#NHSPressure Is No Surprise

All I can do is the best for my patients - when they finally get to see me - and keep saying sorry on behalf of all NHS staff, for the betrayal of their trust
PA Wire/PA Images

It’s a familiar feeling of dread when I start to see the messages on my phone. Emails from colleagues, from the local hospital asking for additional GPs to work; telling me there are no beds for available, again. Then the individual ones start, from friends who are in the middle of it all.

Never seen it like this… so many patients… could do nothing to help… waited 30 hours… so sick… another death… not sure I can face it again.

It sounds like a war zone, and that’s exactly how one friend described it. When the posters popped up on advertising boards just before Christmas, proclaiming that patients would be able to see their GP all over the holidays, I wondered what parallel universe I was living in. This on the day I had seen a fully booked surgery, plus five extra patients, done eight home visits, tried to tackle the urgent blood results and letters, and rounded it off with another full surgery.

My heart has continued to sink over Christmas and New Year, as GP colleagues in surgeries, out of hours and A&E, have worked alongside hospital staff and managers to keep the NHS ship afloat. Trouble is they have been given thimbles to bail the floods out instead of buckets. Realising how horrific things were getting, I offered to share colleagues stories anonymously on twitter, using the #NHSPressure.

All the promises of whistleblowing protection aren’t believed by most NHS staff, and there is a climate of fear. Some staff don’t want to speak out because in their hospital, the whole team is mucking in and it’s not fair to add blame when the problem lies higher up the food chain. Some staff fear for their jobs, employed by big organisations who value large government contracts. Some staff don’t want trial by media, and have seen careers ruined when the press get wind of a “trouble maker”. I’ve been inundated with messages and emails, and shared what I can. It makes for grim reading, and what twitter limits me to explaining, is the following. Its about a lack of surprise.

This is not a surprise crisis. It isn’t a particularly bad winter, or a nasty flu strain that has caused an unexpected disaster. NHS staff have been warning of this for over 18 months. While you could write an essay on the underlying reasons, it comes back this:

The NHS is full, with no slack in the system.

General practice has waits of three weeks or more for routine appointments with doctors and nurses. Despite bright, shiny ideas to increase the number of staff, the failure to address the massive workload means nothing has changed. GPs run the out of hours service for patients overnight and at weekends. Failure to invest in this service, and recognise its crucial value in stopping hospital admissions makes it yet another war zone. Where too few staff spend their time dealing with the nightmare that is NHS111, where flowcharts come above clinical judgement. I have lost count of the times patients have come to see me utterly bewildered at being told to ring an ambulance having rung 111 for a simple medication query or minor cold. I have filled in countless incident forms for those patients who should have been seen by a doctor, or had an ambulance sent, and been told they should stay at home and self-care.

If a patient manages to get to hospital correctly, there is nowhere for them to go. Research shows that if more than 85% of available beds in hospitals are filled, it begins to affect patient outcomes. The rate of complications and infections increases, and care suffers. It is entirely normal for this figure to run over 90% in most hospitals now, rising to the “usual” 95% in winter. The last year has seen continually high rates, with no increase in staff to help, and crucially a reduction in the budgets for care outside hospital in both social services and general practice. This leaves hospitals with an impossible choice – sick patients at the front door, queuing in ambulances; stable patients who could be cared for outside hospital with nowhere to go and no-one to look after them.

It was no surprise to see hospitals having to keep patients in A&E, on corridors, and finally running out of corridor space and using waiting room chairs. Please, take a second to imagine how the nurse feels trying to care for a sick, elderly patient in a waiting room who should be safely in a monitored bed. Take a second to think how you would feel as that patient; cold, tired, frightened. Take a second to imagine that patient is your mother, or grandmother. You would be utterly sickened.

It is no surprise that all NHS staff working in these conditions don’t last long before falling over themselves. Working long shifts in an environment where everything around you is stopping you doing the job you’ve trained for, makes you feel demoralised and powerless.

But those posters are still up, promising the earth. Promising a service with bells and whistles to meet your every need, delivered when and where you want it by a smiling worker. It’s not funded; not even the head of the NHS in England Simon Stevens could persuade the government to give him the minimum extra £4bn needed to standstill. It’s broken and it’s breaking its staff and hurting its patients. This is a deliberate political choice by Theresa May, Philip Hammond and Jeremy Hunt. It makes me unspeakably angry and sad, and my small attempt to tell people about it feels pathetic. All I can do is the best for my patients - when they finally get to see me - and keep saying sorry on behalf of all NHS staff, for the betrayal of their trust. And once again, invite Mr Hunt and his colleagues to spend the day with me, and see if coming out from behind their desks into the trenches changes their minds. I’m easy to find Mr Hunt; I’ll be with my colleagues on the frontline.


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