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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:
FixundFoxi · 04/01/2023 08:50

@Stickortwister The laughable 'care in the community' started with Thatcher. Underfunded and not thought out properly. Shutting down cottage hospitals, discharging long term psychiatric patients with very little back up.
John Major started PFI in 1992 but Labour ran with it and expanded the policy. At the time the Maastrict treaty demanded that public debt needed to be kept under a certain threshold to participate in economic and monetary union so this was a means of keeping debt off the government balance sheets and invest in severely denuded public services. Those moaning that Labour started it should know that the philosophy behind it was that private performance in some cases is better than public, all part of the free market obsession historically displayed by the Tories post Thatcher and New Labour.

Treetrim · 04/01/2023 08:51

Snowmoab · 04/01/2023 08:34

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.

Exactly but let’s talk about the other ‘issues’ so we don’t actually have to land the blame on those who actually voted for this outcome.

The NHS is being let to rot, the tories will privatise and their friends will get the contracts.

I can’t be bothered arguing that it’s not to do with investment. Look at the improvements during the 90s 00s , they were down to investment - in all areas, from primary care to acute.

To argue that its not Tory policy and lack of investment is infantile.

Snowmoab · 04/01/2023 08:52

Treetrim · 04/01/2023 08:51

Exactly but let’s talk about the other ‘issues’ so we don’t actually have to land the blame on those who actually voted for this outcome.

The NHS is being let to rot, the tories will privatise and their friends will get the contracts.

I can’t be bothered arguing that it’s not to do with investment. Look at the improvements during the 90s 00s , they were down to investment - in all areas, from primary care to acute.

To argue that its not Tory policy and lack of investment is infantile.

Of course they're a huge part of it but there are other issues that whilst people are just saying don't vote tory go unaddressed. It's pathetic to be honest.

RethinkingLife · 04/01/2023 08:53

Isn't this the point in US dramas where some character announces that you have to write to and phone your Congressman/other elected representative.

I've written to mine but, of course, I've no idea when my MP's office is opening again.

Thisbastardcomputer · 04/01/2023 08:57

It's good to hear it first hand from someone who is actually on the front line, I don't know how you do it, day after day, but thank you that you continue to do do.

I have no idea of the answer. I avoid going to the doctors and certainly never turn up at A & E.

My daughter in law died the weekend before Christmas, she was taken by ambulance Friday lunch time to A & E, transferred to another hospital by 5pm. Given a procedure Friday 8pm. Operated on 8pm Saturday, operation stopped after she deteriorated, she died early hours of Sunday.

The two hospitals went above and beyond, for that I'm eternally grateful.

Rabbitsandhabits · 04/01/2023 08:58

Whoneedsleep · 04/01/2023 06:18

I was forced to go to a&e the other week because of a kidney infection. I wouldn’t have got to that point if I could get a GP appointment but they wouldn’t see me despite being pregnant. I tried all home methods of treating it but it progressed to the point of agony and still I couldn’t get seen so 111 sent me there. My Gp surgery is always the same, impossible to contact or get an appointment for.

I sat in A&E for 9 hours for some antibiotics (which I was bloody grateful to get!) but maybe if people were able to get actual appointments to be seen for minor things they wouldn’t end up there in the first place. Also not being able to access basic medical care every weekend or bank holiday is probably also contributing.

I actually considered training as a nurse at one point but there’s no way I’m sitting through uni for 3 years unpaid to be spat on.

The whole system is fucked, no idea what the answer is!

As ever the tone is that the GP is avoiding work and not answering their phones or being a bit lazy.

why can’t people see that they are drowning in the same way A&E is?

work from the hospital gets dumped back to the GP constantly plus they have more sick and elderly patients and less staff/funding just the way that hospitals have.

it’s a system wide issue and no single area isn’t under huge strain and working beyond any reasonable capacity.

rookiemere · 04/01/2023 08:58

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

Exactly- the doctors pension situation needs changing and fast, surely that's a quick win to implement.

