NHS winter A&E crisis - it's not good ;(

My pals mum fell last week. breaking bones, a suspected stroke thought to be  the reason for the fall. This was around midnight - calling 999 she was informed it would take up to 10 hours for an ambulance to come - in fact she didn’t actually arrive in A&E until 7pm 

19hrs

Without being funny about it, we’ve had no beds for months and it’s not so much a winter crisis as a year-round crisis.

Still, HMG thinks they can fix elective care without fixing emergency care, and in turn without fixing social care, so it’ll all be fine.

The reason staff are quitting to work in Aus/NZ/Can is not just because the money is better.

This is a salutary reminder of the current NHS situation. Looking back on my crash a bit over 3 years ago aged 74 I can only think I was very lucky to have only waited 2 hours for the ambulance being put on a bed in a side room in A&E and though I had to wait for some time to get seen by a doctor and ultimately x-rayed. There was a hectic situation in the A&E corridors I must count myself as very lucky.

Seeing all the reports of the current situation and seeing the posts above I can't but think my fate would have been somewhat different had it happened now.

Three years on I think I'm pushing my luck still riding some of the things I attempt (don't get me wrong, I don't try big jumps etc).

I think I have to dial things back. I don't want to tempt fate and bring my active years to a premature end (and screw things for my family).

Sorry for this public bit of sole searching.

The reason staff are quitting to work in Aus/NZ/Can is not just because the money is better.

Conditions are better but my job is working on trying to alleviate similar issues to those above in Australia. It's primarily being caused by a staggering lack of access to subacute care meaning acute beds aren't available for those with real need. It all backs up to A&E.

Problem here is to do with funding for different tiers of care comes from different tiers of government.

@reeksy Maybe part of it is the impression that the grass is greener rather than the reality?

One way or another, having to nurse people in a corridor in the ED is not what any of us would recognise as good care.

But again, unless social care (the costs of which are a large part of the reason local government is broken, as well as the effect on the NHS) is fixed, everything else is tinkering round the edges.

My parents are in their 80s, getting frailer and a bit more confused. They are one trip or stumble from a real problem

People who work in the NHS have been trying to say it’s broken for the last 5 years or so, if not more.

Maybe something will happen now if the issues are hitting London too 😂

It’s been an absolute mess for well over a decade and getting worse, the winter pressures do add to it but reality is this all year round. I’m glad I got out when I did. 

Posted by: ratherbeintobago

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Maybe part of it is the impression that the grass is greener rather than the reality?

@ratherbeintobago i'd say there's an element of that, but I don't think the issues here are quite as bad yet.

I've interviewed 100 staff (NUM, senior AH and consultants) over the last few weeks and over half would be from overseas. Plenty of NHS staff that come here prefer it. 

There must be dozens of AI discharge support projects going on, like this one: Revolutionary AI tool helps to free up hospital beds - News | InDaily, Inside Queensland (indailyqld.com.au) 

The trouble is that every year we have genuine crises, come perilously close to collapse and just barely avoid it through luck and heroic effort and divine intervention, but even in the act of avoiding the utter failure it still causes a load of harm but remains short of disaster"... But there's a certain sort of halfwit that when that happens goes "well it was all fine after all, clearly we can let it get a little bit worse". The sane response to a lucky near miss is to go "phew, let's not do that again".

When you do the miraculous with the bare minimum, the only reward is to be expected to do the impossible with nothing

Although you say you didn’t see any time-wasters, if someone has to leave to get the kids ready for school they shouldn’t have been there in the first place. Same with norovirus. My feeling is that problems in A&E are a direct symptom of failures elsewhere (eg being unable to get a GP appointment forcing people into visiting A&E, and bed-blocking due to lack of community care facilities).

Don’t know how it will be fixed as no government seems to be prepared to grasp the nettle and make people pay for their end of life care costs.

A recent Australian and UK hospital experience for ref:

I took my 6 year old to A&E here in Sydney (RPA, in case Reeksy is interested) with a suspected broken arm at the end of November.  We got there at about 8pm on Saturday night.  The hospital is in a reasonably spicy area (it's Sydney, so that's relative) - but the A&E waiting room was reasonably quiet.

