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.

@sheepisheep
tye vast majority of consultants are nearing retirement age, who is going to replace them? Particularly as a lot of junior Drs are emigrating?
I do understand the pressures of supervising juniors and having quality training places, but workforce planning has to include training enough staff. It’s only part of the picture yes, because keeping the staff they train also has to be addressed.

2 nights ago a senior dr from our local A&E was on a video on Facebook saying please don't come to A&E unless it's a real emergency etc.

And the problem with this is sometimes genuine people stay at home. dd nearly died a couple of months ago, she had chest pain and has had chest pain before. We've been to a&e before, we've been to the gp before and they say it's anxiety, or it's muscular, etc even if she is sobbing in pain. So when she is crying with pain again and said she wanted to go to hospital I didn't want to take her, couldn't cope with a ten hour wait to be told nothing is wrong. Turned out she had numerous blood clots in her lungs.

So once we know she is now high risk because she probably has cardiac damage and the clots are still there. So 2 weeks after diagnosis when she is screaming in pain and clutching her chest I drove her to a&e and carried her in. Saw the nurse on the admission desk and explained her history and that I think she is having a heart attack. "yeah fine, take a seat over there".

That's how shit it is. Someone who is very high risk for having a heart attack and has text book heart attack symptoms has to take a seat, screaming in pain, and isn't even triaged!

How will getting the tories out fix the NHS? What are labours plans?

The tories are actually right and we need a semi private system. Do you know any other country with a fully free national health service?

👏👏👏

This has been building up - where have the government been? What have they been doing to help?

Covid was obviously a crisis, but they spent 2021 and 2022 creating one self inflicted Tory crisis after another and then everything imploded under Truss.

Before that Brexit sucked all the air out of the room.

It has been obvious for decades that we have an aging population, and fewer workers are paying for more costly care, but the closest a government got to confronting that was May’s social care manifesto pledge, and that had to be reversed.

Sunak is supposed to be sensible, but doesn’t seem able to discuss the fact that the NHS isn’t working regardless of strikes and after 12 years of Conservative government and with 18 months before the next election, it’s not clear how that will change.

Higher wages will not make a lot of jobs more attractive when you are working in an awful environment. I worked in the NHS at a senior level and was highly paid. Having more pay would not have made a jot of difference to me staying as the environment and constantly being pulled from pillar to post, lack of resources, continual reorganisations, a burnt out team, working excess hours with no overtime and complete frustration led me to leave. No amount of additional pay would have made any of that acceptable or improved the situation.

There should be a minor ailments dept ran separately to A&E.

People needing antibiotics for throat/ear/chest infections etc. Many of these can be diagnosed over the phone and would require no f2f appts. It would help to alleviate the pressures on A&E which shouldn't be for people with these type of complaints.

It would also free up GPs for these types of encounters.

You are a nurse and should know that the GP service is NOT an emergency service. That is what urgent care and Accident and Emergency Care is for.

GPs are just like the rest of the population . They deserve rest, time with their families. Most GPs are broken . They are understaffed and dealing with complex medical issues that have waited too long.
They see >40 patients a day , deal with results , home visits , death certificates, referrals etc.

Give the poor buggers a rest like everyone else. 10 years ago being a HCP was a vocation and we all pulled together but people have had enough now and that goodwill to work for free at the expense of our own health has gone.

The money the Senedd gets comes from central government. Wales does not raise it's own taxes.

we are so lucky in my area to have minor injuries units
3 of them
all highly appreciated by everyone

When I was giving birth I was leaving the unit. A woman came to the door in a wheelchair in well established labour. She said she needed to push. They turned her away as they said they were full and told healer to go to another hospital which is a 40 minute drive away! She gave birth into her tights right outside the door! It's crazy. That was 7 years ago so can't imagine what it is like now. Just hope it does not get privatised.

Horrific.

When you say “Where 5 years ago we had 50 patients in the department on handover at night, we now have 180” I wonder why this is? Surely the huge uplift can’t all be from people who missed treatment due to lockdowns?

Yes but have you considered HCAs and other support staff who are leaving to work in supermarkets? And actually band 5 nurses might reconsider emigrating or moving to the private sector, if a hefty pay rise was offered alongside measures to improve the working environment. Higher pay is an important part of the picture!

The tories are actually right and we need a semi private system.

Despite being in power for 12 years, they have not put forward any coherent plans for an alternative to the NHS. It’s wishful thinking to believe they exist.

