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.

Agree. Some talk about the government funding not just this but demanding many things have more and more poured into them - but it’s taxpayers who they’re referring to. How much more and who pays

Other countries have specialists on tab. Women visit the gyno for anything related to women's health, kids and young teens are looked after by paediatricians, if you have issues with your skin, you go to the dermatologist. All as out patients so in private's practices not hospitals. It's great. More interesting professional opportunities for medics too. The uk has a very strange health system and GPs are often totally out of their depth useless.

@Lauraa7 that's great if you are wealthy. What happens if you are not poor and not wealthy, right on the cusp of not paying but earn slightly too much. What's the cut off point ? I'm an ICU nurse and earn £28k. I'm not well off really. Will I pay ?

I don't see what hope there is to sort this out. It is just too big a problem.

The quality of life here in the UK is pretty dire. People are overworked, stressed out, unhealthy, overweight, and pay loads of taxes. They pay more for utilities and food than other countries. We are a nation of unhealthy people and many have MH issues. Nearly everyone I know over 45 has a health problem. I put on 2 stone since moving back here.

Then, because of the lack of support we get, we are unable to look after ageing relatives. Women, who it has fallen to, have to work FT to pay the bills.

So, massive demand meets poor supply as a result of poor pay and limited resources in the NHS.

This would take 20 years to fix.

We need to scrap the "gatekeeping" role of GPs. People with hearing loss need to see an audiologist, not a GP to refer them to one. Same with someone with an ingrown toe nail who needs a podiatrist or someone with a sports injury who needs physiotherapy. More depts need to have "direct access". After all, we don't need a GP referral to see a dentist or optician, do we? They manage perfectly well to deal directly and refer to specialist when necessary.

As a country we are going through a massive transition that seems to be touching every corner of the country post pandemic.

Issues and problems that have been repeatedly ‘patched up’ are now exposed, unravelling and we are being forced to consider big changes. Russia of course fast tracked this process by creating an energy crisis and cost of living pressures, but most of the big issues we see now have existed for decades and each government have tinkered around the edges. The NHS has been untouchable.

This is also an opportunity for us to change things for the better, to rip off the sticking plasters. To become more robust. We are being forced to look at our complacency, western entitlement and adjust our expectations. AI will help us in the years to come, many changes and imaginative solutions are bubbling up and will soon be our new reality.

We are being forced to modernise, to decide collectively our priorities as a nation and to decide who we want to be in the 21st century. It feels painful. It is painful. Particularly for those suffering but it is long overdue.

Automation is coming, and with it many benefits, we are moving into a different chapter now and perhaps this could be a catalyst for positive growth and change eventually. We can’t stay wedded to our post war ideology forever.

Lol. Overhaul must be the most over used word on mumsnet.
Calls for overhauling the education system on another current thread.
Why does everything need overhauling ?

@torquewench people are using it like a GP surgery for starters. I can’t get an appointment so I’ll head to A&E. People have saved up problems because they stayed at home during covid, we get 3 year histories of things. But the sick are sicker and we have a high number of elderly patients with multi co-morbidities. The aging population means they need more care, care in the community is also struggling. Ambulances are being called by people who can make their own way to hospital. Who calls an ambulance for a UTI in a young, otherwise fit man? If one one family member is ill, some are booking in the whole family ‘just in case’. We have people booking in feeling like their blood pressure is high and it isn’t over an hour but they want a doctor. It’s awful.

That all sounds terrifying but the NHS continues to provide excellent care too. My mother had an emergency diagnosis and surgery a fortnight ago, her care was absolutely excellent and both of the wards she spent time in were fully staffed with calm, organised professionals. There were a tricky few hours in A&E, but she was given pain relief. She arrived in a taxi.

That's not to deny the horrors listed above, but just to say that not all experiences are like that, even this awful winter.

Women visit the gyno for anything related to women's health, kids and young teens are looked after by paediatricians, if you have issues with your skin, you go to the dermatologist.

Very true. Where I used to live, I saw a Gyno for fertility treatment, and he saw me all the way through to delivering my baby, and checkups for me afterwards. My DC didn't go to the GP, they went to a Paediatrician for anything they needed such as vaccinations, a cold and a check-up for weight and development.

