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The NHS – our complex, underfunded service

Our National Health Service is often in the news, and usually, sadly it is not for positive reasons. It is a great national service, and yet the difficulties it faces are complex and multifaceted.

State of crisis?

There has been recent debate about whether or not it is in crisis. The Red Cross warned that the situation was a ‘humanitarian crisis’ although they were admonished by Theresa May for saying so.

There are reports of at least 23 hospitals having to issue a warning known as a ‘Black Alert’, which is the term given when an NHS Acute Trust cannot deliver comprehensive care, leading to patient care and safety being compromised and potential medical negligence.

Staff at the University Hospital of Leicester had to go one more level and declare a ‘system critical incident’, reporting that patients had to wait in ambulances before they could be transferred to A&E.

The view from clinicians

The reports from some hospitals seem at odds to the recent statements coming from Whitehall, denying that there is any kind of crisis. As always, there is a significant gap between what statistics and figures can tell us, and what is actually happening on the ground. Listening to actual patient/clinician experiences is vital to understanding the situation.

In one interview, a clinician with 21 years of experience in A&E departments – the last 12 of them as a consultant in a major trauma centre, stated that emergency departments are close to breaking point, and that the NHS is most definitely in crisis. The NHS has a target to see 95% of emergency patients within four hours, but in one week, that figure was only 78.5%.

The response from the government was to deny that this meant there was a crisis, and instead redefine who the four-hour target applies to. The four-hour target now only applies to ‘urgent health problems’, as opposed to everyone who comes into an A&E.

Overcrowded Accident & Emergency departments

Emergency departments are overcrowded with care being delivered in corridors because there are no cubicles. Patients are waiting for unacceptable periods on trolleys due to unavailability of hospital beds. This is not due to any lack of effort or commitment from nurses and doctors who are working tirelessly around the clock, in the face of challenges including inadequate funding and resources. The impact is that staff become stressed, ill and eventually burn out.

We all expect that doctors and nurses working in an emergency department want to deliver high quality emergency care in a timely fashion and to maintain dignity for their patients.
Overcrowded emergency departments make this impossible to achieve. Even worse is that there is evidence that overcrowding leads to avoidable deaths.

I agree that there needs some re-education around when people should go to A&E. The Government tell us that too many people attend A&E unnecessarily which causes overcrowding. Yet, while I believe there is an element of this, doctors and nurses on the ground say that in fact, departments are overcrowded with patients waiting to be admitted to wards, patients who are deemed too unwell to be discharged home. This comes back to the problem of chronic underfunding across all facets of healthcare.

We know the problems are complex and multi-faceted and we can only hope that serious resolutions and increased funding to address the problems on the ground are forthcoming. Patient care and their safety must be paramount.