Emails seen by The Doctors’ Association UK from senior managers at NHS hospitals reveal a service that is running out of beds, and the despair of those trying to sort it out.

The clinical director at one hospital in Bangor in North Wales said this was “the worst start to a day in… 13 years,” and that meant staff “will have to be risky”. The Royal Oldham Hospital’s Director of Operations said they were facing “one of the worst predicted overnight bed positions that I have ever known in any hospital throughout my career”.

In the community we are hearing from GPs who are having to pick up the pieces. Patients are being discharged into the community, earlier than they should be. There’s open admission about that being described as ‘risky’ by the Chairman in North Wales in one of the hospital.

Dr Jenny Vaughan BBC Newsnight

In this segment for BBC Newsnight Dr Deb Cohen explores how emergency departments across England are struggling, and what the impact has been on patients.

Catch up with the full piece on BBC Newsnight

The situation has arisen at Sunderland Royal hospital because it has been running out of beds despite it having recently added an extra 50 to its normal stock of 970 beds to help it cope with winter pressures.

In a message sent to local GPs last Friday titled “significant surge within the trust”, NHS leaders in the city said: “There has been increased pressures on bed capacity over the past two to three days which is having a severe impact across the trust. Fifty more beds are being used, 40 boarding in different wards and 20 patients were stuck in ED [the emergency department] as no beds available, resulting in some patients having to sleep overnight in ED.

“There has been some cancellations of elective activity [operations] and extra consultants have been pulled into ED to help manage the demand. It would be very much appreciated if you could only refer patients to ED if all other possible solutions have been exhausted.”

The hospital is seeking to buy places in local care homes as another way of freeing up beds and ending the logjam in its A&E.

Those who slept overnight in the unit will have been patients whom doctors had decided to admit as medical emergencies but for whom hospital staff had not been able to find a bed.

Sunderland’s overcrowding is the latest example of how hospitals have been struggling to cope with demand this winter, especially with higher-than-usual levels of flu increasing the pressure on beds. The NHS in England has added about 1,000 beds to help relieve the strain but some hospitals have ended up full despite that.

One local GP said the hospital’s request to send patients to the A&E only if there was no alternative was “exasperating” and made family doctors feel like they were being “a nuisance” when they were already using alternatives to hospital care as often as possible.

In recent weeks the Guardian has documented other examples of how hospitals are struggling to cope this winter. Cornwall Royal hospital recently told doctors they should discharge patients even though they may come to harm as a result because it was so short of beds. The Doctors’ Association UK called the move “morally repugnant and against the very fibre of what doctors stand for” while the British Medical Association said it was “a dire indictment of the state our NHS has been allowed to creep into”.

The trust admitted, however, that there is ‘proportionate risk’ for patients coming to harm. The email, signed by the trust’s medical director, Dr Allister Grant, said that GPs and community services were ‘well-equipped’ to cope.

GP leaders have said GPs could be left with sicker patients, who are beyond their scope of practice. A spokeperson for Royal Cornwall Hospitals NHS Trust said ‘nobody will be discharged if they still need care that can only be provided in hospital’ but for many it is ‘far better’ to be managed in the community or at home.

The email sent by the tust said: ‘One of the mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske Hospital [now known as Royal Cornwall Hospital] either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern. ‘It was agreed however that this would be a proportionate risk that we as a health community were prepared to take.’

It later added: ‘We discussed the fact that the community services, voluntary services and primary care are well equipped to manage some of these earlier discharges.’

Yaso Browne, GP lead for the Doctors Association UK, said early discharges was a risk to GPs as well as patients. She said: ‘If premature discharges are indeed occurring, this is not just a threat to the safety of the individual patient but also to already stretched community services. ‘It may mean that GPs will have to prioritise managing these sicker patients potentially involving work beyond their scope over patients they routinely manage and have been trained to see.’

Dr Browne also told Pulse: ‘This desperate plan puts both patients and clinicians at risk – and is a clear symptom of our NHS in crisis.’

Read the full article in Pulse by Anviksha Patel:

http://www.pulsetoday.co.uk/news/nhs-hospital-trust-says-gps-will-manage-patients-it-has-told-doctors-to-discharge-early/20039983.article

Sammy cites the blame culture, the pensions tax, the junior doctor contract and impossible workloads, amongst others, as key causes of rock bottom morale. She also warns that doctors may be suffering from ‘moral injury’ the psychological harm associated with witnessing sub-standard care due to the system we work in.