We got triaged and shown through to a dedicated Paediatric A&E area within about 10 mins - and 20 mins after that they x-rayed him.  We then had to wait about an hour for somebody to look at the x-ray, then another 20 mins for a second x-ray because the first one wasn't clear enough.  Then about 40 mins or so for the second x-ray to get looked at and the plaster put on.  whole thing took about 3 hours, with a fracture clinic follow-up 4 days later, because they still weren't sure if he had broken it (he hadn't!).

My wife and daughter were waiting in A&E while this was all happening - but they had to leave because things felt like they were getting out of hand - things took a real downwards turn at about 9pm apparently.  Nothing on the scale of what the OP is recounting, but enough for her to leave because she didn't feel safe.

My Mum (in the UK) caught pneumonia just before Christmas - On saturday she felt like she had flu, the on Sunday she felt "much worse" and so called NHS direct - who made her an appt at the drop-in centre in Farnborough at lunchtime (on a sunday).  On turning up, the measured her 02 saturation and sent her directly to A&E (Frimley Park) - they were going to call an ambulance, but her partner was advised that it would be quicker to drive her (which he did).

On arrival in Frimley park, she was triaged straight through A&E and into a high dependency unit - her oxygen saturation was very low, and she'd basically started to go into liver failure.

She was in the HDU from Sunday-wednesday, getting pumped full of antibiotics.  Then on wednesday 9am they moved her back to the main ward prior to discharge - which was (I assume) that they didn't want her blocking a more valuable HDU bed.  It then seemed like had to wait for 9am until 11pm, to get discharged...... it seemed to be that pre-discharge review was what they were waiting for.  ie: she was blocking a bed for 13 hours unnecessarily, because that how long it took them to review her and approve her discharge - which is madness.  In the context of a bed shortage, they are no-doubt prioritizing getting somebody out-the-door, so the fact that 13 hours is what prioritization looks like, is insane.

Despite that glitch at the end - very impressed with her experience of the NHS.  My other finding was that pneumonia is terrifying, no matter it kills so many people.  Mum went from not ill at all, to liver failure within the space of 48 hours.

She's fine now - still monitoring her liver function, but she seems fully recovered.

How have we got here?  Tory governments with an ideological hatred of the NHS.  It's deliberate policy.

On the other hand, I had a cardiac arrest after a gym workout on Tuesday. There was no warning, I went to stretch felt dizzy and next I know is there’s paramedics working on me.Luckily for me one of the guys is a retired surgeon who started CPR and we have a defibrillator in the gym. Paramedics were there in 5 min and worked on me for 45 mins then blues and twos to Ninewells in Dundee. On arrival the heart lab people were waiting to find out what happened. Care in the CCU was excellent. I had an internal defibrillator fitted yesterday and am now home with a long recovery road. If it had happened when out biking I probably wouldn’t be typing this.

Think what I’m trying to say is the NHS is wonderful and learn how to do CRP.

Bloody hell beinbhan, glad you're still with us!

It's not good currently. I came off my bike at the beginning of January, landing heavily on my pelvis (ice slip). Didn't want to go in, but couldn't walk and the pain was horrendous so my son wheeled me in. Arrived about 9am. Sat in a chair until 1pm until a doctor was able to see me. Got a bed in a corridor, about 2pm, then xray at 3pm. Left about 9pm with lots of pain killers, no brake found. I'd only had a sip of water when taking pain meds, and the staff gave me a sandwich about 3pm as I hadn't eaten for over 20 hours.

I've since seen a physio (private) who suspects I have a hairline fracture - I was reviewed by four people (I work at a Uni so used our Physio Clinic).  I've not been back to the GP as I'd need a MRI to prove there is a break. The treatment is going to be the same, rest. What's the point of further wasting scarce NHS resources.  I've discussed this with a number of Physio and Nursing Lecturers at work (quite handy). The physio want's me to go to the GP, but he understands, and I said given all your examinations, I'm inclined to believe you and the suspected break, so we'll treat it the same. It's still very painful five weeks on and I'm still on crutches.

