The frightening images of the chaotic stasis in A&E show the final phase of the collapse of the NHS.
The government have followed Chomsky’s “Privatisation Technique” of defund; make sure things don’t work; people get angry; you hand it over to private capital.
The delays in A&E are the direct result of an insidious managed decline over the past 12 years, with deliberate and widespread cuts in funding leading to fewer staff and services running less well in the face of massively increasing demand.
The remaining staff are working like shrinking cogs in a growing machine; where it doesn’t matter how hard you spin, you can never make things work properly. Everyone is absolutely doing their best, but we are firefighting instead of providing the service that patients deserve because there is no alternative.
Everything feels inadequate: the time I can give people, the services I can offer them, the explanations I give for their situation, and ultimately the care they are receiving. I don’t send patients to hospital unless absolutely necessary, and I don’t ring 999 but instead ask patients to get a lift to hospital as the wait is too long.
The last time I called 999 was in October, and it was 10 minutes before the ambulance service answered. I often keep patients at home who I would have immediately admitted a few years ago and instead review them daily. Colleagues give similar stories of being unable to admit very unwell patients to hospital due to increasingly high thresholds and sometimes being criticised by inundated paramedics for calling an ambulance.
Unlike hospital we have no rapid access to fluids, IV medication blood tests or other investigations. So much of GP is managing patients using clinical assessment alone, and sometimes we just can’t exclude something life threatening.
As well as the damage to emergency services, patients are suffering from untenable delays in reviews, scans and diagnoses that I am confident have led to otherwise avoidable disability and death. Instead of waiting two weeks for a colonoscopy for suspected cancer, it might now be eight weeks, with the wait to see the surgeon being weeks again. This could be enough time for a cancer to spread and no longer be curable. Urgent referrals following abnormal scans are sometimes taking months before the patient is seen.
Patients wait months for hospital appointments and procedures, often being unable to work and developing mental health problems in the process. I have patients who have become suicidal while awaiting joint replacement surgery because we are not able to manage their pain. I write to their consultants who reply telling me that everyone on their waiting list is in the same situation.
Community services have also been cut, meaning that physiotherapy and mental health (which, when done well, can often promote full recovery) have needed to minimise their service in order to meet demand.
The mental health service is not fit for purpose due to exponentially increasing waiting lists and further cuts to available resources that have had to focus on more minor interventions rather than more effective psychological therapies. We have had patients die by suicide after we were unable to get a review from the overwhelmed crisis team.
Everyone in healthcare is forced into giving this diluted version of the NHS we all remember. There is not enough staff and not enough money. I hate it. It feels so inadequate and insulting, and now it is genuinely dangerous.
Recurrent themes amongst colleagues are of unimaginably high workload exceeding 120 patient contacts daily not including results, requests and letters. This is hugely stressful, frustrating and scary, underpinned with the grim knowledge that we are working well below our best just to try to manage the volume.
Last week I was on the phone to a paramedic, receiving a screen message about an unwell patient in the local nursing home and also fielding an urgent query from one of our receptionists. How does anyone make safe decisions in this environment?
GP is not set up for emergency care yet we are increasingly needing to try to provide it, outside of best practice guidance and likely what our professional insurance would cover. Colleagues are taking patients to A&E in their own cars, giving out their personal mobile numbers in case of difficulties overnight and seeing countless extra patients despite being exhausted.
I am concerned that people don’t understand the severity of the crisis. Some seem to believe that there is an invisible safety net that would surely materialise if they were to become severely unwell. But the terrifying reality is that there is no such backup any more.
In all honesty I don’t believe the NHS is salvageable with this current government. It can only be revived if those in power truly value the health of all British people and want a genuine public health service, regardless of patient income. This would be demonstrated through authentic acknowledgement of errors made; dialogue with professionals with recent experience; prioritisation of staff wellbeing and increased funding.
The government say the NHS isn’t failing because they know its already failed. The cogs are too tiny, and the machine has stopped, and the patients are now piling up.
Dr Kath Fielder is a GP and a spokesperson for the advocacy group EveryDoctor