Doctors have told the BMA of patients being stripped of their dignity and a workforce being ‘flogged to death’, as members report the intense pressures of working during the winter crisis.
A London-based emergency medicine consultant described the situation as ‘extremely stressful’ and reminiscent of the situation that existed in hospitals prior to the days of the four-hour target.
She said: ‘Most emergency department patients are now assessed in corridors or, if more ambulant, between the waiting room, a consulting room and a seated area in the clinical decisions unit. We provide safe but not good care as it comes at the expense of [patients’] dignity and privacy.
‘From a personal perspective, I hate keeping anyone waiting, so this situation is very hard. Most patients accept the situation and give verbal consent for assessment. Screens can be used – giving a sense of privacy.
‘Despite this we have only had two complaints relating to assessment in the corridor and I am grateful to all those we’ve treated for their understanding.’
Smoke and mirrors
Another emergency medicine consultant said that despite the huge challenges posed by patient demand, hospitals were effectively being told to disguise the true extent of the pressures they face.
They said: ‘I am aware of executives at some trusts being put under significant pressure by NHSI [NHS Improvement] to downgrade their OPEL [operational pressures escalation levels] status, and being hampered in their ability to get on with trying to sort out the problems by being constantly harassed by phone calls from NHSI.
‘[I am] also aware of trusts who, even when corridors are full and ambulances waiting to offload outside, have been receiving ambulances diverted from neighbouring trusts who are in an even worse position.’
The scale of the winter crisis has also had a tremendous impact on primary care, with the CQC having already agreed to suspend routine inspections of well-performing GP practices and other parts of the NHS in January to help doctors focus on providing care while under increased pressure.
A number of GPs said they were trying to manage more patients in the community to cut admissions to crowded hospitals but risked burnout from working through burgeoning emergency lists.
BMA East Midlands regional council chair and Derbyshire GP Peter Holden said: ‘I’ve come across colleagues in emergency departments exhausted, colleagues in hospital exhausted, GPs exhausted, colleagues elsewhere in the health service exhausted.
‘The Government has flogged the workforce to death,’ he added. ‘I’ve received 64 text messages, begging me to work for out-of-hours services at £120 an hour. Why have I refused them? Because my judgement would be faulty and I’m too damn tired after 15 hours in surgery. The health system is at the limits and it is going to break.’
Nottingham GP Irfan Malik said the past few weeks had been extra busy due to the flu and other viral illnesses, but that pressures had been exacerbated by funding shortfalls and cutbacks.
He said: ‘As our local hospitals become overwhelmed and announce “black” alerts, we are even more cautious in admitting patient,’ he added. ‘This has to be balanced against the risk of patients being more ill with serious conditions over winter. I am sad to see our precious NHS in decline. I hope positive changes will be made in the near future before we lose it altogether.’
Read more from Tim Tonkin and Keith Cooper and follow on Twitter.