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.

I I send my personal sympathy to you @Didiplanthis . General practice is gruelling. My best mate threw the towel in about eight years ago. There's no path to success in general practice, unless you dish out the treatments that patients are convinced they want, she said. And to run a business, which general practice is, on top - is a double commitment.

It's fine for routine stuff, Mrs J's small child has a chest infection etc. But I struggle with the notion that the GP should be consulted for that, unless it's been repetitive and worsening.

I spent several years in the US in my youth, and was always insured through work. Apart from contraception, I needed my ears syringing (Once). As I lived across the road from an eight storey building constructed as consulting rooms for doctors to rent, 100 yards from a charity-funded hospital, I walked over the road, asked for an ENT and was directed to one. I explained my problem, spent two minutes in the consulting room and was relieved of my problem, for $20. I was about 15 minutes late arriving at work. Try achieving that level of efficiency in the NHS. Patients are NOT stupid and routine ailments should be dealt with once.

My GP no longer does ear-syringing to remove wax. It's a hospital referral.

@Falalalalalalaetc So pleased to hear the air purifiers are working in your child’s class and have proved a positive impact on health. If my child is ever well enough to return to school, I would be tempted to buy one myself.

The government is now spending £49 million on CO2 monitors for classrooms. Surely they would be better spending that money on actual air filters?

No I don’t work in a Gp surgery.

Not a hospital referral hear but a take yourself to some savers or other private audiologist

I read this and immediately thought "god im not alone". I could have wrote this word for word about out A&E department, its soul destroying

Yes - for quite some time in some areas, patients have been told that they need to book themselves in with BUPA, SpecSavers, Hidden Hearing, Clearer Ears etc. if self-management techniques don't work. (NB: self-management does not include cotton buds any further than the outer part of the ear.)

afaik, ear wax removal hasn't been an NHS core service since late 2020.

I wouldn't know that @RethinkingLife . I only required the procedure once in the early 1980s.

Now the GP won't help, we've reverted to frontier medicine and use mild hydrogen peroxide to loosen the wax, then rinse. It works, although the fizzing feels very odd.

Social care has to change, the NHS being responsible for safe discharge has to stop. It harsh but it needs to become the families responsibility

Are you also including your colleugues in that @Grumpybutfunny I take it you will be super supportive when they need to take time off to care for relatives.

Yes I think it should come under the same flexible working as childcare. It would even be better if we cut maternity to say 6 months and you got the other 6 months if you need it to look after a parent in old age.

Really really shocking. There's not enough resource to cope. Forget the 4hr wait targets. They've always been impossible to meet, now it's a joke. I don't know what the answer is. I despair at the situation

@Grumpybutfunny So when you say families should care you mean women

Youve just proved it.

This was how I imagined it would pan out, but I'm not an HCP.

It's probably fair to say that social care is broken and that, in turn, is breaking the NHS.

Two years ago we essentially found ourselves in a situation where we couldn't get in adequate home care for an elderly relative, despite being self funders and essentially able to throw money at the problem. The home care agency we were using ended up closing down altogether as they literally couldn't get the staff.

As ever the NHS is a victim of its own success; in 1948, few lived long enough to need long term social care. We've become slightly too good at keeping people alive but no longer able to fend for themselves on a day to day basis.