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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:
DolphinWars · 04/01/2023 08:26

“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!!!”

With the overuse of antibiotics leading to resistant strains of bacteria I imagine this would be a potential nightmare.
I wonder though if it would work if pharmacists or GP surgery based nurses could perform swab tests and prescribe appropriately which would take a huge load off GPs.

cptartapp · 04/01/2023 08:28

Grumpybutfunny · 04/01/2023 08:22

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.

Social care is the responsibility of the individual, not to be lumped on the family.
As functioning adults we should all think seriously and realistically about how we will cope as we age. Is our house suitable? What adaptations do we need? What caring services can I utilise? Is where I am living accessible? Do I need to downsize? Etc etc etc. This would go a long way to minimising the current situation of hundreds of thousands of elderly people in A&E and hospital beds due to falls and poor self care.

WiseUpJanetWeiss · 04/01/2023 08:28

Stickortwister · 04/01/2023 06:20

I agree with you.

Ive become very burnt out this winter.

I think people are getting what the voted for.... however this probably all started under labour ( blair and pfi anyone) so not sure the alternative is any better.

Paying back PFI is about 2% of the NHS budget per year. And we did get something for that money - new hospitals after many years of Tory neglect during the 1980s and early 90s.

I'm no fan of PFI, but I think it's a bit of a stretch to blame it for all the NHS's financial troubles.

Toddlerteaplease · 04/01/2023 08:30

I qualified in 2004 as a paediatric nurse and is also the worst I've ever seen. We had a nice shift last night. And we commenting on how nice it was to actually have three nurses on. This should be our norm, not an occasional thing. I really had to hit me tongue when a Facebook friend was apoplectic because her sons ophthalmology appointment was running 20 minutes behind schedule. I really want to tell her to go and look in A&E.

Lalliella · 04/01/2023 08:32

Anyone who voted for the Tories and/or Brexit - this is your fault. Don’t vote Tory ever again.

Snowmoab · 04/01/2023 08:34

Lalliella · 04/01/2023 08:32

Anyone who voted for the Tories and/or Brexit - this is your fault. Don’t vote Tory ever again.

Or people can discuss the numerous issues which are more likely to bring change? Whilst people seem to fully lay blame with the tories nothing will change.

olympicsrock · 04/01/2023 08:34

One of the first things they should do is to revise doctors pensions. Many senior consultants from 50 are unable to offer extra sessions because it actually costs them to do extra work.
They are retiring early for the same reason. It’s a big problem in my team of consultants as if one of us is sick then others are reluctant to cover as no incentive to do a locum.
The younger colleagues often cannot do more due to family needs with young children.

So who does the extra work?? Mr/ Miss Nobody

sheepisheep · 04/01/2023 08:34

DolphinWars · 04/01/2023 08:18

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 only reason med school places have been restricted is because there have been no plans to increase foundation programme positions, and its entirely unfair to put students through 5 years of med school without them ever being able to work as a doctor at the end of it.

Stickortwister · 04/01/2023 08:35

WiseUpJanetWeiss · 04/01/2023 08:28

Paying back PFI is about 2% of the NHS budget per year. And we did get something for that money - new hospitals after many years of Tory neglect during the 1980s and early 90s.

I'm no fan of PFI, but I think it's a bit of a stretch to blame it for all the NHS's financial troubles.

My point is that the stripping of assets and a few people making ££££ from the nhs started under labour. The nhs is, and continues to be run and funded with shorttermism in mind. Private car parks and getting patients to pay for their own parking , the purchaser/provider split, the privitisation of various " easy " parts. All this is making a lot of money for a small amount of people ( and its not the clinicians actually doing the work!)

Changes17 · 04/01/2023 08:35

KangarooKenny · 04/01/2023 07:43

The was a statement sent out showing that those children who’d had the nasal flu spray were less at risk of strep A. This was from info during the nasal flu pilot, yet take up was down again.

My dc’s class was due to have their flu vaccine at school in December - but it didn’t happen and has been rearranged for February. I imagine it was down to staff shortages

maeveiscurious · 04/01/2023 08:35

Grumpybutfunny · 04/01/2023 08:22

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.