I suspect I suffered a broken rib in Nov 23. Didn't even occur to me to go to A&E to sit in a chair for 10 hours before being told to take it easy for a month, I just followed procedure. Gashed my finger badly last week; in the before time I might've toddled off for a couple of stitches. Now? Superglue out of the kitchen drawer. I imagine this pattern is being widely repeated and wonder what the long term health effects might be when the punter gets it wrong.

It clearly depends on what issue you go to A+E with and at what time of day.  Took wife a few months ago with heart issues and she was in within 20 minutes, had scans etc,. and out within a few hours.

On the other hand I went with possible twisted testicle a few years ago and was sat waiting for 10 hours and then gave up as clearly not seen as an issue.  Went to GP next day who sent me back to hospital but as a 'planned' entry.

I think it just need more transparency and better organisation using modern tools.  Turn up with something triaged as low priority and get told it will be 10 hours so come back in 9 hours.  Could even text people if they can make themselves available in say 30 minutes.  If people don't come back as planned/respond to text then tough, they lose out.

None of that makes it quicker but it would make the best of a bad job.

I usually avoid hospital but I knew I'd done something as the pain of a break is very different to muscular and the fact I couldn't get on the bike or walk to 'ride it off' was a red flag.  I've been living on strong pain killers since.  The triage nurse gave me a bollocking for cycling in icy weather - I explained that's how I get to work, I wasn't out for fun - she apologised (I also have studded tyres). GP appointment will be a waste of both our times as there is nothing they can do and I don't want to take up MRI time for someone that may need it - it's not going to change my treatment plan. I'm glad I saw a private physio.

I've had express treatment in the past - went in with a broken spine, straight through to Resus, no hanging about or triage - was excellent - I was in a bad way though.

A lot of the problem is that it is too far gone now, my wife is a consultant on a cancer ward, they have lost so many staff, and they simply aren't being replaced, she was one of three specialising in breast cancer, one just had enough and moved to italy to eek out their pension, one was just burnt out and walked away and my wife is left working 80 hour weeks and contracted and paid for 35, she has so much time of in lieu accrued it is counted in months, but can never take it, 90% of her job is dealing with staffing and having to make the horrible decision as to which if her patients is most urgent and rearranging clinic and treatment dates to try and treat them in good time

It is all well and good saying they will invest in more staff, but it takes 7-8 years to train a doctor, 3-4 years to train a nurse, if they managed to recruit them all tomorrow to the staffing level they needed, which they won't with the lack of funding, bursaries etc, they won't have an impact for years.

Add that to the fact that they lost a lot of good staff post-COVID as they'd just had enough, and a lot of good Eastern European staff (especially in midwifery) who had enough post-Brexit and the NHS is on its knees. 

Posted by: tjagain

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How have we got here?  Tory governments with an ideological hatred of the NHS.  It's deliberate policy.

This. Very much this. Now we have Farage and his cronies touting the US insurance model. Unless Starmer grows a pair, this will only get worse.

It is all well and good saying they will invest in more staff, but it takes 7-8 years to train a doctor, 3-4 years to train a nurse

Not sure if it's just a Scottish thing, but we've been taking on more medical students for a few years now. The issue seems to be a leaky pipeline i.e. we spend a lot of money training them but they don't all stay in the NHS (presumably for all the reasons outlined above). 

It takes about 15 years to train a doctor to full competence.

IMV as a doctor, a large part of the problem is that due to cost cutting measures hospitals have been replacing doctor time with other professions and it just hasn't worked.

At the same time, subjectively, the quality of medical training has massively decreased, partly IMV because of the reliance on protocol driven medicine to try and replace medical leadership.

Funding to hospitals has actually gone up in the past decade, whilst productivity has plummeted. Whereas in primary care the reverse has happened. However it still hasn't stopped "initiatives" to improve our productivity my making us work more like hospitals.

