We owe our lives to the NHS and its priceless contribution to getting Britons out of the pandemic after a long quest of over two years. However, moving over criticism, blame game and politically charged statements, the UK has to accept that NHS needs to be saved in order to save the British healthcare system. Healthcare workers need to be paid better. The private sector needs to put in its bit to clear backlogs, and government needs to come up with a master plan to save the NHS. Chancellor Jeremy Hunt has warned that the NHS is on the brink of collapse. Hunt warned “we’re all going to be paying a bit more tax,” as he unveiled his Autumn Statement Budget on Thursday. Health leaders have demanded extra funds for the NHS amid record waiting times. As nurses prepare for their first-ever strike, Unite general secretary Sharon Graham added: “Services are at breaking point while workers are struggling to make ends meet. The blame lies squarely with the government. The Prime Minister should use the Budget to avert industrial action and fix the ongoing tragedy of underfunding across the NHS.”
Hunt was told by Sky News presenter Sophy Ridge that “Frankly this doesn't look like a health service that can find efficiency savings - this looks like a health service that is on the brink of collapse”.
The latest figures for September 2022 show a record high of almost 7.1 million people waiting for treatment. 2.87 million patients waiting over 18 weeks for treatment, a further increase from last month. 401,537 patients waiting over a year for treatment – which is around 308 times the 1,305 people waiting over a year pre-pandemic in September 2019.
BMA reports that a median waiting time for treatment of 14 weeks – is significantly higher than the pre-Covid duration. There is also a hidden backlog that consists of patients who require care but have either not yet presented, or who have had referrals cancelled due to the impact of Covid-19 on the NHS; patients who, in normal times, would have been referred for treatment, received elective care and attended outpatient appointments, but who for a number of reasons relating to the pandemic has not yet found their way into the health system.
Asian Voice spoke to NHS doctors and volunteers working towards resolving this looming crisis and we gather that healthcare professionals are on the pandemic has broken the staff to their knees. Yet, both British Medical Association and doctors do have solutions in mind to come out of this crisis. There are also loopholes in the public, figures which indicate that one in three beds are occupied by patients who are fit to be discharged. How can the NHS, the general public and the government come together to get back the healthcare system on its feet? We find out.
Waiting times have rocketed
Since the lockdown eased demand has steadily risen, reducing performance against targets. There were a total of over 2.2 million A&E attendances in October 2022 – a slight increase from the 2.0 million in September 2022.
The number of patients waiting over 12 hours from decision to admission has increased by 34%, bringing the total number to a record high of 43,800 in October 2022. It is now over 60 times as high as it was in October 2019. This figure also represents an underestimate of actual waiting times, as patients will have been waiting for additional time before a ‘decision to admit’ was made.
Outlining the role of the private sector, BMA has enlisted as one of the measures the Government has taken to reduce pressures on hospitals and help cut waiting lists.
A recent BMA survey found that under these arrangements, 60% of private practice doctors who responded were unable to provide care to their patients at the time.
The extent to which private hospitals will be able to take on NHS waiting list initiatives going forward is unclear given the increased demand in the self-pay market and the backlog of private sector patients.
Doctors and healthcare workers working amid ‘toughest circumstances’
Dr Latifa Patel, British Medical Association (BMA) representative body chair, exclusively told Asian Voice, “Doctors and their colleagues working across the health service are doing all they can amid some of the toughest circumstances many have ever experienced. They are exhausted – physically, mentally and emotionally – having worked through a pandemic and now facing huge demand and a record backlog in care.
“We’re looking at the record – and growing – waiting lists with great trepidation, and share the huge frustration of those people who have already been waiting too long to get the treatment they need. We want patients to know that doctors will put everything into meeting their needs, but at the moment it is an uphill struggle, resulting from years of understaffing, under-resourcing and underfunding, only made worse by the pandemic.” Giving a solution to clearing the backlog, Dr Patel told the newsweekly, “Key to addressing the backlog is recruiting and crucially retaining staff across health and social care so there are enough to treat people. This means employers supporting staff and their well-being, but most urgently properly valuing them with improved pay and conditions. The government must reverse more than a decade’s worth of real-term pay cuts for doctors and address absurd pension taxation rules that penalise them for taking on extra work to look after patients. Only by doing so will they stem the flow of doctors away from the NHS when they are needed most.”
