Analysis

NHS in ‘crisis’: voices from the frontline

Healthcare experts have agreed the NHS is in a state of crisis, and are demanding the government takes action.

Healthcare experts have agreed the NHS is in a state of crisis, and are demanding the government takes action


Ambulances queuing in the snow. Picture: Neil O’Connor

Royal colleges, charities and even the head of NHS England have issued warnings to prime minister Theresa May about the state of the health service.

In an exceptional move, the British Red Cross charity publicly declared the NHS is undergoing a ‘humanitarian crisis’ – a claim the prime minister has called ‘irresponsible and overblown’.

But data from NHS England shows attendances at emergency departments are rising, while the capacity of staffing and resources do not match burgeoning patient demand.

And according to the Royal College of Emergency Medicine, the NHS is facing its worst performance against the four-hour waiting target in almost 15 years.

Cross-party process

A letter to the prime minister, signed by 75 leading health and care experts – including the RCN, the Royal College of GPs and the Association of Directors of Adult Social Services – calls for fundamental action to address the problems.

The letter calls on government to establish a cross-party process to review and recommend action on future health and social care funding.

The RCN says nurses ‘from Scotland to London’ are reporting serious concerns about care quality during the worst conditions many have experienced.

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hour waits for trolleys in emergency departments, a number that has trebled in the last four years, according to figures from NHS Digital.

From patients being discharged too early in an effort to free up beds, to triaging patients in the toilet due to lack of space, the stories reveal desperate measures taken in unprecedented times.

No vision

University of Wolverhampton senior lecturer in emergency care and advanced practitioner Jim Bethel says the government response to the crisis is inadequate.

‘Things are worse this year, but they are predictable,’ says Mr Bethel, who works in the emergency directorate at Sandwell and West Birmingham Hospitals.

‘Yet there is still no change in the way primary and community services are set up and people are still coming to the emergency department.

‘There is no long-term planning from government in terms of the population changes we have and there does not seem to be any long-term vision of how things are going to change in the future.’

Linked problems 

Mr Bethel adds that lack of resources and system pressure are leading to burnout and emergency nursing staff feeling demoralised.

‘I have worked with a large volume of people who have either left or are considering leaving emergency care altogether – usually these are experienced staff.’

Queen’s Nursing Institute (QNI) chief executive Crystal Oldman says the sheer volume of patients means the problems move around the system.

‘All the health systems are linked to each other, so if there is pressure somewhere and patients cannot be seen by a GP, for example, they may appear in the emergency department.’

40,500

day increase in transfer of care delays in a one-year period, according to NHS England data.

District nurse pressure

Dr Oldman says QNI’s own research shows one third (34%) of practice nurses are going to retire by 2020, and GPs are already finding it hard to recruit new nurses.

She adds it is crucial more is done to attract and recruit new practice nurses, with the skills to see people with minor injuries and play a part to help avoid putting undue pressure on emergency care.

Community nursing teams are also affected by the pressure on emergency care.

‘We are hearing a lot of the time that district nurses are stepping in to compensate when social care is not available to patients who need it.’

‘Deepening crisis’

Dr Oldman explains many district nurses find themselves helping patients to wash, dress or eat.

‘We know that happens anyway. But when there is additional pressure to move patients out of hospital quickly – and no package of social care in place – many nurses extend their hours to go the extra mile.’

ADASS president Margaret Willcox says councils are ‘pulling out all the stops’ to help support their NHS colleagues, but a long-term solution is needed.

 Ms Willcox says: ‘Adult social care faces a deepening crisis in terms of sustainability.

Added ‘complexity’

‘It’s just as crucial to keep people being cared for at home out of hospital as it is to find social care and primary and community healthcare to get them home.’

Difficulty in recruiting carers in the community, as well as nurses for nursing homes in many areas, is adding ‘complexity’ to funding difficulties, she explains.

According to the latest data from NHS England, there were 24,500 ‘delayed discharge’ days in November 2016 due to patients waiting for packages of social care in their own homes, compared to 16,300 in November 2015.

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leading health and care experts, including the RCN, have written to Prime Minister Theresa May, calling for urgent action on the ‘crisis’ in health and social care funding.

Ms Willcox adds: ‘This delayed discharge figure is likely to be higher over the coming months when the winter pressures take effect. It further fuels the needs for an urgent, long-term and sustainable solution.’

Quicker intervention

NHS Confederation chief executive Stephen Dalton says the pressure on emergency departments is down to a lack of funding in primary, community, mental health and social care.

‘While broad public health programmes have their place, only further and quicker government intervention can fix the imbalance in services that is at the root of this crisis.’


The number of hours it takes to get a trolley in the emergency department has
trebled in the past four years. Picture: Charles Milligan

A Department of Health spokesperson says: ‘We know the NHS is facing increasing demand from an ageing population, but this makes building a safer healthcare system more urgent, not less.

‘Since just last year, we have 3,100 more nurses and 1,600 more doctors. We’re also joining up health and social care for the first time, as well as investing £10 billion to fund the NHS’s plan to transform services and relieve pressure on hospitals.’

Voices from the frontline

The RCN asked its members for their experiences of conditions in emergency departments and many told stories of substandard experiences for their patients and themselves.

One ED nurse tells the college: ‘I had a patient on an emergency department trolley for 23 hours – nowhere in the hospital for her or the other patients.

‘All escalation areas had used the spare beds so we didn't even have a physical bed for her.’

Another emergency department nurse says: ‘Yesterday, when we tried to divert we were told we are unable to do so as three other trusts were on divert and ourselves and another trust had to stay open.

‘Staff morale is at an all-time low as we are underpaid, undervalued and not listened to.

‘As a result we are continually seeing patients discharged too early and re-presenting severely poorly and often septic, due to early discharge.’

A triage nurse says: ‘I have actually triaged in the toilet while someone had severe vomiting, with nowhere to put the patient.’

Carmen Clark, writing on the RCN Facebook page, points out that ‘every area’ of the NHS is struggling, including social care, outpatients and GP services.

‘We don’t need investment in 2020, there will be nothing left,’ she warns. ‘We need it now.

‘The government needs to support care homes so they stop closing and support GPs for the same reason.

‘If we can safely discharge – beds get freed up and emergency departments become less congested. It’s not difficult. There will be no improvement if the community services are not supported.’

Joanne Brogan, on the RCN Facebook page, asks why primary care district nursing services ‘never seem to get mentioned’?

She says: ‘[These] are also on their knees with most days having 18+ visits to do in 7.5 hour shifts with no travel time allowance from patient to patient.

‘Also, a decent pay rise would be nice.’

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