It is absolute ****ing madness.

Posted by: fossy

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I've had express treatment in the past - went in with a broken spine, straight through to Resus, no hanging about or triage - was excellent - I was in a bad way though.

I suppose the only thing worse than being seen very slowly is being seen very, very quickly... 😳

They need to cut out a load of middle management roles which I can't see happening.  In the Private Sector most large companies have a 'cull' of these roles every few years.

Just to contrast some people’s experience: Under medical supervision with 3 monthly checks for an enlarged prostate. Recent blood test shows my numbers still going up so referred for an MRI - get a call the day after and I get option for 2 days later. Anyone that tries to spin this as a Labour Government issue when this is a direct consequence of Tory Policy - reduced funding and failure to address to social care/ council budget cuts.
Met a UK nurse in Australia whilst on hols - she was being paid twice the UK rate

My mum fell at home in Sept 2023, lots of pain with leg trapped under her. My Dad got her into a chair with leg back in front of her with help of a neighbour. Ambulance arrived in a relatively short time and took her through a&e and onto a geriatric fractures ward (hip and knee really)  They opted to plaster as a conservative treatment as she was on dialysis 3x a week for kidney failure, and they felt the risk of an op if it could be avoided was better.

She died 6 weeks later in Nov 2023 - 4 days after being transferred under blue light from this major hospital to a specialist critical care unit.

The cause of death (recorded as multiple organ failure due to infection) is still not final, as that's subject to an as yet unheld coroner's inquest (nearly 18mo later) but her injuries at time of death as recorded included cat 3/4 pressure sores (full thickness, down to muscle and/or bone) and her plastered femur having moved and becoming an infected, open wound (where bone penetrates the skin) under the cast. The critical care hospital referred it, as they couldn't believe 'the state she was in' when they received her, and from the time she was there even though it was a CCU, it was basically palliative treatment.

My Dad, sister and I regularly visited (Dad every day) and flagged this regularly - she was healing OK, so they said for about 4 weeks and in the last 2 deteriorated markedly. It was my sister that finally demanded they remove the cast which revealed the fracture; the pressure sores were largely hidden from us, they were regularly redressed and Mum being Mum, didn't want us looking at her bare bum so we trusted the staff.

I can't say much further because as I say it's subject to an enquiry at both hospital and coroner. This has already been delayed because the hospital's own investigation turned out a report that was full of factual errors and omissions, such that I demanded it be reopened and rewritten. 

Back on topic - it is clearly on its knees and we can point to lack of funding and investment as part of the cause for my Mum's death; IMHO she just didn't get enough expert time to head this off early enough. I try not to blame 'the staff' but I'm finding it hard at times.

Got back from my drama club about quarter to ten on Wednesday evening, next door (he's undergoing treatment for cancer and kidney failure) were just going in, they'd been at A&E since 8am. 

It's not a winter crisis, it's a crisis, it's not just A&E, it's every aspect of NHS hospitals and health & social care that are government funded, it's not new, it's decades of decay.

My trust currently has a vacancy freeze so we've got a lot of unfilled positions. My department is at such a level now that if we lose one more person or there's a long term sick or the like, we'll crumble. We're already looking at reducing our service, stepping back from a full 7 day service, turn around times will be increased, we might trim our test repertoire and just turn samples away. There's an over time ban as well so there's no incentive to cover shifts. There's no contingency. We've worked like this for so long that all good will is pretty much gone.

On the other hand, the consultant team in my department have several long standing vacancies from prior to the freeze that they couldn't recruit into because being a locum is so lucrative. We've had the same locums for a couple of years, they earn literally thousands per week and can dictate what hours they want. There's literally no reason for them to take on a permanent position when they'll get paid way less and have to work more hours. It's bonkers. 

Just need to wait for that magical growth so the country can afford to sort out the NHS.  Or maybe just accept that health costs have gone up and have not be kept in line so now we all have to pay much more to get them back to where they need to be.