Otherwise I'm not sure what the answer is. Unfortunately a major part of the issue is an aging population, that naturally has higher care needs than the younger generation. That coupled with lack of "recuperation " wards for older patients and enough social care funding is a huge part of the issue.

FixundFoxi · 04/01/2023 08:58

@chopc when did the Tories say we needed to semi privatise the NHS ? It's already semi privatised anyway.
Wes Streeting (shadow heath minister) has suggested the NHS work more in tandem with the private sector.

willingtolearn · 04/01/2023 08:59

It's societal and it's winter after a pandemic.

Geographically distant families reducing family support for children and older adults, leads to parents who are very anxious around normal childhood illnesses (made worse by media coverage) and older adults who don't have the support they need.

Unsympathetic and downright bullying workplaces (Hello NHS), who demand you come in whilst your children are sick or you are so that you need 'quick fixes' rather than the 'rest and time' that most illnesses need. They also add to mental stress, leading to burnout/ poor mental health.

Cost of living crisis leading to poorer nutrition, making financial decisions around heating that can worsen illnesses.

Media induced fear about everything, scare stories about rare situations that means everyone needs reassurance about every pain, ache and fever that would normally be self managed - but instead we're encouraged to 'get it checked out' leading to half the country turning up at GPs/ED.

Poor knowledge about common illnesses, despite (or maybe because of) the huge amount of information available online - NHS website is excellent. This leads to people demanding antibiotics for viral or self limiting illnesses ALL THE TIME. In the end they are given them because it's quicker and easier and they just keep coming back, taking up more and more time and resources otherwise.

dutysuite · 04/01/2023 09:00

Will only get worse once the ULEZ is expanded and NHS staff leave because they can’t afford to get to work.

RoseMadderAsHell · 04/01/2023 09:02

Blondewithredlips · 04/01/2023 06:46

It is a complete joke. Those jobs are useless and need to get rid of them.

The NHS is sinking and they advertise stuff like that? Ridiculous.

Just throwing more money at the NHS won't help.

A few years ago our NHS Trust sent staff on an "Away Weekend", the aim was to help hospital and community staff communicate better. No expense spared in a hotel/conference centre. A communication expert was hired.

There were the usual getting to know you games, role play etc, good food and accommodation and the opportunity to watch senior managers getting drunk and making fools of themselves in the evening.
All a complete waste of time and money.

Thismonkeysgonetodevon · 04/01/2023 09:07

@lowercaseletter Unfortunately I have had far too many dealings with my hospital recently, first with my terminally ill parent and now my chronically ill child. I just want to say that my experience has been mixed but the A&E doctors have all, without fail, been truly amazing. So thank you.

It’s heartbreaking what the Tories have done to the NHS, their mismanagement of funds, corruption and complacency for NHS staff is unforgivable.

On the other hand, reading threads on here where, when people suggest things like compulsory masks in medical settings or clean air in schools (would cut down illnesses leading to hospitalisation), they get a barrage of patronising, sneery replies shutting them down. There is a real lack of collective responsibility or will for change from the public which is also to blame.

It all feels incredibly helpless. And I’m so sorry for everyone on the front line.

HopefullyBePregnantViaIUI · 04/01/2023 09:07

Its the exact same in mental health and police services :(

I wont identify where I live due to obvious reasons however Im a charge mh nurse, My role is to complete emergency mental state assesssments - referrals recieved from gp, police, ambulance, a & e, public ect (basically anyone). On a nightshift in particular we have been expected to work as 1 nurse on our own (due to staffing, sickness ect) to cover a population of approx 858,090 people. If thats not a disaster waiting to happen I dont know what is. Individuals who are suicidal, in mental health crisis are contacting my phone line and I physically cannot answer as Im managing police showing up with actively psychotic people, people who have harmed themselves ect. This then backlogs nhs 24, police ect. Its awful, the abuse, physical assaults and completed suicides due to lack of staff and resources are on the rise its heart breaking

87SPD · 04/01/2023 09:09

latelydaydreams · 04/01/2023 07:34

There is a problem in all areas of the NHS. Fewer Drs and Nurses because- who would want to work for less money than they did 10 years ago? Alternatively, those who can stick it out might choose to work as Locums/Bank where rates are higher and you can pick and choose when and how much you work.
Inability to discharge patients to social care/the community is rife because there is a lack of social care/care staff, because they aren’t well paid, the job is hard and as a country we voted for Brexit whichever meant- we lost valuable staff AND we are stuck with very very high levels of inflation.

