Further funding cuts to the NHS will unavoidably endanger patient safety, an NHS leader warned last week after the chancellor’s promise of spending cuts of “eye-watering difficulty”.
Matthew Taylor, the chief executive of the NHS Confederation, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”.
The warning came as figures showed that paramedics in England had been unavailable to attend almost one in six incidents in September due to being stuck outside hospitals with patients. Service leaders say wait times for A&E and other care are being exacerbated by an acute lack of nurses, with a record 46,828 nursing roles – more than one in 10 – unfilled across the NHS.
Five healthcare workers describe the pressures they are facing, including ambulance stacking, rising A&E wait times and difficulties discharging patients.
GP, south Wales
‘Patients are presenting more unwell’
Wait times in A&E have become unmanageable, so we’re seeing patients who have waited so long to be seen they’re bouncing back to us. Things we can’t deal with, like injuries and chest pain. We tell them they have to go back to A&E.
Abuse of surgery reception and admin staff began last year and it’s just scaled up from there. We’ve had staff members who have been verbally and physically threatened and we’re struggling to recruit and retain staff – people are hired and quit in a couple days. A lot of people are going off sick with stress.
Since the pandemic there have been so many urgent care needs we haven’t been able to deal with as much routine stuff – patients are presenting more unwell when they come in and with multiple problems. Mental health presentations have been a huge problem throughout the pandemic. Some people are losing their jobs because they’ve not been able to access timely care.
Paramedic, Midlands
‘Ambulances are being diverted but it’s not helping’
We’re seeing an increase in hospitals diverting ambulances because they can no longer manage. You might be two minutes away, be diverted and then have to travel another 25 miles away. It’s not working, though – patients are still spending six hours or more on stretchers in ambulances. To deal with ambulance-stacking, people are being left in the main waiting area on plastic chairs. Different strategies are being tried but not working.
[I’ve been called to] a rising number of Covid callouts over the last six to eight weeks. People are ringing up and saying, “I can’t breathe”, and when you get there the reason is they’ve got Covid, but they’ve not done a lateral flow test. They don’t need to be taken in most of the time. I wonder whether people just think Covid has gone away and aren’t thinking about it.
Health problems that were not managed for two years [because of the pandemic] now require ambulance help, such as people who have not been managing their diabetes.
If a patient has got a mental health problem there’s almost no proper support. You go out to someone who is suicidal, self-harming, and you know they’ll be treated physically and sent home – it’s just treating the symptom and not the cause. That’s quite hard to see.
There’s been a steady rate of staff leaving the ambulance service since Covid. Most are staying within healthcare, going to primary care, for example. GP practices are increasingly having paramedics attached to them, triaging and taking bloods.
The big picture is that many patients we see are a consequence of a broken system – a lot of callouts for mental health, diabetes, hip fractures would be unnecessary if they’d been managed properly in the first place.
A&E consultant, south-east England
‘I’ve never seen A&E waiting times this bad’
We’re kept extremely busy with an unmanageable workload. It’s bad for morale, dealing with it from beginning of shift to end. Normally acuity is lower in the summer but we’ve had high acuity and high attendances right through summer and into autumn. I don’t know what winter will bring.
The number of 12-hour waits is getting high – waiting times are getting worse and worse. The national four-hour target is achieved 40-50% of the time – I’ve never seen it that bad in 30 years. About a year ago it was 60-70% and we thought that was terrible.
There’s a lot less staff off with Covid than in the summer – most of us have had our fourth shot and there’s not much Covid absence. I can’t remember the last time I admitted anyone with Covid, and we have very few deaths.
Exit block is a problem – we have 200 patients stuck in the hospital because of a lack of social care, which is a substantial proportion of our bed base. Our length of stay is going up and the longer you stay in hospital, the more the risk of getting ill again rises. It affects our ability to make space for new admissions. We have people in the corridors 24 hours a day.
Over the last 12 months the trickle of people leaving is turning into a steady flow. Our specialty on the whole has problems attracting, especially with the nursing bursary gone. Most of the people I’m working with are trained overseas and we frequently have recruiting drives, flying out to the Philippines and other parts of the world.
Younger nursing staff find it very challenging and demoralising. Our specialty has always been intense, but what we don’t sign up for is tremendous pressure, overcrowding, and general unhappiness of patients.
Senior ITU sister, north-east England
‘ITU nurses are being sent on to wards’
Nurses are leaving ITU to do other jobs. In my unit, I’ve lost 5-10 with 10 years’ experience. These people are the backbone of a shift. They are going for less physical jobs, like Pip assessors or working in telephone triage.
Those coming through in the bottom ranks are underprepared and inexperienced. We try to support them the best we can but they rapidly become disillusioned. A lot of people are also quietly quitting from the job – just doing the bare minimum. We now have a downtrodden workforce, psychologically less able to do the job.
Critical care nurses are regularly being asked to support other parts of the hospital. It’s becoming a regular feature every day: wrung-out nurses sent to other areas on their days off that they aren’t experienced in. Some of the nurses have never worked on a ward during their training. It feels very unsafe and it makes people leave or go on sick leave.
We’re having problems with discharge; we have patients sitting in ITU beds who should be on wards, meaning the capacity on ITU is lowered as it’s a domino effect. There’s not enough staff or beds; the number of patients needing a hospital bed is increasing and will continue to. Everyone is trying to get scheduled work done, but cancellations will increase.
Hospital physiotherapist, north of England
‘We’re making more risky discharges’
There’s no care in the community, which has this huge spiral effect – patients stay longer and pick up another infection. People die in the hospital because we can’t get them home. It has got to a crisis point – I never thought it would get this bad.
A year ago, most patients who were fit for discharge were waiting two to three weeks at most; now it’s six to eight weeks. I think our longest has been about three months. The knock-on effect is that A&E is busier – there’s pressure on all of us to get people out.
We now have half the number of physiotherapists and assistants than before the pandemic. Staff leave and are not replaced, or are replaced by a more junior staff member. The guideline for stroke patients is they should have 45 minutes of therapy over five days – there’s no way we can provide that. We have to prioritise patients and that has a knock-on effect on length of stay.
Nurses are understaffed, too, which affects our ability to do our job effectively. In an ideal world, when we come in patients are dressed and ready for physio – now, through no fault of nurses, we have to help with that. It has a massive knock-on effect on their allocated therapy time.
A consequence of not having care in the community is that we have to make more risky discharges. If it’s marginal we now take that decision – we might send someone home who needs four care visits a day with just one. We’re having to use family, who are often desperate to get the patient home, as second carers a lot now. Sometimes the family doesn’t understand how dependent the patient now is and then they get readmitted because they can’t cope.
When patients are readmitted because support is not in place it makes you so disillusioned. It’s mostly elderly and frail patients with more complex needs. We have a growing elderly population but nothing in place.