Although you say you didn’t see any time-wasters, if someone has to leave to get the kids ready for school they shouldn’t have been there in the first place

You go to the GP because you're having problems breathing. The GP sends you to A&E immediately. Do you ignore the expert's advice and go home? No, because the GP hasn't treated you, and you have no other option for treatment. So, you sit there for hours, feeling like death, but at some point you will almost certainly be wondering why on earth you've been told to go there. At what point do you give up? When lack of sleep and hunger and cramp and cold make you feel like you might as well die in your own bed? When you wonder how many bugs you're picking up from the fever-ridden person who is rammed into the little plastic chair next to yours? 'Getting the kids ready for school' is someone who has sat there overnight, at the very least, and may just be making an excuse to escape from the hell on earth that is a NHS waiting room in 2025, or might be someone with no other options than to struggle on with their lives , despite illness, lack of sleep, and lack of treatment.

A visit to local MIU today saw me tooled up with a newspaper, fully charged mobile, power bank and a good book in preparation for the long wait. I was triaged in less than 5 mins, seen in less than 20. I went in with a hurting foot and saw a podiatrist who was brilliant and sorted my foot pain AND the back pain I've been having too. X ray done as well, less than 15 mins. I chatted with Jack, the trainee radiographer from Bournemouth who's studying at UCH Cardiff. He was affable, enthusiastic and positive, just like so many people in the NHS I've met over the last few months.

The (Welsh) NHS gets a bad press and rightly so, there have been so many shocking incidents, delays etc but all of my recent experiences have been very positive indeed. Very telling were the damning comments re: management structures and availability of theater time made by my surgeon prior to my hip replacement.

Today though I didn't even get time to complete the crosswords.

Prince Philip Hospital- Llanelli, I thank you.

About 5 years ago I went to A&E in a French hospital (serves a smallish town) and once I'd been registered etc was directed to a small waiting area. I thought it was a bit poor, only 6 or so seats, no vending machine etc.  But having spoken to the doctor I found out that it was like that because most people don't wait for much longer than 30 minutes!!!

They need to cut out a load of middle management roles which I can't see happening.  

This is utter nonsense.   The NHS is beset by insufficient and inadequate. Management.   Yes in England a fair bit is wasted in the remnants of the fake market ut even so the NHS spends less on admin and management than comprable organisations.

Po3rly trained management is an issue as is government mandated nonsense bureaucracy but too many middle managers?  A myth

Posted by: idlejon

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Although you say you didn’t see any time-wasters, if someone has to leave to get the kids ready for school they shouldn’t have been there in the first place

  'Getting the kids ready for school' is someone who has sat there overnight, at the very least, and may just be making an excuse to escape from the hell on earth that is a NHS waiting room in 2025, or might be someone with no other options than to struggle on with their lives , despite illness, lack of sleep, and lack of treatment.

I don't know what was wrong with her (although as there was no privacy in a tiny room, I knew practically everyone else's history...) but she came back 2 hours later and was seen a while after that. At a guess - having waited all through the night, she probably put her kids ahead of her own health because there was no other option, and then came back as soon as she could.

Posted by: tjagain

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The NHS is beset by insufficient and inadequate. Management. 

This. When I left the Army I took a 2 year FTC working to develop a robust leadership & management development programme for a local trust. 

Sadly the NHS does not have a culture of effective or robust leadership and management, it gives next to no development, has no real benchmarking for what is effective and has a rampant blame culture.

This ain't new though,  it has been raised in countless studies over the years by various individuals internal and external. 

Sadly the NHS does not have a culture of effective or robust leadership and management, it gives next to no development, has no real benchmarking for what is effective and has a rampant blame culture.

I suspect this is all true. When I did the local ‘leadership’ training it was far from robust.

Posted by: Fursty Ferret

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Although you say you didn’t see any time-wasters, if someone has to leave to get the kids ready for school they shouldn’t have been there in the first place.

I almost left A&E without being seen because of a long wait- I was feeling a bit better and balancing the pain and incapacitation level against being more and more fed up, and generally not convinced I was badly hurt- I'd have rather been sat at home with all the comforts, than sat in a plastic chair surrounded by noise and hassle, I very nearly talked myself into it. Turned out I had a broken hip.