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‘Would you choose medicine again?’ I look into the eager faces of the sixth-formers I’ve been asked to speak to. Not for the first time, I hesitate before I answer. I love my job – it’s a great privilege to be a Registrar in Emergency and Intensive Care Medicine. But there’s no doubt it’s hard. The specialities I’ve chosen to train in mean being there 24 hours a day, seven days a week, for our most critically unwell and injured patients. Many don’t survive their journey in intensive care. We do what we can to ease their suffering. Being human means that we often we take that suffering home.

These were struggles that I was prepared for. What I wasn’t aware of was how things would change over the 14 years I’ve been part of the NHS – and it’s these changes that have made it so much harder to do an already hard job. I graduated as part of one of the last cohorts of junior doctors who had onsite accommodation provided in England. I lived with three other new doctors, out of a group of 30 or so of us. None of us knew what we were doing. One day we were medical students, the next we were on call, looking after over 100 patients. We stumbled through it and learnt quickly. There was an unspoken camaraderie. No-one batted an eyelid if you staggered in after several days straight on call and needed to sleep for 24 hours or if you had been involved in an unsuccessful resuscitation and needed to offload in the middle of the night. We worked hard, but we were all in it together. Doctors started losing their physical spaces soon after that. Traditional doctors’ messes were closed to make way for office space. Gone were our on call rooms and canteens so there was nowhere for us to connect with our peers, get our heads down or grab a much-needed coffee after a stressful shift. I feel for our newest doctors who most desperately need those spaces – I’ve found more than one distraught junior doctor who has resorted to using a cupboard as a bolt hole.

Around the same time our medical family was also being disbanded. We used to work in ‘firms’ under a consultant, a team made up of very junior doctors through to senior registrars about to finish their training (still, perversely, called ‘junior’ doctors). That meant someone was responsible for you, had a vested interest in your training, and, if you were lucky, made sure you were fed. Sadly, that structure no longer exists. The reforms were pushed through in spite of widespread protests and mass resignations (as were the ruinous junior doctor contracts, enforced by Jeremy Hunt in 2016). It was a significant blow to our profession from which morale has never truly recovered. Doctors were no longer part of a team but just another number on the rota. We now rarely stay in one hospital more than one year. With little to no say in where they are moved to next, doctors often have to uproot their lives and their families every 12 months, to fill the gaps in their region. Even within that time doctors are shunted around departments every three or four months and – as of last winter – can now be moved around the hospital on a daily basis to work in specialties or wards they have no prior experience of, to cover gaps. If you’re thinking this doesn’t sound safe, you would be right.

Tragically, there have been a number of high profile cases of patients coming to harm, at least in part as a result of under-staffing and rota gaps.

Most recently, a junior doctor was convicted of gross negligence manslaughter following the death of a six-year-old boy from sepsis. The day the child died, the junior doctor was doing the job of several doctors at once, covering six wards, over four floors, without the supervision of the consultant who should have been there that day. The case was a lightning rod for a profession with already rock-bottom morale. For many doctors who had been working themselves into the ground trying keep patients safe, it was the final push they needed to hang up their stethoscopes for good. We probably do work fewer hours than before but 70 hour weeks are still not uncommon, and the workload during those hours has increased phenomenally. I can’t remember the last time I walked in to anything less than a four-hour wait to see a doctor over the winter. ‘Corridor medicine’ has now become the norm, with nurses being allocated to a stretch of hallway instead of a number of cubicles. It’s degrading for our patients, and the least safe option. The situation is hardly better in intensive care. While we have the beds, we don’t have the staff, meaning we have to accompany ventilated patients to other wards around the country that have the capacity. This combination of spiralling workloads and a decimation of morale and camaraderie has been toxic for our profession. Last year, 55 per cent of UK doctors met the criteria for burnout and ‘emotional exhaustion’, with one in five resorting to the use of drugs or alcohol as a ‘coping strategy’. It’s hardly surprising that we are haemorrhaging doctors out of the profession, and it’s only getting worse.

In 2018, just 38 per cent of second year doctors chose to continue their careers in the NHS and enter specialty training with the aim of becoming an NHS consultant or GP – compared to 83 per cent in 2010. This has been compounded by a crisis at the other end of a scale due to punitive pensions tax which has forced up to 69 per cent of consultants to cut their hours. This is a disaster. There is a desperate need for doctors across the whole of the NHS. I can’t blame those who walk away, but each colleague that leaves makes it harder for those of us who are left behind. It is increasingly recognised that what doctors may be suffering from is not burnout at all but ‘moral injury’, the psychological harm that occurs as a result of not being able to give patients the care that they need due to working in a broken system. The term came from the military and refers to veterans that were suffering low level trauma from seeing things which went against their ‘moral code’. For doctors, it’s witnessing substandard care and not being physically able to give patients the care they deserve. I used to walk up and down the trolleys lining the corridor in A&E, already run ragged, looking for that patient who couldn’t wait and knowing I would eventually miss something. It was enough for me to walk away from emergency medicine. I still don’t know if I will ever go back.

