“ONCE more unto the breach” they say to each other grimacing.
It’s 10pm in A&E, the night shift doctors are starting work and the growing winter pressures are evident.
The waiting room is heaving, cubicles are overflowing with patients and the waiting time to be seen by a doctor is growing longer and longer.
The short-staffed team of doctors and nurses battle to try and tend to people the best they can as more patients walk in and more ambulances arrive.
Despite the team’s best efforts, patients with painful broken limbs and infections wait hours to be seen, sat on hard metal chairs in the waiting room, while others spill out into the corridor.
This may sound like fiction but this is the reality faced in A&Es in Yorkshire, and up and down the country, as we speak.
At the start of a new year, I find myself looking back and reflecting on the past 12 months.
Last January, I wrote a blog for the Huffington Post in response to the British Red Cross’s declaration of a “humanitarian crisis” in the NHS and the challenging situation faced by doctors, nurses and other healthcare professionals.
At that time, I was seeing A&Es so full that they had to put temporary partitions within cubicles to accommodate two patients in each one. Elderly patients – sometimes aged in their 90s and beyond – were waiting far too many hours on trolleys for treatment and doctors were often forced to treat patients on the wrong wards or having to delay care simply because of a lack of space, staff and time.
While it is often nice to reflect on how far you have come and the changes and successes that have been achieved, history is repeating itself. Again, the temporary partitions are up, hospitals are desperately trying to fill rota gaps and the staff left holding the fort remain overstretched, demoralised and exhausted.
This week, NHS England urged hospitals to postpone pre-planned operations and routine outpatient appointments to free-up beds and resources to cope with a surge in demand.
Not for a second am I suggesting that patients in need of medical attention should panic that they won’t receive treatment – cancer operations and time-critical procedures will go ahead as planned. The core principle of the NHS is that everybody gets the care they need, and doctors, nurses and all NHS staff are working flat out to ensure that happens.
However, the service is being stretched to a point that is just not sustainable and we need to open our eyes to the effect that repeated cuts have had on our health service, with the current funding no longer meeting patient demand, particularly as patients often need far more complex care.
In order to address these problems in A&E we must look at the system as a whole. A shortage of social care beds – caused by significant cuts in the social care budget – has created ‘exit blocks’ in hospitals, meaning patients who are ready to be discharged can’t be because there is simply nowhere for them to go.
This, together with a lack of hospital beds and a growing shortage of doctors, leads to delays in admissions and patients being forced to wait on trolleys or admitted to an inappropriate ward.
Whilst we push for these much needed systemic changes, I would ask patients to help us, though this situation is far from being their making, by thinking whether they really need A&E before they come to hospital.
Pharmacists are a great source of information if you have a query about your medication, have a cough or cold, or need simple pain relief. Walk-in centres and your GP practice are also available if the condition is not an emergency. If patients can help us by utilising the range of services offered by the NHS, this will really help reduce the burden on our A&Es, therefore reducing waiting times and ensuring those who need our attention the most will get it.
We also need to ensure that our ambulances are available for those who urgently need them, those whose injury or illness is life-threatening.
Sadly I often see people calling an ambulance simply as a means of transport to A&E rather than because they need emergency treatment even before arriving at hospital.
The paramedics in our ambulances are not just drivers, but highly trained medical staff whose actions can save the lives of those with severe illness and injury. Therefore, it is imperative they are kept free to do this.
The NHS was on its knees last January, and it has remained on its knees ever since. We see the phrase “winter pressures” everywhere, but it is incredibly misleading. The NHS is not just under pressure in winter, but in spring, autumn and summer too.
This is not a situation that just needs a short term solution to get us through the winter but a long-term, sustainable solution that will support and assist our doctors and medical staff to allow them to give patients the care they need – and deserve – all year round.
Dr Lucie Cocker is an A&E doctor and chair of Yorkshire BMA Junior Doctors Committee.