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.

I agree - you can keep enough savings to have a good send off, the rest surely is well spent looking after our elderly properly. I can not understand the ring fencing around saxingfs, houses etc. It can only be there to serve the inheritances/wealthy but surely then families can choose to give up careers and care or outsource (as expect to do) but we don’t expect the tax payer to bank roll any longer.

Any kind of cosmetic surgery must be scrapped on the nhs, if you want to change gender you pay for it, we start paying if we don’t show up for appointments or those those are wasting time, we start cutting back on the frivolous. Wart removals etc, free prescriptions to wealthy pensioners scrapped. We need to look at every corner of the NHS and start delivering for real health emergencies and become much tougher about everything else.

Neither of those actions would make up for the shortfall in funding from central government, as I've mentioned. I won't comment on Wales as I don't know enough of their financial situation, but Scotland do raise plenty of money and actually invest in their citizens, as opposed to wasting endless cash on corrupt schemes for the mates of politicians.

After an 11-hour wait with an infected gallbladder and having a nurse come out to shoot oramorph in my mouth in the waiting area, I took out private medical insurance. I have played right into the greedy Tory hands but I cannot risk my or my childs life anymore.

It’s totally broken. The money is crap, I find myself looking at indeed everyday as a way to escape. I work in Primary care and it’s just as depressing. No one wants to be there, no one is loving their work. There is money out there, it’s just directed to the wrong places. “Transformation officers” being paid £80k and not transforming a thing as they have no clinical background so know nothing! GP Partners are quids in, (I overheard one of ours laughing at the Xmas party how covid was a licence to print money for him! Nice!)
My beloved oncologist has been trying to retire from the NHS for 4 years but can’t find a replacement so is carrying on for goodwill. I said to my husband when Covid hit that it’s all very well people going above and beyond with goodwill as “we are all in this together” shit but there will be a time when this goodwill is simply expected from us and we will be burnt out and/ Or give a fuck anymore. That time is now!
they tender out most MH to IAPT or Mind, IAPT have a 10 month minimum waiting list, mind, well don’t get me stared on mind, they fail to deliver year after year but get the same contracts year after year offer a woefully poor service to the same 10-15 people who can’t get out of the mindset that maybe if they got a job and a life might not have mental health issues (I’m not meaning the genuine people with NH issues here before anyone starts on that) then we have the hoards of people with “anxiety” when the vast majority of those are actually just a little overwhelmed with a minor inconvenience and need to help themselves more rather than having a sick note or a pill. Then of course the care home issue. There are no carers because the job is poor pay, poor conditions and little purpose when you are rushing around providing sub standard care and knowing you can do better. Then there is the DES/IIF fund that isn’t really working either, other than for the GP partners making the money. I work 4 days a week and only get a room to work from a day a week if I’m lucky as there is no space to put me in a surgery, and no plans to make room either so I end up doing sub standard work over the phone, it’s shit and demoralising and makes hardly any difference so fairly pointless. When I worked in the hospital building it was no different either. We need minor injuries back open properly, it worked it helped. We need the extended access for GP’s to work properly not the half arsed effort we have now. We need to look at retention of the amazing staff we already have and undervalue. We need to pay carers more and give them better conditions, like travel time paid etc. we need to utilise some ARRS roles like paramedics in GP surgeries more instead of letting them swing around on chairs with no work as the gps and nurses don’t like the idea of them and don’t want them so ignore them. Sort out unsafe discharges so they don’t just bounce back! Bring back half way/rehabilitation hospitals to take the bed blockers out! Rant over!!

I paid $20 for doctor, $100 for scan and I’ll pay about $250 for gyne. Surely this has to be a better system.

Really. You think that's a better system? For whom? Rich people?

Your per head funding is higher than England so how much taxpayers money do you feel you are missing?

I’m a GP trainee in my final year before qualifying. Every single person in my cohort is eyeing up a way to exit primary care. We could work 24/7 and we still wouldn’t be able to meet the demand of the population and people still would think us lazy and work shy.

We have increasing frailty and multi-morbidity and a huge rise in mental health problems and acopia. The system is just not fit for purpose and we are running a third world health system. During my hospital training it was not unusual to have only 1 working computer for a ward (windows XP and I didn’t train that long ago), no chairs so had to sit on bins, equipment falling apart.

Very few of my peers want to do this job anymore. It is dangerous for patients and soul destroying for clinicians. We go into this job because we want to help people, we want to do a good job.

I agree with what lowercase has said, This is how it is. But the reality but we can't keep spending more and more money on the NHS. Someone with the power to do so needs to review what the NHS is for and stop some services, cut back on NON-front line staff, make it more efficient so that there is more money for front line staff. There is an awful lot of spending on the wrong stuff at the wrong time. We can't also expect pharmacies to pick up the slack when there aren't any doctors at surgery's available for months either.

