkable influence on general morale. I'd expect this to have a notable impact on the overall patient experience as well as vital areas such as patient safety and staff wellbeing.

XingMing · 04/01/2023 17:12

So a concerted effort, and a lot more resources for social care is getting a long way towards solving the problem?

A few years ago, our GP practice had more doctors, and no-one worked more than 0.8 of the week, but now there are more younger female GPs but they have families and so work fewer hours. Plus, we've had (relatively) large housing estates built in between the local villages, but there has been no new school or extension to the surgery's premises.

However, off the real subject, I had an eye test today and the optometrist was telling me (because my cataract is ripening nicely) that Devon now has seven private providers carrying out cataract surgery for the NHS (at NHS agreed fee rates). The waiting list is about four weeks, and most of that is while the paperwork goes back and forth.

NewYearNewName2023 · 04/01/2023 17:25

ferretface · 04/01/2023 09:48

Re DNAs (both at the GP and in secondary care) I think it would be interesting to highlight the cost to the NHS of the appointment, at the time the appointment is confirmed - very clearly saying just for information but so people understand the time has a cost which is sometimes quite significant.

They do this on the appointment letters for one of the services I have to attend. The letter that is often dated the day before the appointment, and you inevitably get several days after the appointment should have happened

But it's good to see how much money they have wasted when it drops on the mat

dollybird · 04/01/2023 17:27

XingMing · 04/01/2023 17:12

So a concerted effort, and a lot more resources for social care is getting a long way towards solving the problem?

A few years ago, our GP practice had more doctors, and no-one worked more than 0.8 of the week, but now there are more younger female GPs but they have families and so work fewer hours. Plus, we've had (relatively) large housing estates built in between the local villages, but there has been no new school or extension to the surgery's premises.

However, off the real subject, I had an eye test today and the optometrist was telling me (because my cataract is ripening nicely) that Devon now has seven private providers carrying out cataract surgery for the NHS (at NHS agreed fee rates). The waiting list is about four weeks, and most of that is while the paperwork goes back and forth.

When I was working the CCG, we were receiving invoices from these private providers, who had no contract with us, but did have a contract with an NHS organisation in the country, so were able to invoice us under non contract activity. Invoices were in the hundreds of thousands of £, and we heard they were touting for business in opticians and operating on cataracts long before they needed to be under NHS guidelines.

Morielle · 04/01/2023 17:34

More of the same sentiment from NHS staff here

What can we all do to help?
We must revolt, protest, write, galvanise, do anything we can to highlight this catastrophe the joke of a government - fix this now!
Open the nightingales for non urgent
Recruit nurses from abroad now
Increase pay immediately

https://www.theguardian.com/society/2023/jan/04/nhs-staff-share-despair-working-at-breaking-point?CMP=ShareiOSAppp_Other

WeAreBorg · 04/01/2023 18:09

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.

Great idea!
Quick question for you - you’ve been feeling a bit off for a few months, you’ve unintentionally lost a bit of weight, you feel sick and feel tired all the time. You’re sweating randomly and you keep feeling faint. You have a headache that won’t go away and you feel really depressed.

Which specialist are we going for?

dollybird · 04/01/2023 18:14

I have two letters telling me I am due for a smear test. Thought I'd see if I can book an appointment. My surgery does all bookings through e consult (you can phone and someone will go through the form with you over the phone if you don't have access to the internet). Go online, e consult has been switched off, then see a post on their FB page to say that due to continuous high demand and staff sickness they are unable to deal with routine enquiries and e consult is being switched off. They will review at the end of next week. Is be quite happy to make an appointment for a smear test in 3-6 months time (and hope I'm not on my period that day), but there is no option for me to do so, so I will keep receiving chaser letters until I can.

healthadvice123 · 04/01/2023 18:48

@LeccyBillShill but you need the gp to often guide you to the correct consultant
So if i have a rash yes a dermatologist is prob the right call nut if i have a rash and many other symptoms who do I see

Rabbitsandhabits · 04/01/2023 19:06

LeccyBillShill · 04/01/2023 16:05

Exactly. GPs are just an inefficient additional level of bureaucracy and gate keeping in order to get access to consultants who do the real diagnosing and treatment.

When I read ignorant comments like this about my GP colleagues I think that (some of) the public will end up in the mess they deserve. I would say GP is about the hardest medical job in the NHS.
You really have zero idea.

