It is no surprise to anyone that the NHS is in crisis. Demand has been rising. Waiting lists have been increasing. We have now begun to experience winter pressures during the summer months.
The reality of this situation hits hard at the front doors of the hospital. In the emergency department we are seeing ever-increasing numbers of patients waiting an unacceptable length of time to be seen by a doctor. Often, they have days-long waits in the department on trolleys, or sometimes even on chairs, for a bed on the ward. Emergency departments are regularly holding an entire ward’s worth of patients while trying to manage the constant stream of new patients arriving.
These attendees are frequently patients who have been referred to a secondary care waiting list, but have waited so long for treatment that they present to ED in crisis. Whether it is a hernia incarceration, a severe relapse of as-yet-undiagnosed multiple sclerosis, or crippling pain due to untreated endometriosis – in a well-functioning NHS, these patients would all have received specialist input before their condition deteriorates and an emergency arises. These patients are frequently facing many years of waiting to see their specialist and often years more for definitive management.
Often, patients will present to the ED because they quite simply cannot cope with the pain or symptoms of the condition for which they are on a waiting list. It is so disheartening to see these patients and have virtually nothing to offer them – at least nothing that will improve things beyond the very short term. Had these patients been seen and treated in a timely fashion rather than languishing on a waiting list, many of them would never have ended up in our EDs.
Patients fitted into every nook and cranny that the department can fit a trolley into.
What once was a constant stream of patients arriving at the ED doors is now a tidal wave. This is on top of the Tetris board of trolley-waiting patients fitted into every nook and cranny that the department can fit a trolley into. We are seeing undignified deaths on trolleys. We are having to move patients out of resus spaces too soon to a corridor to make space for someone even sicker.
We are unable to give the care we want to give, or the care patients deserve. We are demoralised. We are beaten. We are circling the plughole.
Our overcrowded EDs, with patients spending days waiting for beds, are unsafe. The Royal College of Emergency Medicine has published data demonstrating the increased mortality associated with increased length of stay in ED. We know this. Without significant investment in waiting lists and modernisation of services to improve ambulatory care and hot clinics, we cannot fix this.
The good ship NHS is sinking. Its crew is burnt out and either going down with the ship, battered, bruised and broken from the unwavering demands and pressure – or they are jumping off to save themselves. Leaving for better pay and better conditions elsewhere, where, crucially, they can provide the good quality care that they are desperate but unable to provide in our overstretched and under-resourced health service.
Clodagh Corrigan is an emergency medicine specialty doctor in Northern Ireland and a member of the Northern Ireland SAS committee