The patient before me is causing concern on multiple levels. She is the first of many complex cases I will encounter during my ten-hour shift as an A&E doctor. At 60 years old, she is suffering from blood cancer and is scheduled for chemotherapy later in the day. However, she is experiencing a fever and a burning sensation when urinating. It is evident that she has a urinary tract infection, which poses a serious risk for cancer patients whose immune systems are weakened by treatment. Additionally, her pallor and overall condition raise concerns that she may be developing sepsis, a potentially life-threatening condition in which the body has an exaggerated response to infection. I must take action swiftly, but the situation is dire.
Unfortunately, the cancer ward where she should receive treatment is full, which is why she has been sent to A&E. Regrettably, even in A&E, there is a lack of available space. Patients are crowded together, with some overflowing into the corridors. This is not even during the peak winter season for patients, but rather during what should be a quieter period in August. It is disheartening to witness the distress of the patient, despite the comforting presence of her daughter.
Ideally, I would examine her in a cubicle, providing her with some privacy. However, this is the reality of the NHS in 2023, and suitable cubicles are unavailable. Instead, she is placed in a cramped room that is essentially a cupboard, with two plastic chairs hastily added. One of the chairs is already occupied by a gentleman suffering from the lung condition COPD, which means I must ask the patient for intimate medical information in front of her “roommate.”
Lamentably, there is a lack of medical equipment readily accessible in this makeshift room. I must wait for over an hour for a nurse to arrive with a blood pressure monitor, let alone any more advanced tools. I don’t blame the nurse, as she is overwhelmed with her workload. Once the nurse finally arrives, we discover that the patient’s blood pressure is dropping, indicating the onset of sepsis. I communicate with the doctors on the cancer ward, who urge me to administer strong intravenous antibiotics as soon as possible.
Thankfully, I am able to fulfill this request. However, when I finish my ten-hour shift at midnight, the gravely ill patient with cancer and sepsis is still in A&E, now laid on an uncomfortable trolley, awaiting a bed on a ward.
Twelve years ago, I made the decision to leave my role as a consultant A&E doctor in a busy hospital to work overseas. At the time, I believed things couldn’t possibly become worse than they were. However, upon my return to the NHS last year, I was appalled to realize that the situation now is far worse than before. In the past, the NHS faced challenges, but patients could eventually receive the treatment they needed. Now, that guarantee no longer exists. People seeking care from the NHS suffer needlessly and even perish — it has become a humanitarian crisis. Some individuals wait over a day to be seen, and even those with serious conditions experience hours of waiting while their health deteriorates. Lives that could have been saved are lost; the system itself is causing harm.
The waiting lists for routine treatment in the NHS have skyrocketed in the past fifteen years, as depicted in the accompanying graph. It is heart-wrenching to witness the daily reality of my shifts, feeling as though I am working in a war zone. Previously, A&E resembled this chaotic state only during the winter months, but now it is an everyday occurrence, even throughout the supposedly quieter August period.
The difference is immediately apparent upon re-entering A&E: the sheer volume of patients and the worsening condition they are in, coupled with a noticeable decrease in staff available to provide care. The outcome is sheer chaos. It is now normal to examine patients in the midst of A&E, whether it be in corridors or wherever they happen to be waiting, all while asking intimate medical questions, perhaps requiring them to expose their bodies in front of the waiting crowds due to the lack of suitable spaces. Even severely ill individuals, like the cancer patient I mentioned earlier, often endure long waits. In the past, she would have been promptly taken to a private cubicle for treatment of her infection before sepsis took hold. Instead, she spent multiple hours tethered to a drip while seated on a chair — only in the late hours of the night was a trolley made available.
Thankfully, she was eventually admitted to a ward the following morning, and her life was saved. However, the outcome could have easily been different; such outcomes occur frequently. The pressure on space and time is overwhelming to the point that I must clean cubicles quickly between patients, a task typically assigned to cleaners. Hospitals are now utilizing spaces that were previously inconceivable, with gravely ill patients receiving care in corridors or on chairs. On certain occasions, I have been forced to treat patients in ambulances parked in the car park. Recently, I had to tend to a patient who had sustained major injuries in a serious car accident under these circumstances. It is distressing for both the patients and myself as the doctor. I have even witnessed a patient experiencing a seizure being placed in an alcove beside a cupboard, with nowhere else to accommodate them. In the past, they would have been promptly placed in a specialized bay with access to medical equipment and a team of healthcare professionals at their bedside. Sadly, this is no longer the case.
During my first shift back, the severity of the situation genuinely shocked me. I questioned a fellow doctor, “What on earth has happened?” He simply shrugged and replied, “It’s just how it is now.”
It is now commonplace to traverse through A&E while desperate patients grab at me, pleading, “Doctor, help me.” Witnessing these scenes is truly harrowing, but all I can do is assure them that we will attend to them as soon as possible. However, the truth remains that there simply isn’t enough capacity to care for everyone.
This past Friday, a young man presented with palpitations, and his ECG revealed subtle abnormalities suggesting hypertrophic obstructive cardiomyopathy, a condition characterized by the thickening of the heart walls over time due to a genetic defect. Unfortunately, there were no available cubicles to properly assess his condition or offer any care. He was unable to receive any assistance and had to leave. In the past, we would have immediately placed him in a cubicle and connected him to a heart monitor to ensure he wasn’t at immediate risk.
Many of the beds in the cubicles designated for examination and treatment have been repurposed to accommodate the backlog of patients awaiting admission. The limited cubicles containing beds are being used as overflow for other departments. This backlog is exacerbated by the increased time it takes for patients to be seen.
Years ago, when I left, managers and nurses would closely monitor our progress to ensure that every patient was admitted, treated, or discharged within four hours. This target was introduced as part of the 2010 initiative, but it is no longer feasible due to the current circumstances.
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