It's just unreasonable to say "shouldn't have been there", you never know what's going through someone's head, what pressures they're facing, what backup they have and how they actually feel about their injury. And saying this to the wrong person leads bad places, that guy who "didn't want to cause any trouble" or "thought it would get better" ends up not going at all. The only world where everyone in A&E "should be there" is one when there's a bunch of people that "should be there" and aren't.

Definitely a problem 15 years in the making.  Maybe 45.

A+E and ambulance waiting times is just the tip of the iceberg - the outward sign. It's wrecked from top to tail.  Medical wards can't discharge people as there's no care or support in the community.. or they are discharged too early due to the pressure for beds... only to return (often via A+E) 2 or 3 days later.   In turn A+E can't discharge to wards, A+E can't deal with patients sat on chairs and on stretchers in the waiting room. And Ambulances can't in turn deposit their patients into A+E as there is zero space.  So they sit outside!A+E for hours on end, tieing up skilled paramedics when then can't go and help others waiting hours for an ambulance.

I be we've all seen experienced it or know someone who has.  

Ma

My daughter is a nurse on a ward in Plymouth, sees it daily.

When I was down there 18 months ago (so not even affected by winter flu etc) the A+E waiting time at Derriford (Plymouth) was 27 hours ! 

My OH's on the PTA committee at the local school, and I get the impression that schools are in the same state as the NHS.

They are struggling to even afford glue sticks, never mind text books. Not enough support staff, unable to manage kids with greater needs. They ask for donations for the local trips. The mums whatsapp groups recently "took a stand" and refused to pay the suggested donation of 5 pounds so the trip was canelled.  :/

I think all the public services are in the same state as the NHS. 

On Friday morning, picking my way down a track at the limit of what I'm comfortable with, I must admit this thread was lurking at the back of my mind. However...

The triage nurse gave me a bollocking for cycling in icy weather - I explained that's how I get to work

I find the nurse's view problematic when the majority of the UK population are eating, drinking, smoking, vaping and idling themselves into a state of chronic ill health. Do they get a bollocking too, every time they turn up to collect their statins and diabetes meds?

My phones suggested news articles has informed me that a number of UK doctors are attending a conference in the ski resort of val disere. Think it was suggested to me as it knows I like skiing, rather than its actual content. It’s the Mail so I won’t link.  
buried deep in the article they mention that many trusts allow funds for training; and that many would be using their annual leave for the holiday/skiing part of it. 
but clearly the right wing nutters want to turn the mouth breathing masses against some incredibly hard working and paid slightly above average working professionals and blame all the NHS’ woes on them. 

No shortage of money , just a shortage of political will to actually make a real difference.

But you know, Labour came with their excuses and their shitty failed ideology.

They're the only ones with the current opportunity to fix this stuff. 

Fiscal rules need to go - along with Reeves or just keep complaining how terrible everything is.

It's fubared. Pain in my hip is real bad again (fall 6 weeks ago). GP practice won't see me and said I can see a physio in March. Explained four physios at work told me I have a fractured hip or pelvis and needs investigating. Explained this. Nope. Phoned 111, GP called back said go to A&E. Spoke to physios at work and they said the same. 

Now sat in A&E taking up resources just to see someone as hip isn't healing well after 6 weeks. Bit shit when a colleague thought I'd had a hip replacement (another physio).

Now in overnight. Xrays again, can't see any breaks. Might send you for a CT.  CT done then nothing for a couple of hours. Doc comes over and I get up and follow him with one crutch. Doc is staring at me. Follow him down to a ward behind A&E and he's still looking at me. OK you've got me worried. You shouldn't be able to walk he said. Me I've been hobbling about for 6 weeks. 

Extensive fractures of the pelvic wing and more concerning, fractured hip socket. Serious break and missed 6 weeks ago.

Yikes! Hope you are pointed in the right direction and receive the care that you need. That sounds very painful. Courage!