'Examinations in corridors and waiting rooms, with nothing but a sheet to protect dignity'; 'firefighting' instead of safe care; patients waiting weeks to be discharged; and NHS staff leaving in their droves.
In their own words, a consultant of more than 30 years and a junior doctor of just over three tell their experiences from the frontline of the NHS today. One medic at the beginning of their careers, another at the close - both sharing the same, terrifying story from different emergency departments in Greater Manchester.
The medics, who wish to remain anonymous, speak to the Manchester Evening News as the president of the Royal College of Emergency Medicine, Dr Adrian Boyle, has said as many as 500 people could be dying each week because of delays to emergency care. A crippled social care system and a wave of flu and Covid are adding yet more pressure to hospitals which are bursting at the seams with patients.
The A&E consultant
“Everybody says this is the worst we’ve ever seen it. It’s the worst I’ve ever seen it and I’ve worked in the health service for more than 30 years.
“If you compare it to 10 years ago, we were all pretty much achieving the four-hour waiting time targets for A&E - and we were giving a good quality of care. It’s very demoralising for staff, we’re losing so many nursing staff and it’s constant, every week somebody leaves.
“There’s a really big turnover and it’s pretty horrible. Jobs are coming up in other areas of the hospital or in the community that are less pressure.
“It’s pretty horrible for patients most of all. The main issue is what it has been for the last few years. There is an exit block from the emergency department because of the lack of beds.
“Our department has rooms for about 35 people, there are regularly 120 plus people waiting for beds - they can wait for up to 48 hours from when they have been referred.
“I’ve seen people that are having their day one and day two patient reviews, still in the emergency department. Doctors are coming to the emergency department to do their ward rounds because there’s not enough room on the actual wards - and that only adds to the overcrowding.
“All the patients needing regular medications and toileting, that’s all falling on the emergency department. We don’t have enough staff, so nurses come from wards which are already struggling.
“We literally can’t move on our corridors at the moment for people being treated there.
“But the corridors are now so full we can’t offload them. That’s having an impact on people in the community who are waiting hours for ambulances, and it will be causing harm.
“Some people do come because they can’t get care elsewhere but A&E isn’t the right place for them. We divert those patients to next-day GP appointments or pharmacists. The problem is all the people needing admission, the lack of beds is blocking those people and means they’re having long waits right at the beginning of their care.
“There’s a lot of patients waiting to be discharged who don’t need to be there. They’re medically fit to be discharged but there’s no social care or home support packages. Funding takes weeks to come through.
“Six week waits to be discharged can be pretty standard if you’ve got no private funding. And a lot of these patients, typically more elderly, are deconditioning [where patients lose muscle function among other abilities as they remain inactive] in that time.
“Older people need to be out quickly, they might have been able to go home but after a six week wait it could be that they then need a care home.
“And the longer they stay in the more likely they are to catch Covid or flu. We’re seeing a lot of nosocomial infection at the moment [infections originating in hospital].
“We can manage and manage, but one small thing will tip them over the edge. All of this is the worst for patients, at least we get to go home after our shifts, it’s like this for them all the time.”
The junior doctor
"I have been working as a doctor for three years and this is the worst I have ever seen things. In A&E I have been forced to perform examinations in corridors and waiting rooms, with nothing but a sheet to protect dignity. It's a daily occurrence that colleagues —grown doctors doing their absolute best in impossible conditions—are crying and having to take sick leave for burnout and PTSD.
"The conditions we are working in are simply not safe, and they are driven by a lack of funding and a lack of staffing. Waiting room medicine can never be safe medicine, it's firefighting.
Are you being affected by the NHS crisis? Get in touch, including anonymously, with our health reporter helena.vesty@reachplc.com
“Junior doctors are voting on whether to strike from Sunday, and I think it is likely to pass because we are all at breaking point. Things can't go on this way and the government has to keep the staff they have.
“[Seeing the highest ever numbers of attendances in emergency departments] is almost a universal issue. It can only go one way in terms of numbers when there's inadequate social care support and wards are completely full… I don't know any A&E department that isn't several times over capacity for patients and understaffed.
“This is a national picture. You get short term respite some days but it never lasts."
What’s does the NHS say?
A spokesperson for the NHS in the North West said: “The NHS is going through a period of exceptional pressure, with demand for its services, particularly for the ambulance service, NHS 111 (which received record call numbers over the Christmas and New Year period), in A&E, in General Practice, for mental health services, and for cancer referrals, as high as it has been for a long time; with the impact felt across the whole of the country.
“Managing the ongoing challenge presented by delays to discharge from hospital is key to enabling us to respond to the current pressures, with many hospitals regularly reporting delays to discharges for high numbers of patients well enough to leave hospital, a factor that exacerbates the pressure the NHS is already under.
“We are working with partners across our health and social care systems, including those in local Government to address the challenges we continue to face around discharge and ensure system-wide responses are in place across the North West.
“In addition, we continue to urge the public to support us where a loved one in hospital is ready to be discharged and they can assist in helping get them home as soon as practically possible to free up beds for urgent patients.
“We are profoundly grateful to the efforts of NHS and care staff across the North West, who have already gone above and beyond the call of duty to ensure our patients receive the highest standards of care possible throughout this difficult time.
“Staff across our hospitals, community services, the ambulance service, primary care and allied health professionals are doing all they can to meet people’s needs and their commitment, dedication and hard work continues to be a point of pride for each and every one of us.
“We would urge the public to ensure they are doing everything they can to contribute to that effort and would urge those who are eligible come forward for flu and Covid-19 vaccines as soon as possible.
“The public can also help us manage the high demand we are seeing by ensuring you are seeking help from the most appropriate health services, using NHS 111 online for 24/7 advice about the most appropriate care for your needs, and only attending A&E if seriously ill or injured. This will help us keep those services free for those that need them the most.”
Mark Fisher, chief executive of NHS Greater Manchester said: “Like NHS services across the country, we are extremely busy in our hospitals, GP practices, pharmacists and community services. The demands of winter pressures and complex health and care needs mean the last few days have been especially busy.
"Staff are doing everything they can to see and treat everyone as quickly and safely as possible. Pressure from flu, Covid and other respiratory illnesses is sustained. We can’t stress strongly enough how serious flu can be especially if you are vulnerable.
"Please know it’s not too late to come forward for a vaccine which can help you avoid being seriously unwell from flu. We are thankful to our staff across health and care who are working tirelessly and grateful to the public for their understanding as the demand for services grows. Please use NHS 111 online to get to know where to go.”
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