Wednesday, 8 Feb 2023

The NHS is on life support and, working in A&E, I'm terrified we won't make it

Coming onto the morning shift, I see grim faces and red eyes. The staff look broken.

They hand over all the patients in the hospital’s emergency department – many who have been there more than 24 hours – but there is a 14-hour average wait and 12 ambulances in the bay with patients still in the back of them.

This is the reality of what it’s like to work as an ​​emergency medicine registrar in a hospital in the UK right now. But my day has only just begun.

I’m given a man to review. He is a mental health patient who has been there for more than three days waiting for a mental health-specified bed, but they are like gold dust right now.

When I walk onto the shop floor, it is chaotic like a war zone. The noise is unbelievable and there are patients everywhere that are squeezed in cupboards and blocking fire exits. I am convinced that if there was a fire, we couldn’t get everyone out alive and that scares me.

My mental health patient has become extremely agitated at waiting for so long. He starts banging his head on the wall faster and faster, blood spraying everywhere, until we have to call security to stop him.

He fights them and is difficult to pacify; eventually we have to sedate him until he can no longer harm himself. Although this is the safest thing for him, it should not come to this.

How would you feel if you had no privacy, hot meals, showers or basic amenities for three days?

I then hear that one of the patients in the ambulances has gone into cardiac arrest. I run out to help but by the time I get there, it is clear the team feel this is futile.

We do CPR but it is in vain. This patient has been waiting for 10 hours. He needed special breathing equipment, but this can’t be done in an ambulance.

Once again, I feel beaten and that we have failed our patients. I know it’s a system issue but that doesn’t stop the moral injury I feel.

Rishi Sunak’s people state it’s a ‘challenge,’ not a crisis. Try walking a day in our shoes

It continues like this for my entire 10 hour shift.

There is no respite from the chaos and turmoil before I head home and sadly realise my son is already asleep and I barely got to see him today. My husband asks how my day was but I feel too battered to even talk about it. I am already dreading my next shift.

This is like nothing we have ever experienced before, even during Covid-19.

We knew it was going to be very difficult this year when extreme waits (the number of patients waiting over four hours between the decision to admit and admission) peaked in July 2022 at 29,317 patients – more than 13 times higher than in July 2021. This crisis has been building and has been obvious for a long time – why hasn’t it been better planned for?

Why has social care not had the cash injection it clearly needs to prevent bed blocking and subsequent difficulties in emergency care? Every patient who dies – who we might have been able to save had they been seen sooner – leaves us feeling traumatised and goes against every ethical principle we stand for.

Why aren’t the Government doing anything about the situation where we have GPs driving a dying patient to hospital themselves or surgeons apparently examining testicles in a cleaning cupboard? Is this what you want for your closest relatives?

Despite how hard we are trying – our goodwill has propped up the NHS for so long – it’s never going to be enough because we don’t have the staff or resources. Rishi Sunak’s spokespeople state it’s a ‘challenge,’ not a crisis. Try walking a day in our shoes.

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For the NHS to continue to run effectively, we need real change, not false promises. It won’t be quick, and it won’t be easy, but we need more funding in social care and better pay for carers and nurses to make those careers more appealing.

Nurses aren’t just striking about pay; this is about having enough nurses to ensure patient safety. We are running on skeleton staff all the time.

If we could discharge all of our medically-fit patients to social care, it would help to ease the massive strain on the system and the staff.

There are so many patients who are OK to go home from a medical perspective but we cannot do that as there is no package of care in place or nursing home funding for them. It’s also extremely worrying that the longer they stay, the higher the chance they have of contracting a hospital acquired pneumonia, which could kill the frail and elderly.

I just don’t understand why this has been so chronically underfunded for so many years. And why the Government’s underfunding has left a shortfall of hospital beds to keep up with demand – there were reportedly 13,500 less general beds in 2020 than there were 10 years earlier, according to NHS England figures.

Never have I seen so many medical staff feel so disheartened, gone off sick or quit. Some have even taken their own lives.

One of my colleagues recently stated that it currently feels like the ‘NHS Hunger Games – who will die first and how?’ It’s sickening to us that we’ve been forced into this predicament.

For many of us, the NHS and its principles run through our blood, and it is hard to give up, but we have a breaking point. And we are steadily reaching it.

Believe me, we are doing our very best – GPs, hospital doctors, nurses and paramedics. But without more resources and staff from the government, it is futile.

The NHS is on life support, and I’m terrified we won’t make it.

The Doctors’ Association UK issued a letter to Rishi Sunak to urgently address the state of the NHS right now, which you can read on their website here.

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