Recruitment of both Doctors and Nurses is stifled and many leave to work overseas after training because they get better pay and conditions.

The Tories in 2019 got rid of the moderate thinking and experienced ( and I am NO Tory voter) members and instead we have a rabble of MPs with little experience and even fewer morals.

As a whole, with population increases, this is utterly unsustainable.

With many of the major unions ( not just healthcare) endorsing strike action, this is likely to continue for some time.

As a nation, we have a government who have effectively stifled public protest, and here we are waiting for 2024. We need PR to ensure that this can NEVER happen again. We should be out on the streets and in many other nations, the public would be.

👏 every word!

HopefullyBePregnantViaIUI · 04/01/2023 09:10

Another example of this aswell - a family member of mines under 40 years old. Attended the GP time and time again with issues in relation to abnormal vaginal bleeding to be fobbed off, thrown medication. It was so bad we attended one night to a and e and were refused to be seen by gynae due to their workload - 3 days before xmas she was diagnosed with cancer at the outpatient clinic.

PaterPower · 04/01/2023 09:12

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.

PFI was an artificial construct, purely designed to hide capex on the government’s balance sheet. It made private companies (all Tory / New Labour donors) an absolute fortune whilst supplying poorly built new hospitals at a massive mark-up.

The contracts also covered much more than the hospital buildings, which is why it ended up costing Trusts £100s to change a single light bulb. Anything that needed changing had to be approved by the PFI holder who could charge even more for the privilege.

Eventually even the Tories couldn’t keep pretending that PFI was a good deal for taxpayers, nor that it had / has brought any efficiencies into the UK health ‘market.’ That’s why they’re not being used now (although there’ve been attempts to rebadge it).

If you look at the various programs run over the years by private companies for Government, I think you’d struggle to find one that has delivered anything close to what was originally promised, for anything close to the original price:

Police radio systems, NHS & Blue light IT ‘modernisation,’ the Royal Mail’s computerised accountancy program, HS2, electrification of the main rail routes, Hospital replacements, school building modernisation, Armed Forces housing (an absolute shit show), Armed Forces recruitment, private prisons, privatised probation services… and those are just what comes off the top of my head.

Anyone deluded enough to think that putting more of the NHS into private hands is just that… completely fucking deluded (or intends to make a fast buck off it).

Kazzyhoward · 04/01/2023 09:13

@rookiemere

Exactly- the doctors pension situation needs changing and fast, surely that's a quick win to implement.

IR35 also needs to be scrapped. I had several clients who were retired doctors operating their own personal service companies to provide locum services, mostly back to their previous practices to cover holidays and sick leave, etc. Because of IR35, they can't do that anymore, so now don't do any locum work at all. A massive loss to the NHS!

People who constantly carp on about "taxing the rich" need to understand what that means. With IR35, the doctor's pension problem, and the withdrawal of the personal allowance when income tops £100k, it's just become "too expensive" for doctors to work more than they need to! "Rich" people don't need to work as much, so the likes of experienced doctors need to be incentivised to work, not punished!

Gymgo · 04/01/2023 09:15

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.

Yes cause nhs Wales and nhs Scotland is run so well

How would any other government do it ?

