Special investigation: Shropshire Star exposes the NHS crisis through the eyes of those who work in the health service
We've documented a patient's journey through the NHS system by speaking to staff who work at every stage of the process.
From GPs, who are seeing more patients than ever – with fewer doctors, ambulance crews battling to get to patients in time, hard-pressed hospital nurses and doctors, and care workers struggling to make ends meet, the system is facing crisis, with many staff describing workers at"breaking point". That is the second highest figure ever recorded and 12 per cent higher than the same period last year, when it was 12,498.
In December only 44.7 per cent of A&E patients in Shropshire were admitted, transferred or discharged within the Government target of four hours. In fact 962 patients at the hospitals waited more than 12 hours in the same month. West Midlands Ambulance Service saw its crews losing 2,000 hours a day waiting to hand over patients in December, while the situation has had a stark impact on its response times.
The Shropshire Star has spoken to a number of those throughout the health system to get their take on the reality of the NHS in 2023 – some who wish to remain anonymous, and others who don't – all are unanimous that it is a system in crisis, and in need of help before it is too late.A GP has told of “overwhelming” levels of work with the feeling that the service has been abandoned by the Government.
“You hear everything that is said and the news and no-one is offering any help, and it feels like we are being left out to dry. It is just quite hard mentally at the moment.” “General practice has got to the point where we are seeing too many people and it is not safe. No one wants to find themselves in that position. I am sure patients don't want that either, but what patients struggle with is us saying ‘you can’t have an appointment today’.
“I have nothing against managers but I have problems with politicians and civil servants imposing proposals from on high that make no sense. The NHS should not be used as a political football, it should be for the best of the population and if politicians wanted the best for everyone they would stop using it for their own gain and use it for the benefit of the population, and the only way to do that is join together on a select committee that has pooled experience.
In December 2021, the average Category 2 response in the region was well inside the target at 14 minutes and 46 seconds. "No matter how many call-takers they take on, no matter how many paramedics they take on they just cannot keep up with demand. "Then you just have to hope they will say I will make my own way there – but you cannot suggest that.
The situation has seen patients dying because ambulances have been unable to attend incidents in time – something that was previously unthinkable, but has now become a reality. He added:"It is not the hospitals' fault we are delayed. They do not have enough staff and they cannot release patients into social care beds."
The sheer level of decline is illustrated when compared to the December 2021 response time – 14 minutes and 46 seconds. Despite the lengthening response time there is a level of public understanding and appreciation, although the paramedic describes how they cannot help but feel guilt at the situation.
The paramedic said:"There are things happening but at this moment in time have I seen a direct benefit? No, I have not, but I do get the hunch there are green shoots around the corner. It will improve with the weather anyway. The winter pressures are always there. What it will be like next winter I honestly don't know. It depends on how those projects work."
Patients are facing long waits in A&E – 962 waited more than 12 hours to be seen during December, while at one stage this month 150 of the hospitals' 700 in-patient beds were occupied by patients who were fit to be discharged – of which 45 have been in hospital for more than three weeks. "It is not a fun time. There is a lot of stress, a lot of pressure and the patients just keep coming – they need to be there because they are poorly, but it is relentless."
She added:"Every bed is taken. They are opening new areas of the hospital desperately trying to get staff to look after those beds, and you still have a queue outside and ambulances waiting outside. It is a horrific situation and it has been building for many years." "It is very frustrating because the hospital is not the best place for a lot of people, while people are sitting in beds waiting to go to places to be looked after they are getting worse. They are not moving around, they are not eating as well, and the requirement is all on us to look after them, which is having a massive impact on their quality of life.
With reference to the current industrial action she said that without steps to improve pay the profession will struggle to attract new staff, and more nurses would leave – increasing the pressure on those that remain. "Another relative said 'this is every hospital, it is not a poorly managed hospital' and something needs to be done. We need something done desperately because it is not going to get any better.""You just feel like the system is broken. It is like 'it is going to break, it is going to break, and now it has broken'. And to walk in in recent weeks and see the number of people we have in the wards, it is really scary and it is really heartbreaking.
Looking back at my life as a junior doctor back in 2015, l told of being punched in the face by a patient who was fed up of waiting, to not finding a moment in a long shift to go to the toilet let alone having something to eat and drink, and exhausted and crying on the drive home after witnessing so many harrowing events.
We knew it was going to be extremely difficult this year when patient numbers didn’t reduce in summer as they usually would. This crisis has been quite clearly developing and extremely obvious for a long time – why hasn’t it been better planned for? Why has social care not had the cash injection it clearly needs to prevent the bed blocking and subsequent difficulties in emergency care? The fact is you cannot admit more patients when you can’t free up the beds to put them in.
Another patient has been waiting on the ambulance outside for six hours. They have sepsis secondary to urinary tract infection and have extremely low blood pressure despite our medical interventions. They need special blood pressure support in intensive care but we are unable to unload the patient to the emergency department, which leaves us feeling desperate.
I personally knew one brilliant and compassionate medical doctor who was so overwhelmed he took his own life, leaving behind a young family. Words cannot describe what a tragedy that is. And around 50 per cent of doctors are now thought to suffer with mental health issues caused by overwork and trauma. Imagine seeing someone die and immediately having to move onto the next patient without even a short break.
Mr Cheetham, 54, who is also the National Clinical Lead for General Surgery at Getting It Right First Time , has outlined a number of issues to address, such as the need to invest in social care to relieve pressure on hospitals and GPs, to improve pay and conditions for NHS staff, and for people to think about maintaining their own health to reduce the demand on the health service.
Mr Cheetham said the issue of community care places was causing a huge strain for hospitals – both in caring for people who don't need to be there, and the delays it causes to bringing in fresh patients. "For me, that is the main thing, that patient is disadvantaged because that patient will recover better at home with the support than they will in hospital.
"We have not invested in buildings or kit. A lot of kit is broken and worn out. Even if we got a lot of money there is decade of underfunding you have got to catch up on. The pay situation has been one of the key problems, with one in five care worker estimated to be in poverty and the average hourly pay of £9.50 currently £1 less that novice healthcare assistants in the NHS, while warehouse jobs with Amazon are available at £11.45 per hour and Aldi store jobs at more than £13.
“With this in mind, we strongly believe the Government should be taking a more holistic approach to tackling this ongoing crisis. "If you consider the spiralling costs of patients being unnecessarily stuck in hospitals, and of ambulances being forced to queue because of the growing lack of hospital bed capacity, it’s obvious that improving community care provision is crucial.
He said:"The NHS and social care are two completely different bodies and one of the problems with a crisis in the NHS is when people are bed blocking and there isn't sufficient providers out in the field to be able to accommodate people who need the help. "The only way I think things will change is with a new government as the current one don't seem to understand that we need more money for what we do."NHS Consultant Mark Cheetham, who we heard from above, has a number of suggestions to improve and revive the health service:There are large number of patients stuck in hospital who cannot be discharged because they are awaiting a care package at home.
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