Rearranging the deck chairs on the titanic should be the headline on every newspaper tomorrow. So aptly put and exactly what is happening.
The reality is that we need a new ship - not that any of the gutless politicians can bring themselves to be transparent about this.

I see no bullish PM on the horizon that has the backbone to grab this country by the horns and steer us out of this period safely. Starmer is weak as dishwater unable to nail his mast to anything, Sunak is a technocratic PM with his eyes firmly on the future pay off and family credibility lavished on his ‘achievement’ and is entirely out of touch. I scan the political horizon for a leader that can light the way - and it’s a sparse and barren landscape.

Let’s see what happens. Tin hats required and some personal responsibility to keep ourselves well and out of harms way when we can, at least in the short term this winter. Until the storm passes.

GP receptionist here. It's worse than I've known it for the seven years in my job. We have a busy practice with 8 partners, two regs, two ANPs and two practice nurses. We never stopped seeing patients f2f because the length of time to have a phone call and then a f2f appointment was ridiculous and doubled the wait.
We do manage to offer enough appointments, only just, it usually means the GPs staying until 9pm or later though. They are horrendously burnt out, often don't eat lunch during the day.
And understandably, we're getting more and more emergencies as people are terrified of going to A&E. Often staff have driven patients in themselves, if safe to do so, because the wait for an ambulance is too long.

I’ve worked in A&E for nearly 20 years, and this past year has been the first time I’ve felt overwhelmed at work. There are no community services to discharge to. Beds are lining corridors or any other empty space there happens to be. We are assessing patients in waiting rooms, corridors, ambulances. Our 2 hourly board rounds, that should take 20 mins, are taking over an hour because of the volume of patients. A&E has turned into a ward, but can’t function as a ward. We can’t shut the doors. We can’t divert patients to a different hospital-they’re all the same. We’re all exhausted.

We need a hybrid system like Germany compulsory insurance the free at the point of demand model is failing.

I would also like to thank every medic and health care professional posting on here.

I am deeply sorry it is so bloody hard for you, but you are making a difference, you are doing an incredibly amazing job every day to the patients you care for, even if it’s not to the standard or level you would always choose and trained for.

I hope we can change this, turn it around - improve patient care, your well being, your salaries and hours.

We do care.
We all want to help.
We all want a solution for you and for the public.

I think a really simple fix would be to ban MPs and their families from utilising private health/ medical care, and banning their families from accessing private education unless they are good enough to get a scholarship.

We need to motivate our MPs into sorting out services for everyone, and they have no incentive to when they are using privilege, parallel systems and queue jumping.

Well what were you suggesting?

Just to clarify the OP was copied from
Social media & are not my words, but echo my sentiments

The public need to treat it with respect. The amount of people I know who seek out immediate treatment for every minor ailment is shocking.

redundant systems like test and trace

Which had absolutely nothing whatsoever to do with NHSE.

I have had dealing with NHS recently and it has been extremely quick and efficient.
Mate of mine went to doctor 15th December - very messed up knee - is in for a replacement 17th Jan. I do not think that could be bettered.

The problem is with it is that no matter how much money is thrown at it it will never be enough.
All those who want more money allocated will complain when they are paying more tax to fund it and be here saying that they are struggling and that the tax should be less.

Jeremy Corbyn warned everyone before the 2019 "Brexit" election and even showed people the government plans to force American style health insurance on everyone but people still voted for this shower of filth.

Good job to them. /slow clapping.

Grumpybutfunny · Today 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.

These all sound like really good ideas

I live in South Devon and You can go online and see how many people are in A&E, urgent care or minor injury units, so when I fell and broke a bone we logged on and checked the waiting times for A&E, the urgent care centre and the two nearest minor injury units. DH drove past A&E to the next town as they had the lowest numbers waiting, I was seen, xrayed, plastered and wheeled out to our car by the nurse within two hours. Currently waiting times range from 33 minutes to 2hrs 20 minutes so I know which one I'd choose. Obviously somethings have to go to A&E but people with less serious injuries being directed elsewhere must help.

I don't know if other areas have the same sort of thing but I think it was well worth the time it took to check before we left home.

Just checked and currently the waiting time in the urgent care centre is down to 25 minutes.

@willingtolearn thank you, though it’s physio she wants to go in to so will qualify (hopefully) 2026… She’s knows she could work privately, but had always seem herself working for nhs.

That’s great. Thank don't think we have that but very useful

I think that's probably because you live in Devon . I think inner city and over populated areas are more over run.
Sounds like a great system though that could work well in other areas.