A fearful anonymous consultant tells it as it is… Is this whistleblowing? Would he be punished if his name was known? Of course it would… Please note the comment on the perverse incentives. It is the rules of the game as defined by the politicians which have been destroying the large mutual that we used to know as the NHS – and which is now becoming the No Hope Service. When doctors seeing patients are not experienced enough many rarer diagnoses are missed until too late or until treatment is expensive… We need more experience at the front line and this means, for the next decade, GPs retraining in A&E and out of hours care, and the abandonment of “QOF”, the system of performance related pay for GPs. As in most crises, the rich will do relatively better.
There is a lot of talk currently about the NHS being in a state of crisis.
I’m not an expert on healthcare policy but I do, however, have 21 years experience of working across emergency departments – the last 12 of them as a consultant in a major trauma centre.
With emergency departments so close to breaking point I can confidently say that the NHS is most definitely in crisis.
It has been a relatively mild winter with no flu epidemic (yet) but the figures paint a different picture.
The NHS has a target to see 95% of emergency patients within four hours, but that figure was 78.5% on average last week.
How does the government choose to respond? By denying that there is a crisis and instead redefining who the four-hour target applies to.
Jeremy Hunt has said that the four-hour target should only apply to ‘urgent health problems’, as opposed to everyone who comes into an A&E.
The figures are one thing but what is happening on the ground is even more disturbing.
Emergency departments are overcrowded with care being delivered in corridors because there are no cubicles, and patients are waiting unacceptable lengths on trolleys as there are no beds available within hospitals.
I can assure you that this is not because of any lack of effort or commitment from nurses and doctors on the front line who are working tirelessly around the clock.
Indeed, the situation is incredibly frustrating as we are left to face the day-to-day reality of inadequate funding and resources.
We are happy go the extra mile – it comes with the territory.
When this happens every shift for months on end, however, and your workload is double what your department is equipped for, it becomes unsustainable.
Staff become ill, stressed and eventually burn out.
Despite an enthusiastic start, many junior doctors have left frontline specialties such as emergency medicine as, despite offering one of the most rewarding and interesting careers, the constant battle to deliver high quality care with inadequate resources is taking its toll.
Stabilising emergencies by leading the care of the critically ill and injured in those initial vital hours is a core role of an emergency department doctor.
I suspect that few enter the job thinking that they will spend their time searching for trolleys when there are none left, shuffling patients into any space that they can find to examine them and having to repeatedly apologise for the long wait and lack of beds.
Doctors and nurses working in an emergency department want to deliver high quality emergency care in a timely fashion and to maintain dignity for their patients.
Overcrowded emergency departments make this impossible to achieve.
Even worse than that, there is evidence that overcrowding leads to avoidable deaths.
The reason that overcrowding has become such a problem is not, as the politicians might have you believe, because too many people are attending A&E unnecessarily.
Yes there are a small proportion of patients whose needs may be better served via another route but simply telling people not to go to A&E unless they have a ‘true emergency’ does not work.
The fact is that departments are overcrowded with patients waiting to be admitted to wards, patients who are deemed too unwell to be discharged home.
This is unsurprising given that our hospitals are being run at excessively high occupancy rates, which reached 95% in the first weeks of 2017.
The chronic underfunding across all facets of health care – and social care in particular – has led to a situation whereby there is nowhere to send these patients to once they have recovered from their illness or injury.
Underfunding coupled with a perverse system of financial incentives for trusts means that there are not enough beds available for emergency admissions.
This so called ‘exit block’ is what paralyses emergency departments, and in recent years the winter crisis has lengthened to cover much of the year.
Healthcare workers are driven to the point of exasperation being told ‘you need to be more efficient’.
We continually strive for more efficient ways of working and we do make marginal gains in some areas.
But any efficiency gains become insignificant when our departments are gridlocked with dozens of patients waiting for beds.
In addition, cost savings that we make are dwarfed by the hundreds of millions that the NHS spends paying locum staff to fill the gaps left by burnt out and disillusioned staff.
When demand and expectation increases year on year but resources and funding do not, what you get is a crisis.
I genuinely fear for what lies ahead. You know you’re in trouble when even the Chief Executive of NHS England, Simon Stevens, says that the government is not funding the NHS adequately.
Those of us that remain on the frontline will continue to do our best to maintain a safe, high quality emergency service but the real solution lies at the hands of the government, who must act now to address this sorry situation.
This blog was put together with the help of the British Medical Association, the voice of doctors and medical students in the UK.