If training places in a&e were increased then junior doctors who currently locum would be working in a&e for less money than they get as locums. They work as locums because they get better pay and can choose to work less or get work the same and get a house deposit together. Pay matters.
More doctors wouldnt help the bed blocking issues but more nurses might mean community hospitals could be reopened and some people shifted there.

Covid means we need more health staff long term, so more training places.
In the short term we need to hang on to every one we have, that means better pay. The government need to come clean and say we have to tax more to pay for it or this is what you get.

There is no easy solution. I didnt vote tory, am fully vaccinated, still wear a mask in crowded spaces so I havent had covid or flu, havent been near a gp in years. My conscience is clear -how many people complaining now can say the same?

This idea that simply voting in another government who will throw loads of money at the NHS and wave a magic wand to make everything better is just so simplistic. And wrong.

No the NHS is not fit for purpose. It cannot carry on the way it has in the past.

The same sort of people who think it's all the Tories fault are the same people who start on about the American model as if it's a binary choice between the two ideas. Impossible to have a reasoned debate about the way forward with this sort of nonsense floating about, and the idea of the NHS as a sacred cow which shall not ever be criticised. Or that everyone working for the NHS is a selfless angel.

We pay for it with taxes though, should the system change to become semi private why should the taxation remain the same?

What treatments should go under private and what should be through NHS?

I also have went private recently for one of my children for a health issue in the hope it would be dealt with quicker. The initial assessment required for it could only he completed in the NHS so as it stands there are many things private can't even offer.

Cool cool. Who's going to pay for the additional hours for gps to work 7 days? Are you going to restrict weekday appointments to create more at the weekend? Where are you going to get the staff from, given the current retention and recruitment crisis in gp?

I’m not arguing, as I don’t know enough about the situation, but surely the long term restricting of trainee drs has directly led to there not being enough staff to keep training them, and long term the only way to fix the shortage of hospital drs and GPs (as I understand there is a shortage) is to recruit and train more, somehow.

I’m certain there is very little can be done to improve things without a huge overhaul, but surely part of that must be increasing numbers of staff to a workable level?

In the meantime the government should be doing something to alleviate the immediate pressure on the health service.

The Twitter thread I read also pointed out that moving to a truly 24/7 NHS, including GP surgeries, would mean a 40% increase of staff, so not something that can be fixed quickly and easily, as there aren’t the numbers of trained staff ready to take on these roles.

Ability to buy the antibiotics with the most resistance over the pharmacy counter would help. They aren't much use for serious infections but will help with milder infections and not risk us losing another antibiotic. Would also help with all the parents convinced their kid need antibiotics for a virus!!!

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. Nightingale staffed by the army/volunteers as an immediate solution. Tho it's looking like flu has peaked so may be to late for this to work now.

Next year a plan for a separate flu A&E for the elderly so serious illness aren't missed in normal A&E. Could look at this being staffed by students and AHCPs with a set protocol in place.

Defined criteria for attending A&E so you have to answer the questions at the counter if you don't have a reason to be there your sent home by security.

MH crisis teams to be available 24/7 in major A&E with a secure place to take patients other than A&E possibly with police support.

Why on earth would any GP want to work weekends routinely?
Where are you going to get the doctors to staff a 7 day service?
Are you going to pay doctors more to work more antisocial hours and miss family time?

If my children got A grades at A level I would not suggest medicine as an attractive career option.

GPs are not supposed to be emergency care providers… they are about managing chronic conditions .

Currently the Tories are just providing the worst of both worlds. They don’t believe in the NHS, so have little interest in its improvement, but also know the NHS is popular with voters so don’t seriously suggest anything else.

There is a shortage of GPs, perhaps if the government bothered to address this when it was clear it was going to a problem we'd be in a better position. As they didn't (quelle surprise) the system is fucked. Staff are the most important asset in healthcare, when the government and a portion of the population treat them with contempt and don't deem them worthy of fair pay of course this happens.

I think you've missed the point. I was saying the merely increasing medical school places is not the answer. There needs to be proper workforce planning with decent supervision and pay, and care for junior's wellbeing. If conditions were better people would be less likely to emigrate or leave medicine entirely. Increasing med school places does not solve the problem, it creates a lot of challenges in training and supervising and also conversely risks a worsening of work conditions and pay, potentially increasing the fallout rate in line with recruitment. How does that help anyone? It just wastes money on training.