I’ve been a consultant obstetrician and gynaecologist in Wales for 27 years. I’ve always been proud to be a small cog in the NHS machine, acknowledged to be one of the most cost-effective and best health services in the world.
However, for several years, doctors have been reporting that 'it’s never been so bad'. We’re seeing year-round bed pressures, ambulance queues outside ED (emergency department) and escalating waits for diagnosis and treatment. The increase in life expectancy was falling even before the COVID pandemic and the situation is becoming increasingly more alarming.
At a recent meeting of doctors, I heard harrowing examples of patients dying whilst waiting for an ambulance. Others told of patients with chest pain sitting for hours in the ED before being assessed in waiting rooms, followed by days in ED waiting for a hospital bed. So ‘normal’ has this become, that GPs reported patients refusing admission rather than suffering on a trolley, waiting in a corridor for hours or days.
While there are more tales of the NHS saving lives, many of you have your own similar stories or have been told the NHS simply isn’t there for you now. This is horrifying. The NHS is failing patients daily and the situation is getting worse.
If I’d read these words 37 years ago when I started my career, I would have been shocked. It’s a sad reflection that this isn’t shocking to many healthcare workers, whose morale has taken a battering.
COVID has exacerbated the current situation. The NHS was in a bad place long before now, worsened by an under-provided social care system and earlier decisions to cut hospital and community care beds. The effects are predictable; not enough has been done to develop credible and tangible actions that deliver for patients.
COVID deaths have risen recently, but the narrative now treats it as just another respiratory virus. The rate of infection is 40 times that at this time last year. One in 14 were estimated to be infected recently. Decisions to ‘open up’ our society have ‘closed up’ our NHS. Infection rates have decimated the NHS workforce, compromising the ability to deal with increased demand.
There’s much talk about ‘tackling the NHS backlog’. The number of patients awaiting treatment and diagnosis is staggering. As doctors, we’re frustrated and angered about the lack of facilities available to let us do our jobs and help patients. It’s a systemic problem that needs to be tackled at its core. For example, some surgeons in the NHS are operating for just half a day each week. Not only is this frustrating for the doctor but it’s wasteful and there are plenty of patients waiting for treatment.
The pandemic has shown us that we must invest massively if we are to have a modern health service. Redesigning services should be based on patient need, equity and reducing health and social inequalities. While aiming to ‘streamline’ referrals, investigations and treatments is laudable, it can lead to those able to shout loudest having the greater say, with unintended consequences and health outcomes getting worse in Wales, not better. There also has to be ‘give’ in the system, so that surges in demand don’t collapse a service already pared to the bone.
We’ve recently written again to the health minister, repeating on-going concerns around ambulance waits, along with a failure of employers to focus on staff wellbeing and keeping staff in their jobs, leading to serious system failures. The NHS is only as strong as those propping it up.
The biggest single block to the system is doctors being unable to discharge patients into social care. Often, simple solutions to discharge patients safely are blocked. A reform of social care is long overdue, and we must bring together health and social care urgently before more people die.
Meanwhile, it’s important people are aware of which services to access. Pharmacists help with common minor health complaints; minor injuries units offer health advice; out of hours can usually be accessed by dialling your GP number and NHS Direct Wales is open 24 hours a day. Sometimes the emergency department is the correct avenue to take.
As the assessment and treatment of patients is streamlined, direct admission for treatment can be planned – but this needs capacity and staff. The right patient, in the right place, at the right time is something we agree with Welsh Government on. This seemingly simple ask means emergency services can be freed up to help those most in need.
Without immediate action, clear direction, and leadership – alongside an understanding of just how patients and staff are suffering – parts of our precious Welsh NHS have a shaky and uncertain future. Listening to patients and staff is one thing, acting on what they need is another. It’s now or never.
Phil Banfield is chair of BMA Welsh consultants committee and a consultant in obstetrics and gynaecology