And why are people allowed to have £23k in the bank and start receiving contributions to their care. Slash that figure down to £7.5k, leave enough for a funeral and use up every penny of the rest.

Genuine question because a lot of this sounds staffing related:

Does anybody think that getting a hold on cost of housing, living and inflation would persuade more to fill those vacancies?
If you could have a nicer life on the same income, would that be an incentive to stay / join?

We are being forced to look at our complacency, western entitlement and adjust our expectations.

Definitely this.

@Wotrewelookinat

It will be nearly 10 years until your child will qualify. I believe in that time we will see the destruction of the NHS as it is now, and hopefully a phoenix will rise from the ashes. I don't think it will look the same, but I think it will have to treat it's staff better.

They could always delay, but it might be they will qualify to the start of a bright new future.

Don't forget, if you are found to have made a mistake when looking after 30 patients between 2 of you, some acutely unwell and stepped down from resus, some with significant mental health issues and some who are a falls risk and really need a 1:1, you could be taken to the NMC, have your PIN taken away and all the training you have completed will have been for nothing. No wonder people are phoning in sick left right and centre. Every shift is a potential for error - far more than it ever has been. You simply cannot give the care you want and need to give people in the current situation. I think more urgent care centres would be a good start, and make social care a rewarding career by paying people more money. Same for care home staff. Why would someone work in a care home doing physically and emotionally demanding work for NMW when they could get paid more to work elsewhere?

Then my expectation is they refund my contributions because I expected a basic level of care and it's clearly not there!

We’re seeing much of this strike disruption due to inflation and yes generally high inflation is making staff issue worse. I think the intention is to wait out strikes and inflation is due to fall - then more reasonable pay offers will be palatable.

Whether they stick to it not sure, could change

I see this bandied about on so many threads.

The Welsh government still gets its funding from Westminster, it is them that are at fault -not the devolved administration in Wales. The powers the Welsh Assembly has won't help them secure additional funding from central government for their NHS.

Cost of housing damages this country in so many different ways:

2 adult-working households to pay for housing then cannot care for elderly parents.
higher healthcare workers salary needed to meet housing costs.
UK taxpayers pay so much in housing they cannot afford to pay extra in tax for better public services.
People have children later in life due to saving up for a house first, resulting in more IVF and more complicated pregnancies.
Elderly patients unable to return home as their house is unsuitable. They don’t want to downsize due to stamp duty and there being nowhere suitable to downsize to.

build more housing!!!

And this not their fault gets bandied about too. Funding is higher per head and they can raise taxes.

Wales are free, like Scotland, to raise income tax to increase revenue if they wish to! Or they could scrap the costly free prescriptions for all policy!

It doesn't help when GPs don't want to see patients, and they end up in a and e or a walk in centre. It just blocks emergency patients

I am a nurse in the nhs and our hospital is bursting at the seams. I don't know the answer but I do know about 50% of my department have left in the last 2 years. I'm quite newly qualified (3 years) and I'm thinking of leaving. I can't deal with the stress and the responsibility and the fact I can't even provide the most basic care because there are just too many patients and not enough time.
On a personal level, I've been unwell for weeks and managed to get some blood tests done and can't even get a follow up because there are just no appointments. I phone every day at 8am and they are all gone.
Something needs to change.

Stats show GP's are seeing more patients now than before COVID.
Still not enough capacity for demand.

Every word of that is true. Unfortunately, for decades, we've not had the calibre of senior politicians to do it, hence why every Parliament is just re-arranging the deckchairs on the Titanic rather than having the balls to tackle the serious issues. All down to short term thinking, politicians just looking as far as the next General Election and doing things to improve their party's chance of re-election rather than what's best for the country. Then they wonder about voter apathy! The serious politicians work away quietly out of the limelight in committees, but must be very demoralised. The ministers and prime ministers are generally light-weight and only in those positions for their own ends rather than the good of the people. Look at Sunak, we all know he'll be off to a lucrative future once he's done what his paymasters want of him - just at other ex PMs, Blair, Cameron, etc., who've made a fortune on the back of being ex PMs!