Matthew Taylor, chief executive of the NHS Confederation, said its members were issuing the “strongest warning” about “the huge and widening gap between what the NHS is called upon to deliver and the funding and capacity it has”. The warning came as figures showed paramedics in England were unavailable to attend almost one in six incidents in September because they were stuck outside hospitals with patients. Service leaders say waiting times for A&E and other care are being exacerbated by an acute shortage 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 face, including ambulance overcrowding, increasing A&E waiting times and difficulties in discharging patients.
GP, South Wales
“Patients show more malaise” Waiting times in A&E have become unmanageable, so we are seeing patients who have been waiting so long to be seen coming back to us. Things we can’t deal with, like injuries and chest pains. We tell them they need to go back to A&E. The abuse of reception and surgery management staff started last year and has only escalated from there. We have had members of staff verbally and physically threatened and we struggle to recruit and retain staff – people are hired and quit within days. Many people get sick from stress. Since the pandemic there have been so many urgent care needs that we have not been able to deal with so many routine things – patients are more unwell when they come in and with multiple problems. Mental health presentations have been a huge problem throughout the pandemic. Some people lose their jobs because they don’t have access to timely care.
Paramedic, Midlands
“Ambulances are diverted but it doesn’t help” We are seeing an increase in hospitals diverting ambulances because they can no longer manage them. You could be two minutes away, get diverted and then have to travel another 25 miles away. It’s not working, though – patients still spend six or more hours on stretchers in ambulances. To deal with ambulance stacking, people are left in the central waiting area on plastic chairs. Different strategies are tried but they don’t work. [I’ve been called to] an increasing number of messages about Covid in the last six to eight weeks. People knock and say, “I can’t breathe,” and when you get there the reason is that they have Covid, but they haven’t had a lateral flow test. They do not need to be taken most of the time. I wonder if people just think Covid is gone and don’t think about it. Health problems that have not been treated for two years [because of the pandemic] now they need ambulance help, like people who have not dealt with their diabetes. If a patient has a mental health problem, there is almost no appropriate support. You go to someone who is suicidal, self-harming and you know they’re going to get physical therapy and send them home – it’s just treating the symptom, not the cause. This is very hard to see. There has been a steady rate of staff leaving the ambulance service since the Covid era. Most stay in healthcare, going into primary care, for example. GP practices increasingly have paramedics attached to them, who examine and draw blood. The big picture is that many patients we see are a consequence of a broken system – many referrals for mental health, diabetes, hip fractures would have been unnecessary if they had been properly treated in the first place.
A&E Consultant, South East England
“I’ve never seen such bad A&E waiting times” We are too busy with an unmanageable workload. It’s bad for morale, dealing with it from the beginning of the shift to the end. Normally the acidity is lower in the summer, but we had high acidity and high entries throughout the summer and into the fall. I don’t know what winter will bring. The number of 12 hour waits is increasing – waiting times are getting worse and worse. The national target of four hours is achieved 40-50% of the time – I have never seen it this bad in 30 years. About a year ago it was 60-70% and we thought that was terrible. There are far fewer staff with Covid than in the summer – most of us have had our fourth shot and there is not much of a Covid absence. I can’t remember the last time I admitted someone with Covid and we have very few deaths. Exit block is a problem – we have 200 patients stuck in hospital due to lack of social care, which is a significant proportion of our bed base. Our length of stay is increasing, and the longer you stay in hospital, the greater your risk of getting sick again. It affects our ability to make room for new imports. We have people in the hallways 24 hours a day. Archie Bland and Nimo Omer take you to the top stories and what they mean, free every weekday morning Privacy Notice: Newsletters may contain information about charities, online advertising and content sponsored by external parties. For more information, see our Privacy Policy. We use Google reCaptcha to protect our website and Google’s Privacy Policy and Terms of Service apply. Over the past 12 months the flow of people leaving has turned into a steady stream. Our specialty as a whole is experiencing recruitment problems, especially with the end of the nursing fellowship. Most of the people I work with are trained abroad and we often have recruits, flying to the Philippines and other parts of the world. Younger nursing staff find it very challenging and discouraging. Our specialty has always been intense, but what we don’t subscribe to is massive pressure, overcrowding and general patient misery.
Senior sister to ITU, North East England
“ITU nurses sent to wards” Nurses are leaving the ITU to do other jobs. In my unit, I have lost 5-10 with 10 years of experience. These people are the backbone of a change. They go for less physical jobs such as Pip assessors or work on phone triage. Those who pass to the last places are insufficiently prepared and inexperienced. We try to support them as best we can, but they quickly become frustrated. Many people also quietly quit their jobs – just doing the bare minimum. Now we have a downtrodden workforce, psychologically less able to do the job. Critical care nurses are regularly called upon to support other parts of the hospital. It’s becoming a regular feature every day: squeezed nurses are sent to other areas on their days off in which they have no experience. Some of the nurses have never worked on a ward during their training. It feels very unsafe and makes people leave or go on sick leave. We are having problems with the rejection. We have patients sitting on ITU beds and they should be on wards, meaning the ITU capacity is reduced as it is a domino effect. Not enough staff or beds. The number of patients requiring a hospital bed is increasing and will continue to increase. Everyone is trying to complete scheduled tasks, but cancellations will increase.
Physiotherapist Hospital, North of England
“We make more dangerous disposals” There is no care in the community, which has this huge spiral effect – patients stay longer and get another infection. People die in the hospital because we can’t take them home. It has reached a crisis point – I never thought it would get this bad. A year ago, most patients fit for discharge waited two to three weeks at most. now it’s six to eight weeks. I think our longest was about three months. The downside is that A&E is busier – there is pressure on all of us to get people out. We now have half as many physiotherapists and assistants as before the pandemic. Staff leave and are not replaced or replaced by a more junior staff member. The guideline for stroke patients is that they should have 45 minutes of therapy over five days – there is no way we can provide that. We have to prioritize patients and this has a negative impact on length of stay. Nurses are also understaffed, which affects our ability to do our jobs effectively. In an ideal world, when we come to patients they are dressed and ready for physiotherapy – now, through no fault of the nurses, we have to help with that. It has a huge impact on their allocated healing time. One consequence of not caring in the community is that we have to make more dangerous disposals. If it’s borderline, we now make that decision – we might send someone home who needs four care visits a day with just one. We must use the family, who are often desperate to take the patient home, as second caregivers now. Sometimes the family doesn’t understand how dependent the patient is now and is then re-admitted because they can’t cope. When patients are readmitted because there is no support, it makes you so frustrated. They are mainly elderly and frail patients with more complex needs. We have a growing elderly population but nothing exists.