So, how do we fix this? First, we need to treat staff like human beings if we are going to have any hope of stemming the exodus of clinicians. It’s as simple as restoring some on-call rooms so we can get our heads down, and stop crashing our cars on the way home. Or it’s as basic as ensuring that junior doctors have leave for our own weddings. Honestly, at this stage, just letting us have access to now-outlawed NHS coffee overnight would be a significant morale boost. It’s not going to sort everything, but it might make it that tiny bit easier to do an increasingly tough job. If we don’t start looking after our doctors, we won’t have anyone left to look after our patients.

If we don’t start looking after our doctors there will be no one to care for our patients

North East health chiefs have urged patients to “use services wisely” as shock figures show A&E waiting times soared this winter.

Dr Rinesh Parmar, chair of The Doctors’ Association UK and an intensive care doctor, said: “These figures, the worst on record, will sadly not come as a surprise to front-line doctors, who are working themselves into the ground to keep patients safe this winter.

“Poor morale and spiralling workloads have contributed to a staffing crisis in emergency medicine with A&E doctors showing the highest level of burnout across all specialities.

“Emergency doctors and our nursing colleagues are doing their utmost under very trying circumstances and it is the Government who must be held to account for these latest performance figures – which is almost certainly a direct result of years of under-funding.”

BMA emergency medicine lead, Dr Simon Walsh, said: “How many wake-up calls does the Government need?

https://www.chroniclelive.co.uk/news/worrying-statistics-expose-record-waiting-17546694

Accident & Emergency waiting times are now the worst on record, with more than a fifth of patients waiting more than four hours.

Medics warned that they were “on their knees” as the NHS continued to miss a raft of key targets.

EDs should see at least 95 percent of patients within four hours.

But the figure fell to 79.8 per cent in December, the lowest performance since records began in 2004.

The number of patients enduring waits of more than 12 hours on trolleys also hit a new high last month, with 2,347 patients stuck in corridors and side-rooms, more than double the previous month.

https://www.telegraph.co.uk/news/2020/01/09/ae-waiting-times-worst-record-medics-say-nhs-knees/

A&E waiting times hit their worst-ever level in December, amid growing pressures on the NHS, new figures show.

One in five who attended an accident and emergency unit last month were forced to wait more than four hours, the target time the government aims for 95 per cent of patients to be seen in.

Of those, more than 2,000 people waited upwards of 12 hours for a hospital bed, a huge rise on the 284 who endured similar wait times in December 2018.

Dr Rinesh Parmar, chair of The Doctors’ Association UK, which campaigns for improved working conditions for doctors, warned the latest wait time figures came as a “direct result of years of underfunding”.

“These figures, the worst on record, will sadly not come as a surprise to frontline doctors, who are working themselves into the ground to keep patients safe this winter.

“Poor morale and spiralling workloads have contributed to a staffing crisis in emergency medicine with A&E doctors showing the highest level of burnout across all specialities.

“Doctors and our nursing colleagues are doing their utmost under very trying circumstances and it is the government who must be held to account for these latest performance figures.”

https://www.independent.co.uk/news/health/nhs-waiting-time-patient-delay-emergency-department-a9276366.html

In an email sent to senior clinicians the Royal Cornwall has encouraged doctors to discharge patients before they are ready. This is despite the fact that the Trust has admitted these patients could come to harm, stating that this is a ‘proportionate risk’. The full email is available on request.

Whilst frontline doctors are all too aware of the pressures Trusts are under in the middle of a staffing crisis and a shortage of beds, doctors cannot stand by and watch patients being put at risk.

Three weeks ago, over 2000 doctors wrote to Boris Johnson in a letter co-ordinated by The Doctors’ Association UK, warning that without urgent change, the NHS would be heading into its worst winter crisis yet. These calls have gone unheeded.

Dr Rinesh Parmar, Chair of The Doctors’ Association UK and an intensive care doctor said:

“We understand the extreme pressures that NHS Trusts are currently under. Doctors and other frontline staff have been speaking for months about how patients are coming to harm due to the crisis in the NHS. This crisis has not emerged overnight but on this government’s watch over the last decade. Now comes the revelation that an NHS Trust is asking doctors to take risks and discharge patients early, knowing that this may cause harm. This is morally repugnant and against the very fibre of what doctors stand for. We care for our patients and respect their dignity, not simply dispatching them early into the community to already over stretched struggling services. Our patients deserve better than these short-sighted ploys to generate beds at the expense of their health.”