I know someone who has been suspended for 6 months pending a investigation band 8 full pay , do you really think this would happen in a private business and I'm sure this happens a lot

BillyMurphysFace · 04/01/2023 09:16

Sadly it's not just hospitals or GPs which are suffering. I work in an NHS psychology department (not general mental health, nor crisis service). Our service opened in July 2022 and we already have a waiting list of what must now be 700 people. People wait months just to be first seen. People wait months for medication reviews. We have little to no triaging system and the service is generally quite badly run. Raising problems to our superiors doesn't really get us anywhere - the assistants are more or less running the service, and there's only a handful of us. Our waiting times are constantly going up and up, and there's nothing we can do. There's just not enough people, not enough time in the day, and we're not commissioned as much as we should be. Not to mention there are at least 2 posts in my service sitting empty, because they can't recruit anyone for whatever reason. It's all such a massive mess.

Advicerequest · 04/01/2023 09:16

I needed antibiotics for an animal bite and was told by the GP receptionist to go to A and E as the gp didn't have any appointments!!!!

Didn't go to a and E as a and E over stretched . By the time i'd fought my way back into the gp system the following day the infection had spread into my hand which was shiny and swollen and was heading down towards my wrist.

Kazzyhoward · 04/01/2023 09:17

PaterPower · 04/01/2023 09:12

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.

PFI was an artificial construct, purely designed to hide capex on the government’s balance sheet. It made private companies (all Tory / New Labour donors) an absolute fortune whilst supplying poorly built new hospitals at a massive mark-up.

The contracts also covered much more than the hospital buildings, which is why it ended up costing Trusts £100s to change a single light bulb. Anything that needed changing had to be approved by the PFI holder who could charge even more for the privilege.

Eventually even the Tories couldn’t keep pretending that PFI was a good deal for taxpayers, nor that it had / has brought any efficiencies into the UK health ‘market.’ That’s why they’re not being used now (although there’ve been attempts to rebadge it).

If you look at the various programs run over the years by private companies for Government, I think you’d struggle to find one that has delivered anything close to what was originally promised, for anything close to the original price:

Police radio systems, NHS & Blue light IT ‘modernisation,’ the Royal Mail’s computerised accountancy program, HS2, electrification of the main rail routes, Hospital replacements, school building modernisation, Armed Forces housing (an absolute shit show), Armed Forces recruitment, private prisons, privatised probation services… and those are just what comes off the top of my head.

Anyone deluded enough to think that putting more of the NHS into private hands is just that… completely fucking deluded (or intends to make a fast buck off it).

All of that is poor procurement practices. If the public sector are stupid enough and incompetent enough to hand out contracts that aren't value for money, don't understand contract wording, and don't control the contracts, then obviously the firms providing the services aren't going to complain, are they?

All those things NEED private firms in one form or another. If a trust decides to build it's own hospital, it still needs private firms to actually build it, doesn't it? Or do you think the NHS should start employing bricklayers, plumbers, etc directly on their books?

The problem is down to the fools negotiating the contracts!

Allthegoodnamesarechosen · 04/01/2023 09:18

torquewench · 04/01/2023 06:03

Whats happened locally to this doctor over the last 5 years that's caused such a massive increase in people coming in to A&E?

Hush your mouth

XingMing · 04/01/2023 09:19

GPs need paying by the appointment, instead of for the number of people registered or hitting targets for prescribing statins. A modest charge, taken over the phone when making the appointment, would discourage DNAs.

But yes, my (late) DMIL spent 27 hours with suspected fractures on the floor of her nursing home before an ambulance arrived, in September 2022.

Fuwari · 04/01/2023 09:20

The public sector as a whole is broken. I’m in the criminal justice sector. Not enough police to investigate crime, no Court slots for hearings, no prison places to put anyone, so all but the most serious of crimes get community sentences but there’s barely any probation officers left to supervise those. Staffing in prisons at dangerous levels.

The problems in the NHS affect more people, obviously. But it’s across the board in the public sector. Teachers are leaving in droves, as are social workers. All of these services need more money but there isn’t any.

Everything is broken.

Advicerequest · 04/01/2023 09:20

I now routinely pay for a private nhs doctor consultation and then send the letter to the gp to action (eg prescriptions, further I investigations).

Had to pay privately for physio after an accident as I can't get continuing appointments on the nhs ... I'd seen the ohysio but when I go to rebook next appointment they never have any spaces coming up!