Stark headlines of the NHS buckling under unprecedented levels of pressure at the start of 2018 make for grim reading, but the reality on the ground is yet more painful. I have been a GP for 10 years and I’m seeing demand soar for all types of health and social care and services stripped to their core. Hospitals are dealing with the subsequent fallout.
This winter I have admitted several patients to hospital – often as a last resort – with various types of flu, sepsis, heart attacks or breathing difficulties. Most have been elderly and/or housebound. Many have waited hours for an ambulance to arrive, regardless of the degree of urgency that I have conveyed on the phone. Ambulance crews have been working under immense pressure, from bottlenecks in emergency departments and wards, and this has had an impact on response times.
I saw a woman who presented with chest pain suspicious of a heart attack; she waited more than an hour for an emergency ambulance to take her to the hospital. She was lucky – although she had suffered a heart attack, she made a good recovery.
I heard stories this week from patients and junior doctors of corridors crammed with trolleys in our local hospitals, with average waiting times of more than seven hours to be seen, sometimes much longer. One patient, who I had sent with breathing difficulties, abandoned the hospital after a seven-hour wait. He said he would take his chances at home.
For every patient I thought of sending to hospital, I considered alternatives. For example, I would send someone home with treatment if I considered it to be medically safe – and if there was enough support from family or carers who could call for emergency services if their condition deteriorated. There are also clinics dealing with some specialties, such as respiratory or surgical, which see patients on the same day, and urgent telephone advice is available from a consultant or registrar in many specialties such as gastroenterology or renal. I took these admission avoidance measures if I could. But they also get very busy in winter.
There were no free beds locally and trying to locate a bed in hospital is like finding gold dust. This means that even when patients have been seen by doctors they have to wait for many more hours on uncomfortable trolleys until a bed (anywhere) becomes available. Another patient with heart failure was moved from a cardiology ward in the middle of the night to an outlying (orthopaedic) ward where the new team did not know his complex history and had to start afresh. He felt that this removed all continuity of care and delayed his discharge.
NHS staff are working flat out and with empathy. They are making the best of what they have. But the acute shortage of beds coupled with rising winter demand (from flu, changing demographics and social disarray) means that we are in the midst of this crisis (despite what the government may tell us).
But you also cannot pour from an empty cup. Many NHS staff are physically and emotionally drained. This government has steadily sucked the lifeblood from the NHS with its half-baked ideas, management speak (and twisting of facts) and blatant refusal to fund services adequately. It wants seven-day routine health service when basic five-day provision is under threat. But its greatest failure has been a lack of leadership and any clear long-term strategy to manage the crisis. Last year, the Red Cross described the winter conditions in hospitals as “a humanitarian crisis” – this year the top down mantra isno different: “See more patients. Discharge more patients”. This short-term approach does not solve the problem. Patients will still need beds and an appropriate length of time to be given treatment, or primary and intermediate care so robust that it can absorb the effects of cuts in hospital beds and other secondary care services. Otherwise all we will continue to see is a revolving door of patients, ambulance delays, A&E queues – and an annual winter crisis that may last the whole year .
It is a symptom of bad planning that there have been no lessons learned from previous years. Another patient of mine has had her gynaecological operation, due this January, cancelled – she has already waited months and is very upset.
If the government has a credible plan (other than stopping all elective work, which is not an effective solution, and making Jeremy Hunt responsible for social care as well as health in the cabinet reshuffle) then let’s hear it and not its apologies. My patient doesn’t want an apology: she just wants her operation to go ahead.
• Zara Aziz is a GP partner in north-east Bristol
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