The NHS is facing significant winter pressures. One nurse explains what it’s like working in an Accident & Emergency department.
“It’s heartbreaking. I’m just, today, like just so heartbroken by the state I’ve left my department in this evening, and, um, it shouldn’t be like that.”Beth, A&E nurse
Beth is a nurse at one of London’s accident and emergency departments. We’re not using her real name.
“I’m just on my way home from work. I started at 7.30am this morning and yeah, and it’s 11 o’clock at night now.”Beth, A&E nurse
Beth sent us this message as she walked home after a busy day at work.
“I’ve done a 15 hour shift today and this is now 65 hours in six days.”Beth, A&E nurse
A&E nurses typically do 12 and a half hour shifts – though they’re only paid for 11 and a half of those hours – and switch between day and night shifts.
“The department was full and the acuity of the patients – so the sickness level of the patient – was just too great for me to comfortably leave at handover.”Beth, A&E nurse
This time of year is always busy for hospitals but analysis by The Times found that in the week between Christmas and New Year there were 1,600 more deaths than usual across the country.
In fact, throughout 2022 as a whole, fifty thousand more people died than normal. Excluding the pandemic years, that’s the highest number of excess deaths since 1951.
Beth’s experience isn’t unusual, so why is this winter so bad for the NHS?
Hospitals across the country are under significant pressure.
In early January bed occupancy in England was at 96 per cent. At the same time a year ago it was 93 per cent.
“We have got a very full hospital, well, hospitals, plural, that are struggling to discharge enough people that will make space for the people that are arriving via ambulance.”Beth, A&E nurse
That’s because they’re dealing with a combination of Covid, flu and a respiratory virus known as RSV – which means more people than normal are turning up in ambulances and at A&E.
“We had multiple patients that were ventilated going in and out of cardiac arrest and that just requires like a huge, huge amount of resource… And… I didn’t feel comfortable leaving my night staff colleagues to deal with it. Um, it’s not safe. It wouldn’t have been fair to the patients and certainly not fair to my colleagues.”Beth, A&E nurse
As more patients are admitted it puts pressure on hospital staff to move current patients through the system.
“Doctors have to make decisions about people that are gonna be discharged that maybe are the closest to being fit for discharge. So maybe they need an extra 12 hours in hospital or even a day in hospital. But, um, because we need to make space, we will discharge them and discharge them to community care. So things like district nurses, GPs.
What that then does is then put pressure on the, the community services that are obviously stretched already… and they’re also giving them sort of sicker patients… So this, the community care is not being given as adequately to these patients, and then they end up getting sicker and then having to come back in an ambulance.”Beth, A&E nurse
Beth says the other problem with the discharging process is the number of patients who no longer need to be in hospital, but are still taking up a bed that could be used by someone else.
“There are patients… hundreds and hundreds of patients, probably thousands across the country that are sat in hospital beds, that are medically fit for discharge, however, they don’t have the social care in place, so they don’t have the right package of care…They don’t have enough carers, they don’t have a nursing home space… even things like equipment, like equipment being delivered to people’s houses, um, means that they can’t necessarily be discharged from hospital.”Beth, A&E nurse
Recent NHS England data shows that a record number of patients had to wait for 12-hours or more to get a bed after a decision was made to admit them.
The government has said it will spend £200 million on a “discharging fund” for NHS bosses to buy thousands of beds in care homes, hospices, hotels, and private hospitals.
But there are problems there as well. Successive governments have failed to reform social care and now care homes are reporting their most acute staffing challenges ever.
Estimates from the charity Skills for Care found the sector had 165,000 vacancies last year – that’s about 10 per cent of its workforce.
So even if there are beds available elsewhere, there aren’t enough staff to manage them.
“We’re just being pushed, pushed, pushed. You know, it’s always been a hard job. Nursing has always been a hard job but when you are not paid adequately, when you are not given enough of you, and the pressure is growing and you’re not given the resources to keep up with that demand, that becomes an impossible task, that becomes an unsafe task.”Beth, A&E nurse
“We are so used to tragedy. We are so used to sadness. We are used to difficult people… it’s nothing new, there’s nothing new for the NHS to, to be, you know, careful with money and be tight on money, that’s not a new phenomenon to now to this specific Tori government that’s been going on for years since the NHS begun. But I think it should be a huge alarm bell to everyone, despite that always being the case, now is the time that the nurses are striking for the first time, the ambulances are striking…”
The government points to extra funding for the NHS during this parliament, which it recently topped up, but a decade of squeezing public spending has come at a cost.
Last week, ambulance crews went on strike.
This week, nurses are due to walk out again.
And junior doctors are expected to vote for industrial action.
“We are doing our best. We know that the ambulance crew has done their best. We know that the GP has done their best, and we’re all just trying to do our best.”Beth, A&E nurse
This episode was written and mixed by Imy Harper.