Perspective from staff within NHS

[lowercaseletter]

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.

totally agree @Kazzyhoward.

Pensions, 100k threshold withdrawal and IR35 are ridiculous.

I do think though that there should be some control of effective locum/bank rates. Incentivising rates that promote locuming rather than staffing is ineffective long term.

The money would be better used for improvements in long term pay and conditions.

Yeh I don’t want Wales or SNP versions

@latelydaydreams yes locum rates are ridiculous. I'm amazed any nurses or doctors actually stay in the NHS rather than going fully shift based and working much less for more pay.

It seems obvious that you'd put a cap on that and use the money to up nurses salaries and pay generous overtime instead of insane locum rates.

So what do YOU think has gone wrong?

A terribly eye opening account of the state of our NHS. Unfortunately the account loses credibility with me with cheap and no-specific parting shots at Matt Hancock and the Conservative Party, which indicate political leanings and ulterior motives. I find it frustrating how Junior Doctors and Nurses unions strike and pontificate about "saving our NHS" etc. but are quite open about their willingness to return to work if those evil tories give in to their pay demands.

As a country, we need to permit our government to really drill into what is causing these problems. Work out why there is such an increased demand. Work out where the system is broken down and establish a plan. There is so much failure demand in the NHS, i.e. cock ups and "not my job" situations lead to more visits, phone calls, letters, emails for things that an efficient organization could one-and-done. The NHS needs the tools to be leaner and more efficient.

Yes, its staff are at times incredible, but the orgainsation can be pig-headed, resistant to change. Better resourcing may well be needed in some areas, but despite the "tories running the NHS into the ground" narrative, real terms spending on the NHS has grown year on year since 2010.

I have no idea if the NHS is fixable, doubt it very much. It's always in crisis and money doesn't seem to be the answer. I think perhaps what it was set up to be is no longer what it's used for. There are too many people now, we live longer lives, demand is too high. Management are advertising for crazy roles at 100K. We probably do need to look at the French health model.

My GP surgery has an additional service offered by the Livi app. It's free and you can get antibiotics prescribed over the phone if deemed necessary. It's not the overall answer by any means but the service is excellent.

Well yes, you cropped my post to omit the bit where I said I wasn't a fan of PFI. I'm not. You only have to look at the Carillion fiasco in Liverpool...

PPs were saying "Oh PFI - it's Labour's fault the NHS has insufficient funding" as a cop out to avoid addressing the absolute devastation the Tories have visited upon the NHS. I was simply calling that out.

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.

and you can’t get a GP appointment because they are over stretched dealing with, not only acute conditions, but also dealing with patients who have been on waiting lists to be seen at the hospital for several months (or even 18+ months!) and are struggling with their conditions. Add in patients who book in for little Thomas who ‘has woken up with a cough this morning’ or someone with a rash who could see the pharmacist, it’s no wonder you can’t get a GP appointment. For info to save someone waiting to see the GP, pharmacist can prescribe for UTI’s these days.

I just want to say I agree 100% with this. I was one of a group of parents who paid for air filters in our children's classroom and it's fairly clear that they're making a difference - despite elsewhere (including in my other DC's secondary, where they move between classes) viruses being insanely rampant the levels of sickness absence have been lower than last year and also compared to data pre-pandemic and most importantly the teacher less sick since the filters went in.

They cost about £100 each and the classroom (which is big, as in an old building) needed two. The cost of proper air filtration and ventilation in schools would be more than paid for by one winter's lower respiratory illness bill for the NHS, not to mention the human costs.

Went to my GP surgery recently. Despite all staff there still wearing masks, hardly any of the patients were (I did and always do - it seems like basic respect). I don't understand how people are so RUDE. If you're going to the doctor because you have a cough, surely the least you can do is make the most basic effort not give it to all the frail elderly waiting for blood tests in the waiting area? People sitting there coughing with no attempt whatsoever to cover their mouth. And then they moan because the GP surgery is understaffed due to sickness and wonder why the receptionists are now behind a door rather than sitting behind the desk with people coughing freely over them.

One thing that could also be done to ease pressure on GPs is stop the ridiculous attendance policies that require if a child happens to be a sick a lot one winter / doesn't have that magical 97% attendance immunity that you have to make a GP appointment on the first day of every period of sickness thereafter. Massive waste of GP time.

Yeah, my mum was about 8 hours in the back of an ambulance outside A&E recently as there was no space for her. It was like a warzone in there. Waiting room packed and people on beds in corridors.
In no way a criticism of the staff who were absolutely amazing and lovely. Felt so, so bad for them. I've worked some tough jobs but seeing that, and the expectation to having to go in to deal with it day in, day out, must be extremely draining and traumatic. I definitely couldn't do it. They deserve their pay increase, and some! and a system that works and is properly funded.

These FB type posts / rants seem to have the same flavour.

So many nurses and doctors are now so burnt out you’ll get loads quitting or being on long term sick. I’ve seen so many people posting ab encouraging them to move to Australia and New Zealand where they’ll get treated better as staff.
The public think the answer is to make broken people work 7 days a week for free?
GPs are broken and if you want them to work sat/sun then they need 2 days off in the week. You wouldn’t expect that in your office job and if you were told to come and work on your annual leave you would tell you boss to fuck off.

The problem is the 1/3 of people in hospital well that people don’t want to help out by looking after relatives at home for a few weeks and there are no carers.

Would you charge everyone?
The biggest users...the elderly, children, the disabled or those on benefits?
Or would those groups be exempt and the charges just fall to the poor sods in the middle yet again.
Most of my DNA's are over 65. People would quite happily charge 21 year old John, but try with 81 year old George (statistically likely to be more able to pay) and there would be an outcry.