I agree with the social card dude needs addressing. What about drink and drugs. I was in an A&E a while ago midweek in the day and 70% was drug and drink related.

They need to have a drunk|drug tank for these cases. Most of the care is watch and wait so this doesn't need to be in A&E

FixundFoxi · 04/01/2023 08:36

Stickortwister · 04/01/2023 06:20

I agree with you.

Ive become very burnt out this winter.

I think people are getting what the voted for.... however this probably all started under labour ( blair and pfi anyone) so not sure the alternative is any better.

Ah that's ok then 🙄
@FangedFrisbee I loved theatres, really good team effort and you can actually care for your patients ! Good luck !

Snowmoab · 04/01/2023 08:37

maeveiscurious · 04/01/2023 08:35

I agree with the social card dude needs addressing. What about drink and drugs. I was in an A&E a while ago midweek in the day and 70% was drug and drink related.

They need to have a drunk|drug tank for these cases. Most of the care is watch and wait so this doesn't need to be in A&E

Or they could increase access to support services? Address the societal and mental health reasons that make people drink or take drugs to excess?

gogohmm · 04/01/2023 08:38

I know its incredibly complex but I suppose the problems all stem from overuse of a&e. Could any a&e doctors say whether they all should be there (in which case we need more capacity for a&e) whether half or more should really have waited for a gp in the morning (I know easier said than done but for the purposes of this question did they need a&e) or whether most of the patients actually should have come through a&e but the real issue is that there's no bed elsewhere in the hospital so they can't be admitted?

I'm guessing the answer is a bit of all 3!

From personal experience I see a lot of the issues are related to an aging population, and more people with serious chronic illnesses. My dp's dm has been to a&e 4 times in 28 months for falls, twice for infections sent by her gp. She lives alone, has mental capacity and has no desire to move (the children do not have power of attorney). She's one person, 6 trips all by ambulance (she calls herself), she isn't alone (and yes we feel bad but she's 100 miles away, offered to bring her here but she refused)

Danikm151 · 04/01/2023 08:38

I attempted to call the drs last week. I was number 1 in the queue for 40 minutes!
by the time I got through- no appointments left. Call back at 8am tomorrow. People can’t schedule when they are sick!

The funding the NHS gets needs to be allocated correctly.

walk in centres- that were created to take the pressure off a&e are closing down left right and centre. Now you need to call 111 to go to an urgent care centre and if there’s no appointment you are told to go to a&e

pharmacies can diagnose some conditions and prescribe medication but this isn’t advertised

RackJussells · 04/01/2023 08:39

My fiancé works for the NHS and has said the exact same words, it’s not breaking, it’s broken.

My Gran recently fell and broke her shoulder and cracked her head open. My mum and dad drove her to A&E with my sister as there were no ambulances, and then they had to wait all night to be seen.

I also have a friend who works on the ambulances as a paramedics assistant and she echoes what has been said about the waits and the dire state of the NHS.

It’s such a sad state of affairs and my heart really goes out to all the staff, especially those on the front lines. I can’t imagine how they cope day in and day out.

Bunnynames101 · 04/01/2023 08:40

My heart breaks for front line staff. I monitor the A&E dashboard in my hospital as it affects my workflow. The changes in the stats have been horrific. Then last week I had to attend as a patient. The staff were lovely albeit clearly over stretched. There should be 12 nurses to fully staff our ED, we had 5. I wish I could do more to help, but right now the best I can do is get well enough for work again and make sure my department stays afloat for them.

To my NHS patient facing colleagues, from those behind the scenes, we really are routing for you in everything from strikes to keeping the place going. You deserve so much better.

Talaforniababe · 04/01/2023 08:40

In Ireland if you don't have a medical card (low income), you get billed 100 euro for using A and E. Doesn't stop me going completely if I need it but definitely gives me pause for thought before going! I've had to go twice in the last two years and paying the money afterwards was a pain in the arse. I know the whole point of the NHS is that it's free but maybe that just doesn't work anymore because people are taking advantage.

dollybird · 04/01/2023 08:41

If people can be driven to A&E then they should be. An ambulance isn't a taxi.

