Around the country NHS accident and emergency units and GP services are in meltdown as the winter bites at a time of chronic underfunding and staffing shortages.
Ambulances have been seen stuck outside jam-packed emergency departments and two patients have died while lying on trolleys at a hospital in Worcestershire. Last week, the British Red Cross said that the NHS is facing a "humanitarian crisis" that requires "urgent action". With more cold weather expected in the coming days, things could get even worse. A letter to Theresa May published on Wednesday by the Royal College of Physicians and other senior doctors said that without an immediate cash injection the NHS "will fail". More than 20 hospitals have declared "black alert" – the highest level – as overcrowding means they can't guarantee patient safety and provide their full range of services.
To get a better idea of how this happened, we asked a junior doctor, academic foundation doctor, nurse, paramedic and an administrative coordinator, all working in different parts of the country, to share their thoughts and experiences. Interviewees asked for their names not to be included, with one describing a "witch-hunt against staff that speak out" and a "climate of fear". Here's what they told me.
IT'S A WARZONE
"'Humanitarian crisis' is a completely fair description of what's happening. I heard an A&E doctor describe it as similar to a warzone, and I can understand where they are coming from. The hospitals are full, there are people everywhere, people being treated in corridors."
"We've always talked about winter pressures, but these last few weeks it's just got to the stage where the calls are outstripping the resources we have. With the ambulance service we have 12-hour shifts, but we are working 13 to 14 hours. The other week the demand on the service was so high that meal breaks were reduced down to 20 minutes."
"We are getting patients being discharged with no care package in place because they are the well-est patient on that ward and the hospital needs to free up a bed. It's just not a safe situation."
DELAYS THAT KILL
"I've just come back from the hospital after being on leave and I have a caseload that stretches back ten days. I work in cancer services, and bear in mind we are supposed to have a 24-hour turnover. If my CT scanners are backed up for days that could quite easily turn someone who has an operable cancer into an inoperable one."
"We are taking life threatening calls that have to wait up to an hour when there is supposed to be an eight minute response time."
FAILING THE PATIENTS
"Last week I had a family whose grandmother was very unwell and I wanted to speak to them and explain that she was probably going to die. I wanted to talk to them on the Wednesday but I got so busy that I wasn't able to until the Friday. By the time I spoke to them she was literally about to die and they didn't have time to call the rest of the family to come and say goodbye to her. I think that is quite a major failing on our part."
"We had a lady in her eighties who fell over and was found on the floor with a possible hip injury. Because of the demand we couldn't get to her for three to four hours. When the crew finally arrived she was taken into hospital and the crew had to wait another hour-and-a-half to hand her over. Then that poor lady was sat on a hospital trolley in a big room full of strangers, noise and drunk people."
"Every time we come on shift there are also lower grade jobs like broken legs and abdominal pain that aren't classified as threatening that have probably been waiting two to three hours."
"Morale in our hospital is just non-existent. The doctors ask the nursing staff to do things and the nurses don't do them because they don't have enough time. Then the doctors get annoyed at the nurses and the nurses get annoyed at the doctors. It's just created a horrible environment to work in. Everybody is stressed. I'm very unhappy and I'm not convinced I want to be a doctor any more."
TRUST ME I'M (NOT) A DOCTOR
"At the moment I regularly get beeped by bed managers who don't have any kind of medical background whatsoever pressuring me to send patients home, which is completely inappropriate. I don't have time to properly assess my patients and I also don't have time to properly communicate with the patients or have family discussions with them."
"During the current crisis many hospitals are running a zero days per week non-emergency service because they are so overwhelmed by new patients and have to take all the beds for sick, old people. As a knock on from that, our surgical teams are currently being asked to look after medical patients because the medical teams are so overwhelmed. That's inappropriate for the patients and for the surgical teams who don't necessarily have the correct expertise. It's also affecting surgical training, because operations are being cancelled."
"Patients are getting sent home with medical devices inside them – things like catheters that should have been taken out before the patient was discharged, and then followed by 24 hours of monitoring. They are coming out with skin damage that should have been allowed a few more days in hospital to heal."
"Because the patients being discharged still have nursing care needs it means we are having to go in and take extra work."
STRESSED STAFF ARE WORKING THEMSELVES TO TEARS
"When I first joined the ambulance service over 20 years ago I thought this was going to be a job for life. Now, I can't see anybody lasting out the frontline because of the stress and pressure. I've said to people I won't make it to retirement age – I'll be dead before then."
"It is pretty rare to start and finish on time, and most of us are going in on our weekends off. It gets to a point where you are just constantly tired."
"On my current placement I have found it impossible to get more than two days leave next to each other. I worked with one girl last year who was so stressed because she couldn't be confirmed time off for her own wedding a year, six months, and then three months in advance."
"Administrative staff are overworked. I had three members of staff last year alone go off sick with stress. There have been occasions where I have worked 15 days in a row."
"We have a lot of staff who are in tears at the end of shifts."
"The government likes to raise this point about an ageing population. But that's not the problem. The reason this is all happening is that the Tories want to break up and sell off the NHS. Various policies are being put into place which are facilitating this transition and putting incredible pressure on the resources we already have. Up until now it's kind of been an abstract, political debate, but now, with the current winter crisis, people are literally dying."
"Firstly there's underfunding. The Tories have lied about how much money has gone in and there is a big shortfall. Then there are cuts to community and social care. This is the most important thing that keeps old people out of hospital. Thirdly, GPs are under incredible strain. Many are retiring early and not enough want to replace them. So people can't see their GPs and come to A&E instead. Finally there's the Junior Doctor Contract. Despite government spin, this does nothing to address emergency care or help at all with the current crisis."
"Morale is rock bottom and we've got a health secretary insisting that it's not happening."
A GRIMLY PREDICTABLE CRISIS
"This has been coming. Progressively, NHS Trusts have been going into debt for consecutive years and the government haven't bothered to listen. Staff are overstretched and under-qualified. It genuinely does look like the system is being set up to fail so they can sell it off. That is the general consensus among staff."
"When I first started in the hospital coming out of university I would look a bit weird saying a few mates are going out on protests. Now I'm seeing people walk around with hammer and sickle badges. I don't know any sector where you have seen that jump."
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