Dr Jenny Vaughan, Law and Policy Officer and Learn Not Blame Lead at The Doctors’ Association UK said:

“Lack of beds in NHS hospitals should not mean that patient safety is compromised. We are in a crisis at present, both in our hospitals and in community care. Sadly, if and when something goes wrong as a result of the pressure on already over-worked frontline staff, it’s not the managers who end up in the firing line. Patients and staff should not be paying the price for lack of available bed capacity in our hospitals”

CONTACT

press@dauk.org

1. The Doctors’ Association UK (DAUK) is a trade association for UK doctors. Run by frontline NHS doctors, DAUK campaigns for patients and the NHS as well as advocating for the medical profession. DAUK has been vocal on patient safety issues and has consistently campaigned for safe staffing levels.

NHS England figures release today show that A&E performance is at record low in England. In December, just 79.8% of patients were seen in the Emergency Department within 4 hours, down from 81.4% the month before. This comes following revelations last month that for the first time every major A&E department had failed to hit it’s four hour waiting target in England.

This comes as a GMC survey of 6400 ‘specialty’ doctors seen by DAUK and published this morning showed that up to 30% clinicians reported feeling burnt out to a ‘high’ or ‘very high’ degree.

Dr Rinesh Parmar, Chair of The Doctors’ Association UK and an intensive care doctor said:

“These figures, the worst on record, will sadly not come as a surprise to frontline doctors, who are working themselves into the ground to keep patients safe this winter. Poor morale and spiralling workloads have contributed to a staffing crisis in Emergency Medicine with A&E doctors showing the highest level of burnout across all specialities. We are therefore are struggling to retain the A&E doctors the NHS so desperately need. Emergency doctors and our nursing colleagues are doing their utmost under very trying circumstances and it is the government who must be held to account for these latest performance figures – which is almost certainly a direct result of years of under-funding.”

CONTACT

press@dauk.org

1. The Doctors’ Association UK (DAUK) is a trade association for UK doctors. Run by frontline NHS doctors, DAUK campaigns for patients and the NHS as well as advocating for the medical profession. DAUK have been vocal on patient safety issues and have consistently campaigned for safe staffing levels.

2. A GMC survey of 6400 doctors revealed up to 30% of participants reported ‘high’ or ‘very high’ feeling of burn out. The survey was of doctors not in training or consultants, other wise specialty doctors, associate specialists, or locally employed doctors. Due to attrition of doctors training in Emergency Medicine, non-training grades such as those surveyed make up a significant proportion of doctors working in Emergency Departments. The initial findings of the survey can be found here: https://www.gmc-uk.org/education/standards-guidance-and-curricula/projects/survey-of-specialty-and-associate-specialist-and-locally-employed-doctors?utm_source=DAUK&utm_medium=email&utm_campaign=SAS_LE_results

Eleven million patients have endured waits of more than three weeks to see a GP since Boris Johnson pledged to eradicate such delays, The Sunday Times has revealed.

In his first speech in Downing Street last July the prime minister said: “My job is to make sure you don’t have to wait three weeks to see your GP.”

However, in the four months for which figures are available since then, 11.3m patients have waited longer than three weeks. Of those, 5.6m waited more than a month.

The data emerged from The Sunday Times investigation lead by Andrew Gregory’s into waiting times as evidence mounts of a wider NHS crisis facing the prime minister.

The Sunday Times article outlined the investigation and covers The Doctors’ Association UK letter which was signed by over 2000 doctors, including 900 GPs, warning that the service is “on its knees”.

Speaking to The Sunday Times Dr Yaso Browne GP lead for The Doctors’ Association UK said:

“The waiting times and GP vacancies all speak of a crisis that has occurred as the Government refuse to acknowledge and deal with the reasons why.

Single handed practices have very little chance of surviving and there is a drive to have less continuity of care, which reduces demand and improves health outcomes, as primary care is financially forced to adopt Primary Care Networks i.e large scale working. GPs are doing the best they can for their patients within the terms and funding set by the Government.

No GP wants to feel like they go in to work to firefight and deal with more patient contacts than is safe to do so but this is reality for many. We are seeing more patients with higher more complex needs within 10 minute appointments and the reasons very broadly speaking reflect an inadequately prioritised health and social care system. There needs to be a commitment to appropriately fund primary care needs including allied work force such as district nurses and health visitors. Without this it will come as no surprise that the government will again fail at their pledge of increasing GP numbers to what is needed. It is not appropriate to focus our attention simply on the rates of patients who ‘do not attend’ appointments as we know often it is by those with vulnerabilities such as reduced social capita or mental illness. We need to focus on why there is a crisis and not its symptoms.”

https://www.thetimes.co.uk/article/eleven-million-patients-wait-more-than-three-weeks-to-see-gp-x9jgzsrrf