A winter like no other

have witnessed many of my colleagues finding a quiet place [on the ward] to cry because the pressure is too much.’

This was the heart-breaking admission submitted by one hospital doctor in Scotland to the BMA’s pressures portal, on the unimaginable and unsustainable situation facing many of the country’s emergency departments this winter.

Describing one recent shift, the doctor painted a demoralising, yet increasingly common, picture of a hospital unable to cope, with every bed and corridor filled with patients, 10 ambulances queuing outside and with the average wait time for a patient’s first assessment coming to eight hours.

‘It was one of the worst shifts I have ever experienced but it is like this almost every time I go to work now,’ they explain.

‘Even worse is to come home from shifts like this. [Shifts] where I have had to be several doctors for the day, where I’ve been assaulted and shouted at, where I’ve watched people die and wondered whether it’s because I didn’t see them fast enough.

‘Now, with a cost-of-living crisis and years of pay erosion, I get home and wonder whether I can afford to even put the heating on tonight.’

Bed demand

Weekly data published on 26 January by NHS England reveals that 95 per cent of beds across all adult general and acute hospital wards in England were occupied by the week beginning 22 January.

Data for this date also shows that the number of patients staying in hospitals in England for seven to 21 days hit 97,196 compared with 87,080 in 2022.

Pressure on beds is not a phenomenon limited just to England, with hospitals in every part of the UK experiencing huge challenges around being able to discharge patients safely and appropriately, and thus allow new cases to be admitted.

‘Over the last month or so things have just really escalated and become so much more difficult,’ says associate specialist in emergency medicine at Belfast’s Royal Victoria Hospital Siobhan Quinn. ‘This time last year, we might have had 30 to 40 patients on trolleys waiting to get admitted to the ward, whereas now it’s gone up to 80, and it’s been at this level now for the past three or four weeks.

‘There are a significant number of patients occupying inpatient beds, who are medically fit for discharge, but can’t get home because there isn’t the appropriate care package or family support, or there’s something that they need in the community that isn’t available for them. This has been going on [in Northern Ireland] for such a long time it has been causing moral injury. It’s very upsetting for the doctors and the nurses. Many of the nurses leave crying, some of them even have told me they come into work, crying before they’ve even set foot in the place.’

Corridor treatment

A report published last month by the Lords public services committee described the situation in emergency healthcare services as a ‘national emergency’, with overcrowding and delays in care endangering patients and presenting ‘a serious risk to the sustainability of the National Health Service’.

The report, which drew on evidence compiled before the onset of pressures seen this winter, makes clear that a rise in demand coupled with the difficulty in discharging patients owing to insufficient community and social care services, is driving the unsustainable situation.

It is these factors, along with chronic understaffing, that are contributing to appalling and previously unthinkable scenes in many emergency departments of patients waiting or having to be treated in nonclinical rooms and even corridors.

‘During my last 10 on-calls I have not seen one patient in a bed or even a trolley for assessment,’ a hospital doctor based in Swansea tells the BMA Wales pressures portal. ‘We are using cupboards, borrowing rooms in outpatients and I have had patients with drips lying on the floor. Often patients in the waiting rooms have not even been given food and drink. We recognise emergencies such as hyperkalaemia but are unable to even give immediate life-preserving treatment due to lack of space and staff.

‘This is warzone medicine with no safe place for us to hide,’ warns an emergency medicine staff, associate specialist and specialty doctor from the north of England. ‘Watching people reattend as they were discharged under extreme pressures, watching patients share rooms with strangers, assessing trauma patients in the view of everyone in the middle of the emergency department, having no private space for people to air their emotional and physical pain is not only harmful to patients but to those of us who look after them.’

Mental toll

Ambulance backlogs, and the enormous waiting times faced by patients so far this winter, has changed many bma.org.uk/thedoctor doctors’ perspectives as to what a good or bad day now looks like in emergency departments.

‘A “nice day” now is patients only waiting six or seven hours [to be seen] compared to 12,’ says Lailah Peel, a junior doctor working in the west of Scotland.

‘Most patients are really understanding and are generally really nice. They will thank us and tell us that they know how busy things are. There have definitely been situations where patients aren’t getting painkillers as quickly as they should be, or their antibiotics as quickly as they should be.’

Dr Peel, who is deputy chair of BMA Scotland, says having to work under such incredibly pressured conditions is taking an enormous toll physically, mentally and emotionally on many emergency department staff.

She adds that she fears that such unbearable conditions could lead to an entire generation of young doctors being put off pursuing a career in emergency medicine.

‘We’re all at that point of burnout, with people being constantly asked to work extra shifts or to provide cover, people are just absolutely exhausted, and it weighs quite heavy on you.

‘We [doctors] are all quite stoic and we’re all coping until we’re really, really not coping, and I think that’s something that’s very scary. It feels like we’re all kind of hanging on in there by the tips of our fingernails and asking ourselves “can we keep going?”.’

Breaking point

With the BMA this month set to launch a consultative ballot of consultants in England, consultants committee deputy chair Simon Walsh warns many frontline doctors are now at breaking point.

‘Although we are moving out of winter, the enormous pressures facing urgent and emergency care services remains acute for hospitals across the UK,’ he says.

‘From shortages of beds and staff to the extensive waiting times facing patients, the situation in many emergency departments is unsustainable and frequently unbearable for the doctors and other healthcare staff subjected to it.

‘With the BMA preparing to contact consultants in England as part of a consultative ballot over the potential for future industrial action, the Government can no longer ignore the mounting calamity in our health service and must meaningfully engage with the medical profession to find solutions to the crisis.’