Pandemic has broken the NHS and brought the staff to its knees
Dr Indranil Chakravorty MBE, a Physician, Researcher in innovation, health Inequalities, and medical education told us that the pandemic has broken the NHS and brought the staff to its knees. The backlog of missed procedures, delayed appointments and consequences for missed or delayed diagnoses of life-threatening conditions is colossal.
He said, “In the NHS this week, we as frontline clinical staff discussed an imminent crisis-management strategy which united the most junior to the most senior professional in experiencing a sensation of impending doom like never before. To mitigate the risk of overcrowding in emergency departments, the ambulances queuing outside with high-risk patients waiting for delayed necessary treatment, and some who were inevitably going to suffer harmful consequences of such inordinate delays or suboptimal therapy - we agreed to spread the risk and manage extra patients in corridors or empty spaces within clinical areas. A process described as ‘onboarding’ and trialled with mixed success in some hospitals in previous winters.”
Dr Chakravorty believes that the anxiety in offering suboptimal treatment, missing life-saving treatment and over-burdening a workforce who are already traumatised and tired by the pandemic. “Albeit, this is a clever strategy to spread the risk from the front door to the rest of the clinical areas, there is no denying that while the emergency departments have a higher number of clinical staff, most ‘downstream wards’ and clinical areas are usually running on empty on most ‘good’ days,” he said.
But what can the government do? How can the public help? Dr Chakravorty said, “There is no easy solution. However, there are some measures which can reduce the pressure. The UK Chief Medical Officers and the regulator for doctors wrote to all professionals that if a ‘crisis’ were to strike, the traditional approach of holding the individual clinical professional punitively responsible for any acts of omission/ commission (human error) would now take the working environment and pressures into account when judging them. This reassurance is designed to reduce the anxiety of being held responsible for delivering care in an unsafe setting for the individual.”
He believes that still, it does not take away the moral, ethical and ultimately legal responsibility of providing the best possible care for every individual patient under one’s care at all times. There are no robust systems to record and classify the clinical risk of all patients within each clinical area.
One in three beds occupied by patients well enough to be discharged
A report published in the Guardian has revealed that as many as one in three hospital beds in parts of England are occupied by patients who are well enough to be discharged, with a chronic lack of social care meaning many do not have suitable places to go. Guardian analysis of official data shows that on average 13,600 beds across NHS England are occupied every day by patients who doctors say are medically fit to go home or to a care home, equivalent to one in seven beds in acute hospitals in October. However, that rose to more than one in five at 35 of England’s 121 acute hospital trusts, and to almost one in three at two trusts – North Bristol and Wrightington, Wigan and Leigh NHS trust.
Mental health consequences for clinicians
According to Dr Indranil, in good times, the NHS records around 3000 deaths and 300,000 episodes of human error each year. “The mental health consequences for clinicians who may inadvertently find themselves in such situations are immeasurable. Hospitals must provide a safe and responsive system for escalating concerns and suitably trained crisis management teams to respond when the alarms are sounded. The reassurance may be there, but no such adequately resourced teams exist in most hospital settings. The NHS Trusts will need to drastically ration the number of patients brought in for ‘face-to-face’ clinical reviews and use telephone, video consultations and remote monitoring for most non-emergency processes. The community diagnostic hubs will need to be up and running in every hot spot, so the hospital diagnostics are kept for emergencies or cancer detection. In primary care, every clinician should be pressed into working independently, within their competency and escalating based on evidence-based guidelines,” he added.
When asked what the public can do to help, Dr Chakravorty said, “The only advice one can give to members of the public is to access their healthcare needs either through their GP practice, using online consultations, pharmacies where possible or accessing the NHS 111 triaging service, unless there is a dire emergency. Ambulances should only be used in an emergency; other forms of transport should be preferred whenever possible when travelling to a clinical facility.