My tuppence worth is that it's the whole system that is broken.

Yes A&E is in the news, but if you look at the whole system, A&E just happens to be getting the attention.

If you take some steps back and focus on avoiding admission, rather than someone actually going to hospital, they wouldn't be in a&e in the first place.

We have an aging population, who have almost definitely got more frail faster because they were told to stay at home for months, and years of failure to plan for community and admission avoidance services - not just social care, but community nursing and therapy services, general practice - all those services have been run down and ignored and it's those services which need to be funded and resources properly to keep people well, keep people and home and have the resources to put in care provision to keep people at home instead of going to a&e - that means urgent social care, frequent community nurse visits that can be set up same day. It's cheaper than hospital, but they have been under resourced for years so don't have the capacity to meet that demand.

There is such a focus on getting people discharged, when actually what we need to look at is avoiding people being admitted in the first place.

i am sorry op, I can hear your anguish. Thank you for everything you are doing.

Yes the NHS is broken. It can’t be fixed and needs a huge overhaul of historical proportions. It’s much bigger than any one party. It will probably require a cross party approach and agreement, that is where we are.

A lot of my medic friends blame Blair’s decision to make the GP services a Monday to Friday service rather than the 24 hour care that used to be offered. Unfortunately the hospitals take the hit out of office hours and at weekends. GPS only offer a part time service at best, this needs to change urgently. Nurses specially trained could see patients with low level health issues overseen by a doctor. The conservatives have not paid our medics enough - nor incentivised anywhere near enough. Free uni places should be a starting point and good salaries with hours that are reasonable and an attractive package to entice the best.

We have rightly just taken in millions of Ukrainians and Afghans, additionally we have gained tens of millions in the last few decades, and yet we still have 1970s infrastructure and it is not just health care that is a burning issue, but housing, school places and other services are also now under severe strain. Personally I think the immigration systems now need to close for two years, so we can get a handle on this critical situation and look after our new arrivals properly and everyone that lives here. Things can only her worse if we carry on as we are.

We need to be honest about the limits of serving over 70 million ageing people attending to every health need under the sun.

We could start with levelling up aggressively. Second homes, empty investment homes, non doms, wealthy non working pensioners should be contributing a hell of a lot more. As it is, the young and working populations are shouldering way too much of the responsibility and the wealthy pensioners are needing more and more care. Anyone that owns a home should be paying for their own care, social care without question. The system was not designed to provide cradle to grave care on this epic scale!

We need to prioritise.
We need to agree what the NHS will offer and how it will be paid for. No more sticking plasters.

The moment of truth has now arrived.

I think the simple answer is already taking place- there’s a 3 year doctorate coming up with hands on training and a bursary and better funding. A lot will be applying for that and it will cover the lack of doctors.
GP needs to stop dishing out 8am ring on the day and maybe stay open later- do split shifts between a few doctors instead of one- up their pay
Bring back the fully paid nursing degree whilst doing your 3 years so students aren’t burnt out or create a nursing apprenticeship?
More staff plus more pay plus more vacancies = quicker turnaround for treatment = less time in a and e
ta da

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.

@cptartapp I'd take a charge from everyone. And refund it on attendance if the patient actually required Rx treatment, was unwaged or on pension credit. Frankly, I think everyone else should chip in a nominal amount. It would deter the lonely frequent flyers and the timewasters who should have used Livi or 111 or the pharmacist.

I left the UK 15 years ago and the service was poor then. I now live in Melbourne and last week I went to my GP, I got a referral for a scan and gynaecologist appointment. I had my scan today and gyne appointment is on Friday.
I paid $20 for doctor, $100 for scan and I’ll pay about $250 for gyne. Surely this has to be a better system.

That's terrible, and I'm so, so sorry you've been put through this.

It's a symptom of the failed system, when people are afraid in in pain and terrified and feel like they're not being taken seriously/the urgency isn't there they lash out. It's awful that frontline staff bear the brunt of it.

I never thought I would be that person but I went to A&E with my husband recently (after an ambulance wouldn't come out) and he was in such a bad way almost screaming in pain and there was such a lack of urgency (made to queue in a shack for an hour to even check in) I found myself getting incredibly irate and upset and angry, because of the fact I couldn't do anything for him and it felt like nobody was helping. Of course logically I knew that wasn't true and everyone is suffering and the staff are all doing their absolute best, but I realised how easy it would be for some people to lose their rag and take it out on staff.

I rolled my eyes at the receptionist when she told me we were in the wrong place and quite rudely said 'why did you walk past that sign saying queue?' (we hadn't been anywhere near the sign as we'd entered through a different entrance) and felt awful for it. When I went back later once he was in the ward I went and apologised. They must get numb to it.

There are pockets of NHS services that are doing well though and have high morale. I work for one. Brilliant management, manageable workload, never work a minute of unpaid overtime, investment in training for staff if they want it, support but no micromanagement, and waiting times to begin therapy are a matter of weeks where in other parts of the country people are waiting years.

What happens if you can’t afford those sums lauraa7?

@Swissmountains

I agree totally!

"The problem is the 1/3 of people in hospital well that people don’t want to help out by looking after relatives at home for a few weeks and there are no carers."

I totally agree bed blocking is a problem, but it's not generally that people don't want to look after relatives.

Most of us are still working due to rising retirement ages and some can barely look after themselves never mind elderly dependents with complex needs.

Secondly it's not for a few weeks is it ? Social services get a whiff of a relative and there will be no support to be given, because of the shortages in their budget for care.

Blaming people is not the answer, it's the system and processes that are broken.