How bad could he be NHS winter crisis really in the next few months? For a paramedic already used to waiting hours with patients in ambulance lines outside hospitals in the London area, the answer is almost too worrying to say out loud.
“I’m afraid the service will crash,” he says. What would that mean for emergency responses? “I’m looking forward to the day when they just have to tell people, ‘Sorry, unless you’re in cardiac arrest, we can’t go.’ It looks like we’re on the brink of that because I don’t know what else they can do.”
An A&E registrar in the East Midlands shares his despair. “I am very worried about the winter,” says the junior medic, who like the paramedic asked not to be named. “There is a lot of concern. People say: surely it can’t get any worse, can it? What the hell are we going to do if he does?”
Let’s take a moment to absorb five reasons why frontline staff in the UK’s decentralized health services are so concerned. You may want to take a deep breath.
First of all, the halls are full. At the end of last month, the number of beds in England occupied by patients who had been in hospital for more than three weeks had already exceeded the highest level in any of the last five winters – that’s before we even get into December.
Many of these people were so ill that they could not leave, although 40 per cent were medically well enough to be discharged, but lacked social care to enable them to return home safely, which What does it mean 19 out of 20 beds in England are occupied. Bed blocking in Scotland is also in a record.
Second: almost three in 10 ambulance patients get stuck in queues outside hospitals too busy to receive them. This is about double the pre-pandemic rate and worst performance on record for early winter. In Wales, ambulance crews wasted 28,143 hours in queues in October, also a record.
Third: 7.2 million people are waiting for NHS treatment in England, up 60 per cent more than before the pandemic. One in seven people in Scotland is on a waiting list; the number in Wales is a all time peak.
Fourth: vacancies in the English NHS are at a maximum of five years, equivalent to 133,446 full-time health service employees are missing. Scotland has a record nursing shortageand in Wales nursing vacancies have almost doubled since last year.
Worst of all: more than 200 kills in England in the last full week of November is believed to have been caused in part by problems in urgent and emergency care, according to the president of the Royal College of Emergency Medicine. “Excess deaths” happen every winter, but could it be worse this year?
If we are in this situation now, what will things be like in January?
No wonder Dr Layla McCay, Policy Director for the NHS Confederation, who supports and speaks for the entire healthcare system in England, Wales and Northern Ireland, says Yo that members fear “this is potentially the worst winter on record” – sentiments echoed in Scotland. Sir Chris Whitty, England’s chief medical officer, has even said that doctors may have to break “established rules to care for people” to cope.
It is difficult to predict how severe the detente will be. That will depend on factors like how low temperatures drop, how savagely the flu attacks the population, the number of wards closed for norovirus outbreaks, how many staff must stay off work with Covid, and whether a new variant emerges.
“winter war rooms” are among the plans being made to help the system survive as well as possible until spring, along with 19 new community diagnostic centers and an optional recovery task force focused on reducing delays. However, patients of all ages cannot be prevented from suffering.
“We are already seeing significantly more children coming into A&E with respiratory problems, such as RSV and flu,” says the A&E registrar. “It is a big concern. The pediatric team [in my hospital] they have to ask the adult team for help. I get more offers for appointments in pediatrics than I have ever been offered before, because they are so busy.”
On top of all that pressure, and protesting below-inflation wage offers while you have to cope, will be this month’s strikes. nurses in England, Northern Ireland and Wales will picket on Thursday and again the following week, although not abandon the most crucial services. For calls that are not life threatening, ambulance equipment in England and Wales it will be withdrawn on December 21 and 28.
The near-term outlook is already bad enough for the NHS. If we’re ever going to solve this problem long-term, rather than trying to put plaster after plaster on oozing wounds that keep reopening, some fundamental questions need to be asked (and for the sake of clarity, the rest of this article will focus on England).
How have we found ourselves in a situation where our health services are completely overwhelmed for months on end, where an entirely predictable seasonal surge in demand from the NHS not only risks occasional problems lasting a few days, but results in result the winter crisis, a multifaceted nightmare so ingrained in our hospitals that doctors now consider it an inevitable annual event?
To prevent this ritual of overworked facilities and overworked staff from becoming increasingly dangerous for patients, is funding the biggest problem? Are there deeper organizational factors? Or ultimately, it is the bigger problem that the unacceptable continues to be accepted in what even traditional government supporters now call “broken britain”?