It all starts with a single case of flu, Dr Matthew Roycroft says.
“You know when it comes, one person is fine,” the trainee doctor, who specialises in geriatric medicine, said. “But you know the way the graphs go with it. It goes from one person to two people, from four to eight, to hundreds, to a thousand people coming in over a short period of time.”
As it spreads, Roycroft admits he gets a sinking feeling. “It’s here. Winter is starting.”
Year after year, the NHS is brought to its knees as winter hits, bringing with it spiralling A&E waiting times, huge bed shortages, and staff pushed to breaking point.
Last year alone saw the health service forced to cancel thousands of non-urgent operations and lift rules against mixed-gender wards as waiting times and ambulance queues hit unprecedented levels, with experts dubbing it the “worst winter on record”.
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As UK temperatures once again begin to plummet, HuffPost UK has spoken to medical professionals who all describe the intense pressures they are under to meet the demand for help.
Looking to the months ahead, paramedic Martin Berry – who qualified in 2005 – is confident that this winter will be the most challenging to date.
“Every year has been busier than the last – I’ve got no reason to suspect this year will be any different.”
Each winter crisis hits frontline NHS staff in different ways. But for Berry, the story of one patient stands out among the thousands he treats each winter.
Last year, the paramedic and his team were called to the scene of a car accident, where a man had been injured. “We were expecting severe internal injuries and he had a fractured dislocation to his elbow. He was in a lot of pain and we packaged him up as best we could,” Berry explained.
But despite the seriousness of the man’s injuries – and his need for strong painkillers – Berry was forced to wait with him for three hours in a hospital corridor before a bed became available.
Any patients the veteran paramedic could have treated in that time were forced to wait. “I couldn’t just leave him in a corridor. It’s not just physical space that is lacking – hospital staff are trying to manage everyone else, and their staffing is decided by the number of beds they have to cover.
For Berry, it was just one of many “really difficult days” over winter. “You go home feeling that you somehow could have done better for the patient, even though you know there’s nothing else you could have done because it’s a system problem.”
The situation impacts his mental health, too. “It’s the constant drip-feed of pressure and demand – winter just exacerbates that. As much as you try and focus on the fact that you can only do one job at once, you then turn up to an elderly patient who has been on the floor for six hours. That’s very difficult to manage emotionally for someone who joined the service because they want to care for people.”
It’s a feeling shared by many NHS staff over the winter months – and not just those who treat patients. One 111 call handler – who asked to remain anonymous – described how pressure on the NHS’ urgent medical helpline becomes “absolutely relentless” over winter.
Staff are trained to assess callers’ symptoms over the phone. They are then able to connect patients to nurses, GPs and emergency dentists, book them face-to-face appointments or, if necessary, send an ambulance to the caller.
“Calls stack up all day and all night,” the call handler said. “The responsibility we carry is mind-blowing and we are in the lowest pay band in the NHS – we are paid the same as porters,” she continued. “It’s so very stressful that our staff turnover is 60% a year.”
According to the 111 worker, who started the job in 2017, it is not uncommon for other parts of the NHS to “bat pressure away to us”.
“GP surgeries and walk-in centres both have been known to tell patients to call 111, knowing perfectly well we are a referral service and can’t magic up appointments where there are none,” she said. “Sometimes I want to cry at the waste, the pointlessness of it all but I am too tired.”
One call last Christmas from the wife of a recently-discharged patient suffering from constipation left her “crying for days”, she said. “He simply needed a district nurse to come and sort that out. The patient’s wife told me: ‘There’s nobody here for us anymore, all the services are gone.’ It all but broke me.
“A clinician came and took the call over – that never happens – and sorted it out because I couldn’t speak any more, I was crying too much.”
Her fears over what this winter could bring comes as Theresa May prepares to unveil her much-awaited ten year plan for the NHS – a plan that has been shelved twice thanks to the prime minister’s Brexit woes.
The long-term strategy will unveil how health officials intend to invest freshly-boosted NHS budgets, with an extra £20 billion set to be pumped into the health service in England each year by 2023.
But “jobbing junior doctor” Jeeves Wijesuriya – who is also the chair of the BMA junior doctors committee – believes the health service’s currently attempts to deal with annual winter crises could be setting the NHS up for even more serious problems in the future.
“Training suddenly takes second place and the workforce that we are trying to prepare years from now suddenly have all of their learning opportunities cancelled or moved,” he said, calling it “unacceptable”.
Meanwhile, doctors in certain specialties are expected to work “outside the scope of their experience” and without proper supervision in a bid to tackle short-term pressures in other areas of the health service, Wijesuriya claims.
It’s a sentiment shared by Roycroft, who has worked in the NHS for the past 10 years. In order to even begin to tackle the pattern of winter crises, staffing levels must be dealt with, he said.
In the first quarter of 2018, there were almost 90,000 full-time NHS vacancies in England alone.
“If you have a system that is understaffed and under-resourced, you end up putting pressure on everybody,” Roycroft explained. “In almost every aspect of being a doctor, they are being pushed too much – there’s not enough people, there’s not enough money, there’s not enough staff in supporting areas. People are stressed with it.
“Can you do something about it? Yes you can – you can get more people.”
Speaking to HuffPost UK, the shadow health secretary, Jonathan Ashworth, said: “These powerful testimonies from the frontline reveal an NHS under intense strain after years of financial squeeze, bed reductions, staff shortages and deep cuts to community social care provision and health services.
Ashworth said the coming days and weeks were likely to reveal “more harrowing stories of elderly, vulnerable often confused patients languishing on trolleys in corridors or left in ambulances unable to even be admitted to an overcrowded hospital.”
He added: “The Tories have been running down the NHS for nearly nine years now and this is the dismal result. Instead of hubristic tweeting, Tory ministers need to get a grip of the scale of pressures facing the NHS. Patients deserve better.”
With a crisis looming, Wijesuriya said things have to change. “A crisis is something you aren’t expecting, it’s something that you don’t anticipate.
“Anyone and everyone can see what is going to happen this winter.”