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You can find the current article at its original source at https://www.theguardian.com/commentisfree/2017/jul/27/nhs-doctor-understaffing-patients-at-risk
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| Version 4 | Version 5 |
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| As an NHS doctor, I see lives put at risk every day | As an NHS doctor, I see lives put at risk every day |
| (11 days later) | |
| A new joke is doing the rounds in my hospital. How many doctors does it take to change a lightbulb? The answer is 11. One to do the actual changing, the other 10 invented by Department of Health spin doctors in response to the latest headlines about NHS understaffing. | A new joke is doing the rounds in my hospital. How many doctors does it take to change a lightbulb? The answer is 11. One to do the actual changing, the other 10 invented by Department of Health spin doctors in response to the latest headlines about NHS understaffing. |
| This week, those headlines could not have been more stark. Data from NHS Digital revealed that there are more than 86,000 vacant posts in NHS England – a rise of 15.8% on last year, and the highest number on record. But not one of the doctors and nurses I work with was remotely surprised by the news. One day’s fleeting headlines are our everyday lived and breathed reality. | This week, those headlines could not have been more stark. Data from NHS Digital revealed that there are more than 86,000 vacant posts in NHS England – a rise of 15.8% on last year, and the highest number on record. But not one of the doctors and nurses I work with was remotely surprised by the news. One day’s fleeting headlines are our everyday lived and breathed reality. |
| For us, understaffing is no dry statistic. It’s a constant stress gnawing away in your stomach, a degree of fatigue that sometimes makes you want to vomit, a look of entirely justified anger or despair distorting the face of the patient in front of you, a blinking back of tears in a toilet cubicle because you think you might not make it to the end of your shift today. In short, when you’re a doctor or nurse at the NHS’s sharp end, understaffing is horribly human – or inhuman, depending on your perspective. | For us, understaffing is no dry statistic. It’s a constant stress gnawing away in your stomach, a degree of fatigue that sometimes makes you want to vomit, a look of entirely justified anger or despair distorting the face of the patient in front of you, a blinking back of tears in a toilet cubicle because you think you might not make it to the end of your shift today. In short, when you’re a doctor or nurse at the NHS’s sharp end, understaffing is horribly human – or inhuman, depending on your perspective. |
| I’m a junior doctor in a large hospital. On my ward, the nursing vacancies now top 30%. And we’re lucky. On the ward next door, more than half the nursing posts lie empty. The trust simply can’t find anyone willing to fill them. That means unless expensive locum cover can be found – which it often can’t – every nurse on the ward is looking after twice as many patients as he or she should be. Frequently, one of them will break down in tears. Two of our very best nurses – the supremely experienced, unflappable, irreplaceable ones whose expertise and example are the bedrock of the ward – recently threw in the towel. Unable to stand it any more, they walked away from their careers in hospital nursing. | I’m a junior doctor in a large hospital. On my ward, the nursing vacancies now top 30%. And we’re lucky. On the ward next door, more than half the nursing posts lie empty. The trust simply can’t find anyone willing to fill them. That means unless expensive locum cover can be found – which it often can’t – every nurse on the ward is looking after twice as many patients as he or she should be. Frequently, one of them will break down in tears. Two of our very best nurses – the supremely experienced, unflappable, irreplaceable ones whose expertise and example are the bedrock of the ward – recently threw in the towel. Unable to stand it any more, they walked away from their careers in hospital nursing. |
| Keeping everyone safe will demand superhuman efforts that I’m not sure I have the stamina to keep providing much longer | Keeping everyone safe will demand superhuman efforts that I’m not sure I have the stamina to keep providing much longer |
| For the doctors, it’s little better. All our rotas are littered with gaps – missing doctors where the on-call cover should be. That means that when I’m starting out on a night shift, attending to all the medical emergencies the wards throw my way, I’m frequently handed another doctor’s on-call bleeper. Now the nurses will page me for twice as many patients. I’ll run from heart attack to stroke, haemorrhage to sepsis, and keeping everyone safe will demand superhuman efforts I’m really not sure I have the stamina to keep providing much longer. | For the doctors, it’s little better. All our rotas are littered with gaps – missing doctors where the on-call cover should be. That means that when I’m starting out on a night shift, attending to all the medical emergencies the wards throw my way, I’m frequently handed another doctor’s on-call bleeper. Now the nurses will page me for twice as many patients. I’ll run from heart attack to stroke, haemorrhage to sepsis, and keeping everyone safe will demand superhuman efforts I’m really not sure I have the stamina to keep providing much longer. |
