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You can find the current article at its original source at https://www.theguardian.com/commentisfree/2018/jan/05/nhs-doctor-let-patients-down-crisis
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| Version 4 | Version 5 |
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| I’m an A&E doctor. This is how we’re forced to let our patients down | I’m an A&E doctor. This is how we’re forced to let our patients down |
| (11 days later) | |
| I’ve arrived five minutes early for my shift in a hospital A&E department. I walk through the corridor behind the department, already crammed with hospital trolleys. I shut them out of my mind. I’ve still got five minutes of breathing space before they become my immediate reality. | I’ve arrived five minutes early for my shift in a hospital A&E department. I walk through the corridor behind the department, already crammed with hospital trolleys. I shut them out of my mind. I’ve still got five minutes of breathing space before they become my immediate reality. |
| The trolleys are staffed by paramedics. They brought the patients in, there’s nowhere for them to go, and there are no hospital staff to look after them. So the paramedics wait with the patients, checking on their pain and repeating their vital signs – instead of being out there responding to the soaring number of emergency calls. | The trolleys are staffed by paramedics. They brought the patients in, there’s nowhere for them to go, and there are no hospital staff to look after them. So the paramedics wait with the patients, checking on their pain and repeating their vital signs – instead of being out there responding to the soaring number of emergency calls. |
| A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. | A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. |
| NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. | NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. |
| Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. | Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. |
| The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. | The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. |
| Read a full Q&A on the NHS winter crisis | Read a full Q&A on the NHS winter crisis |
| Most of the patients in the corridor today are elderly. Some clearly have dementia, and are confused as to where they are. There’s no dignity, no warmth and a very long wait ahead before the hospital starts seeing and treating them. It turns out that I didn’t manage to shut them out of my mind at all. | Most of the patients in the corridor today are elderly. Some clearly have dementia, and are confused as to where they are. There’s no dignity, no warmth and a very long wait ahead before the hospital starts seeing and treating them. It turns out that I didn’t manage to shut them out of my mind at all. |
| As I walk into the changing rooms there is chaos everywhere. A crisis has hit all the staff. The cleaners have needed to help with getting cubicles and bed areas turned around faster and faster, so the staff areas have moved to the bottom of their list. There are literally no clean scrubs or uniforms left for any of us to wear. “Don’t worry, whatever you’ve got on is fine, just start seeing patients.” The bosses are as stretched and as desperate as anyone else. | As I walk into the changing rooms there is chaos everywhere. A crisis has hit all the staff. The cleaners have needed to help with getting cubicles and bed areas turned around faster and faster, so the staff areas have moved to the bottom of their list. There are literally no clean scrubs or uniforms left for any of us to wear. “Don’t worry, whatever you’ve got on is fine, just start seeing patients.” The bosses are as stretched and as desperate as anyone else. |
| I am allocated to the “minors” area. This area was designed for ambulatory patients who could be walked into a room, seen and walked back out to the waiting room to wait for results. It is already full of patients on hospital beds, pushed two together in three out of the five consultation rooms. Some are elderly, confused, alone. Some are young, injured or very unwell. One is a mental health patient with severe anxiety. This is not the place to make her feel better. Far from it. | I am allocated to the “minors” area. This area was designed for ambulatory patients who could be walked into a room, seen and walked back out to the waiting room to wait for results. It is already full of patients on hospital beds, pushed two together in three out of the five consultation rooms. Some are elderly, confused, alone. Some are young, injured or very unwell. One is a mental health patient with severe anxiety. This is not the place to make her feel better. Far from it. |
| Over the PA system, pre-alerts for ambulances carrying critically unwell patients are announced – the ones whose condition is life-threatening. In 11 minutes, four ambulances carrying patients who need immediate resuscitation arrive. This would saturate the system on a good day. Today they have nowhere else to go. | Over the PA system, pre-alerts for ambulances carrying critically unwell patients are announced – the ones whose condition is life-threatening. In 11 minutes, four ambulances carrying patients who need immediate resuscitation arrive. This would saturate the system on a good day. Today they have nowhere else to go. |
| The inadequate care we are providing is the inevitable reality of the government’s funding decisions | The inadequate care we are providing is the inevitable reality of the government’s funding decisions |
| I hear a call for “security urgently” over the PA system. The call is repeated two minutes later. We all know it’s for show. The security team are stretched and scattered all over the hospital, and can rarely answer those calls. This time a staff member had been attacked by an intoxicated patient. | I hear a call for “security urgently” over the PA system. The call is repeated two minutes later. We all know it’s for show. The security team are stretched and scattered all over the hospital, and can rarely answer those calls. This time a staff member had been attacked by an intoxicated patient. |
| As I walk back down the jammed corridor, increasing numbers of screaming and crying patients line the lanes, creating an emotional and physical obstacle course that every staff member walks down. It’s truly sickening. | As I walk back down the jammed corridor, increasing numbers of screaming and crying patients line the lanes, creating an emotional and physical obstacle course that every staff member walks down. It’s truly sickening. |
| What’s worse is that this situation was entirely predictable. The inadequate care we are providing is the inevitable reality of the government’s funding decisions. If you strip back funding, force hospitals to make savings they can’t afford, devastate primary and social care, and fail to invest in staffing or resources to match demand, we are forced to tell our patients: “I’m so sorry, we can’t look after you safely today.” | What’s worse is that this situation was entirely predictable. The inadequate care we are providing is the inevitable reality of the government’s funding decisions. If you strip back funding, force hospitals to make savings they can’t afford, devastate primary and social care, and fail to invest in staffing or resources to match demand, we are forced to tell our patients: “I’m so sorry, we can’t look after you safely today.” |
| And for many of us, we’re tired of apologising on behalf of the ministers who have made these decisions. It’s just too much. We are too tired to keep trying to smile. We are struggling to try to make it work. We’re sorry we’ve let you down, but we’re broken and we need your help. | And for many of us, we’re tired of apologising on behalf of the ministers who have made these decisions. It’s just too much. We are too tired to keep trying to smile. We are struggling to try to make it work. We’re sorry we’ve let you down, but we’re broken and we need your help. |
| • The anonymous writer is an A&E doctor who works in a hospital in south-east England | • The anonymous writer is an A&E doctor who works in a hospital in south-east England |
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