“Ultimately, the public will need to lobby the government to increase investment in the healthcare infrastructure, staffing and resources for health promotion and prevention of diseases. This will inevitably lead to a rise in national insurance contributions, or the NHS will disintegrate into a failed social institution like transport and postal services.”
NHS is an important national asset
NHS GP Dr Aaliya Goyal told Asian Voice, “The NHS is an important national asset that should be protected so it is accessible to people when they need it. There is a huge backlog, largely due to the disruption of the Covid-19 pandemic. There is also a hidden backlog of patients who require help but haven’t accessed care yet, and this can store up problems for the future.
“We can all work together to ensure the NHS remains sustainable. The government can recognise these pressures by communicating them honestly to patients and removing targets which are unachievable and add to the pressure clinicians feel. They can also direct resources to the services and areas which need it most.
“Workload pressures mean it is even more important to look after our NHS employees with a zero tolerance approach to abuse and access to occupational health services and other services which offer psychological support. The poor pay and working conditions can also contribute to the feeling of being undervalued, adding to the risk of highly trained and skilled staff leaving the NHS.
“Finally we can all educate patients on how we can work together to ensure services are used appropriately. This could be making sure they know when self-care is appropriate, use of online resources, pharmacists, dentists and other healthcare professionals inside and outside of the NHS, while ensuring they feel confident speak to their GP or seek emergency care when they need to.”
Top leadership expert on how NHS is at ‘breaking point’ – and why we need to act now
Speaking to Asian Voice, leadership expert Kul Mahay, who spent 30 years working for the police and now works with organisations to help develop cultures where people perform to their very best, action must be taken immediately to support our NHS who feel ‘exhausted, drained and undervalued’.
A recent study commissioned by the University Hospitals of Derby and Burton NHS Foundation Trust reportedly discovered how low morale and overall physical and mental exhaustion affected staff at the Trust’s Accident and Emergency Department.
The December 2021 Empowering Voices report, which involved 45 members of staff including 14 consultants and doctors, was seen by the Local Democracy Reporting Service and details – which included how staff had been instructed to ‘cry privately’ rather than in front of patients as they struggle to deal with burnout – were reported in local media.
Other hospitals have reported similar pressures and Kul, from Derby, said: “We all clapped for NHS and key workers during the coronavirus pandemic, but it is now, as hospital wards are full to capacity and there is a massive backlog of appointments, that they need our support.
“It’s not just in hospitals; dental practices are struggling too. GP surgeries are feeling under pressure. They need empathic leadership to help combat low morale, sickness and burnout which, ultimately, poses a risk to patient care.
“People are exhausted, frustrated and sad in healthcare. They are going off sick in droves. I’ve been working with a healthcare sector provider in the Midlands recently which employs 1,400 people. They recognise that, over the last two years, healthcare has been one of the biggest industries affected by the pandemic and that it is important to carry out an internal ‘health check’ on their own teams.
“Like so many other areas of the healthcare industry, this organisation is experiencing high levels of turnover and abstractions and trying to an ever-competitive pool of potential recruits. It is not alone. I am helping many to explore the type of leadership and culture that is much-needed in this post-covid world.”
Kul, who specialises in emotional intelligence and creating healthy cultures, feels that whilst healthcare staff are probably the most affected, other public sector organisations are also experiencing high levels of stress, burn out and turnover from their staff.
He recently spoke to the CEO of the UK College of Policing, Chief Constable Andy Marsh, for his podcast called ‘Human Centred Leadership,’ and there was a clear acceptance that the police service is living through unprecedented times, with multiple challenges experienced over the past two years.
“Often we think of public sector investment as an increase of resources and staff and, to a large extent, that is true,” added Kul.
“However, unless we also invest in the cultures of our great public sector institutions and help them to become organisations that people aspire to be a part of, we will always struggle to deliver the highest quality of service that we can.”
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BOX ITEM
What the BMA is calling for?
- Prevent hospitals from being overwhelmed
- More funding
- Measures to retain the medical workforce
- Planning to increase NHS capacity
- Better collaboration between primary and secondary care