| Recently, as the ambulances queued up around the block – in my hospital, like many, the “winter crisis” has turned into a year-long phenomenon – a patient with sepsis became stranded. His blood was riddled with infection, but the management was simple. Aggressive intravenous fluids and broad-spectrum antibiotics. He needed them both, immediately. The trouble was that there wasn’t a single bed left in my hospital, and there were scores of other patients trapped inside the ambulances, all in desperate need of the A&E bed he temporarily inhabited. So a manager turfed him out to the hospital “discharge lounge” – a kind of holding bay meant for medically fit patients who have been discharged from hospital and are waiting for transport home. There he sat for several hours – without fluids, antibiotics or even a nurse to keep an eye on him, as sepsis slowly and inexorably overwhelmed him. By the time he was transferred to a proper ward, he was approaching death. My colleague did her best, and mercifully he survived. “There but by the grace of God,” she told me afterwards, the disgust in her voice raw and ugly. | Recently, as the ambulances queued up around the block – in my hospital, like many, the “winter crisis” has turned into a year-long phenomenon – a patient with sepsis became stranded. His blood was riddled with infection, but the management was simple. Aggressive intravenous fluids and broad-spectrum antibiotics. He needed them both, immediately. The trouble was that there wasn’t a single bed left in my hospital, and there were scores of other patients trapped inside the ambulances, all in desperate need of the A&E bed he temporarily inhabited. So a manager turfed him out to the hospital “discharge lounge” – a kind of holding bay meant for medically fit patients who have been discharged from hospital and are waiting for transport home. There he sat for several hours – without fluids, antibiotics or even a nurse to keep an eye on him, as sepsis slowly and inexorably overwhelmed him. By the time he was transferred to a proper ward, he was approaching death. My colleague did her best, and mercifully he survived. “There but by the grace of God,” she told me afterwards, the disgust in her voice raw and ugly. |
| No one can pretend this is world-class care. It is, instead, a travesty made all the more distressing for staff by the fact that we’ve already been here once before. The infamous Mid Staffs scandal exposed the dignities and dangers to which NHS patients can be subjected when staff are stretched too thinly to provide proper care. Robert Francis QC, who led the independent inquiry, concluded that its root cause was the trust’s eagerness to save money by slashing its numbers of frontline staff: “With hindsight, it is possible to discern an ever more desperate situation,” Francis wrote. “A chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care.” | No one can pretend this is world-class care. It is, instead, a travesty made all the more distressing for staff by the fact that we’ve already been here once before. The infamous Mid Staffs scandal exposed the dignities and dangers to which NHS patients can be subjected when staff are stretched too thinly to provide proper care. Robert Francis QC, who led the independent inquiry, concluded that its root cause was the trust’s eagerness to save money by slashing its numbers of frontline staff: “With hindsight, it is possible to discern an ever more desperate situation,” Francis wrote. “A chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care.” |
| How, I ask myself every day, can the government possibly ignore the dangers of Mid Staffs-style understaffing on a national scale? How can they pretend everything is rosy when frontline staff, the Royal Colleges and even Francis himself are united in warning that the NHS is facing “an existential crisis”? In the wake of Mid Staffs, the government promised that never again would they allow finances to come before patient safety. If they had to look the patients in the eye like we do, I do not believe they would break their word with such impunity. | How, I ask myself every day, can the government possibly ignore the dangers of Mid Staffs-style understaffing on a national scale? How can they pretend everything is rosy when frontline staff, the Royal Colleges and even Francis himself are united in warning that the NHS is facing “an existential crisis”? In the wake of Mid Staffs, the government promised that never again would they allow finances to come before patient safety. If they had to look the patients in the eye like we do, I do not believe they would break their word with such impunity. |
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