Bepis · 04/01/2023 08:42

dollybird · 04/01/2023 08:41

If people can be driven to A&E then they should be. An ambulance isn't a taxi.

Not everyone has a car or access to a taxi service. I agree ambulances aren't a taxi but they are there to transport very unwell people to get medical care.

Sparklybanana · 04/01/2023 08:43

I went to the Dr whilst we were still required to wait outside the building and the attending asked me if I was a medical doctor. I said that I wasn't and she replied "you must be so relieved".

I've never forgotten that. It was the first hint to me that it's the hardest job in the world right now and just a brief look at the dm comments and it's full of bile about how the NHS is overreacting about masks and nightingale hospitals. These people need to witness the chaos.
My friend is a nurse - she said she recently started working a part time week but she still works overtime. The whole country is relying on burnt out medics but the conveyor belt needs fixing. Pharmacies need the freedom to carry out clinics, perhaps having an in house Dr paid for by customers who want a quick fix and subbed for people who are on benefits. Hospital buildings for people to be released into with fewer trained personnel than an a&e to care for those too well for a hospital but not well enough to go home. Use of ML to diagnose queries- is my mole cancerous? What's this rash? Machine learning could diagnose you and free up a Dr. Even if these were all double checked by a Dr then it would take minutes rather than a full appointment. ML for local wait times and busy times. If you knew that your wait time was 12 hours - would you wait for your Dr to open in the morning instead? Private a&e. I know this is controversial but if some patients are willing to pay to be seen earlier than 3 days then that does free up the waiting time for others.

Something needs fixing and having random tories saying they're idiotic for desperately requesting measures to reduce sickness is not going to help at all.

Maytodecember · 04/01/2023 08:46

Seymour5 · 04/01/2023 06:41

How do experienced clinical staff, working at the sharp end, feel when they see jobs like this advertised? www.lbc.co.uk/news/nhs-looking-for-an-115k-director-for-lived-experience/

Wasn’t it John Major who brought in all these management posts? He’d experienced management in banking so thought it’d work in the NHS ( because they’re so similar, of course)
And Thatcher cut a lot of money from the NHS in the 80s.
The common denominator -Tories.

Ihavedogs · 04/01/2023 08:48

MissyB1 · 04/01/2023 08:14

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!

Not one of my team who left did so due to pay, they left for a promotion or due to the general environment.

When talking about pay, the whole NHS package is often overlooked, such as the amount of annual leave, sick pay, pension and staff support programme (the latter may or may not be used). Supermarkets do not offer the same overall renumeration package. In my experience when NHS staff have looked to move outside the NHS, pay has generally not been the main reason, but the environment has played a major part including not being able to spend enough time with patients. For some, especially doctors there can be a lack of opportunity for promotion.

When you are working in an environment where it feels like everything is falling down around you and you are being pulled from pillar to post, and you feel like you are not able to do your job to the best of your ability and are failing patients, no amount of additional pay will improve that, or change what is fundamentally wrong.

Marmitepot · 04/01/2023 08:49

I signed the form for my son to have the flu vaccine at school and he said he didn’t get It 🤷‍♀️

olympicsrock · 04/01/2023 08:50

Someone mentioned that medical school places are limited because of a fixed number of Foundation doctor jobs. This is set fairly low and does not really account for leave or sickness.

For the last two winters we have had huge sickness amongst Foundation doctors particularly with waves of Covid. As newbies to an area they often live together in Groups of 4+. They also do a lot of direct patient care so get every bug going. This sickness has meant that junior doctor cover on wards is very low impacting how quickly patients pass through their hospital journey , junior doctor morale is low , they are run down and training is poor.
The result is that after 2 years of misery they are desperate to leave the NHS.

The government should understand that they need to build contingency to healthcare staffing . 20% more Foundation doctors , more medical student places.

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