BellaCiao1 · 04/01/2023 19:47

I think the public need a pathway where they can go online to the NHS website and receive primary care based on their symptoms. A HCP would have a better idea but for these type of ailments and similar e.g:

Pharmacist:
Styes/Boils other such swellings
Constipation
V & D (phone consultation) etc

Minor ailments:
E.g Things like throat, ear, chest infection that the patient knows what is wrong as it may be recurrent and just need antibiotics

Minor injury:
Going over on ankle
Staving finger
I.e injuries that are uncomfortable but don't require emergency care and can be x-rayed by a nurse led unit (there is one near mw that is fab). You usually can get an appt within 24 hrs

This would help GPs up a little bit for more general medicine.

Accident:
Broken Legs etc
Things that need more immediate treatment

Emergency:
Loss of consciousness
Stroke
Heart Attack etc

I don't feel accident and emergency are the same thing so possibly 2 different depts with staff spread out might alleviate a little of the pressures. Especially if the minor accidents and ailments are being dealt with elsewhere.

Or maybe this makes no sense at all Confused🙈

willingtolearn · 04/01/2023 20:00

@BellaCiao1 This already exists to an extent on the NHS website which gives specific advice for different illnesses and where you should go with what symptoms

e.g www.nhs.uk/conditions/flu/

People don't use it, ignore the self care and when they can't get a GPs appointment immediately head straight to ED despite having none of the red flag symptoms

IncessantNameChanger · 04/01/2023 20:13

I'm not sure anyone blames the nhs staff surely? Part of the problem is being shot down as NHS basher when you say the nhs is broken. When I told my gp that the socail care system was a cluster fuck he just seemed to be resigned to it. If I ever say anything bad about service at the gp they close ranks and take it as a personal insult that I have to wait two years for an allergy test. Part of the issue needs to be stopping the attitude that the NHS is infallible.

But yes absolutely what twat decided all nurses need a degree and to my nurses another healt care professional pay for their degrees.

They should reverse that asap.

Didiplanthis · 04/01/2023 20:18

I have just worked my last day as a GP.... I'm done, burnt out and finished.. ive done the job for 20 years. I'm good at it. I have been offered more locum work than I could possibly ever do and have turned it all down and accepted a minimum wage job far far away from healthcare...the job is truly awful. Harder than any non medic could ever imagine, and getting worse by the day. The recent public ignorance and vitriol is what finally finished me off. I find it genuinely bizarre that people honestly think we are sitting behind locked doors trying not to see people when every minute of every day from 7am till 9pm is filled ten times over with direct patient care... people can't get appointments as there are no more to give... you can't see 2 people in the same appointment, and the 8-6 day has already expanded to breaking point.. there are no staff to do weekends and evenings... no drs, no nurses no receptionists. We are looking after really sick people who should be in hospital and under specialist care but they have been discharged or are waiting 2 years to be seen... just because there is a 2 year wait to see a cardiologist...doesn't magically mean I am a cardiologist for the next 2 years while someone needing specialist care can't get it and I'm doing my best but am working wayyyyyyy beyond the level of a generalist but shitting myself that I'm going to fuck up because I also have to know about Everything else as well... all this crap about 'kerrching'... gps raking it in for ticking boxes... if we don't tick boxes we don't get income to pay staff, heating, bills..no one pays us for keeping someone alive for 2 years waiting to see someone they need to see now... no one knows or cares about that...

Anyway... not my problem any more.. and not the problem of the hundreds of gp's leaving because nothing we ever do will ever be good enough,as no one wants to hear the truth. It's so much more.convenient to beleive the daily mail. I'm not saying people aren't getting crap care ... they absolutely are...but it isn't going to get any better while no one listens...

CoffeeBoy · 04/01/2023 20:32

I think some stupid people do blame the nhs staff. I see some horrible videos on tiktok, patients berating staff in a&e and it’s those patients who put the videos on tiktok thinking they’re in the right for ranting. Blaming staff for the length of wait, blaming them saying their kid with a snotty nose should have priority over really sick adults because they’re kids. Loads of stupid shit.

spuddel · 04/01/2023 20:37

@Didiplanthis I'm incredibly sorry to hear your situation got so bad, although not at all surprised. Everyone has been shafted, patients and medical staff. I don't think the doctor's union has been very successful either in helping general practice. The Government seems to create an ad for every ailment known to man, ending with See Your GP if you're worried! Ridiculous.

The bottom line is, the current NHS does not work, general practice has been mopping up the chaos and is now itself in chaos, patients are livid and the politicians utter more platitudes. We need to tear it down and start again.

latelydaydreams · 04/01/2023 20:47

100% @Didiplanthis .

I am not clinical, but management and GP workload is unsustainable.

Working 14 hour days is hard, and decision making is affected when you’re very tired/stressed.

The reality is that a 3 day working GP will be doing the same ( and probably more) hours in those 3 days as most people do in 5.

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