The state of the NHS

This is a shot of the patient list on my computer just before midnight last night.  It's not the whole patient list - that's too long for one screen - I think there were still over 60 patients in the department at that time.  The top 26 patients have a negative time in the colourful column towards the left - that is the number of hours and minutes OVER 4hrs that they have been in the department.  So the patient at the top of the list has been in the department almost 12 hours at the time of my photo.  Most of those patients have been referred for admission and are waiting for a space on a ward to become available.

I've blanked out the ages in the next column to prevent any risk of patient indentification.  

The most astonishing part from my point of view is the huge increases in patient attendances, especially at night, over the time I have worked in Norwich.  

When I first started working there in 1994, we saw fewer than 40,000 patients a year.  We had ONE junior doctor working the night shift, with senior cover from home.  The junior doctor could expect to get at least some sleep - there was a small bedroom available.  There were periods during the night when we would be "patient free" and the nurses watched videos.

Last year, we saw nearly 120,000 patients.  We have 5 juniors and 1 or 2 middle grade doctors working the night shift, and they never stop!  We have 2 seniors in the department until midnight (one of them last night was me). 

Even without the current problem - which is largely an outflow problem due to lack of beds in the hospital - the nursing and medical staff would be busy with new arrivals.  As it is, the patients waiting for admission take up most of the available cubicles, so the new arrivals have to be seen and sorted by rotating them through just a few cubicles.

This situation is by no means unique to Norwich, it is reflected in ED departments throughout the country.

Edit - I've added a copy of an article published today on a doctor's website - there are some pretty sarcastic comments by readers, which I cannot copy for you, on what exactly is meant by "disaster" and "coping".

NHS winter plans averted disaster - agency 22/02/2018

Good planning and hard work have helped the NHS survive the winter, a key government agency has said - controversially.
Hospitals faced more demand than last year – linked to the flu outbreak – but kept waiting times to the same level, according to NHS Improvement.
Its findings were challenged by many organisations, who argued the evidence pointed to a service “on the brink.”
Its quarterly assessment of the state of hospitals reveals that nearly 10% of posts are vacant – some 100,000.
The figures – which only show performance until December - show hospitals cumulatively showing a £1.28 billion deficit after nine months of the financial year.
NHS Improvement says that A&E departments achieved a four-hour standard of 89.5% in the last quarter of 2017 compared with 89.6% at the end of 2016.
Chief executive Ian Dalton said: “NHS staff have yet again delivered their best for patients in the face of rising demand. More people than ever before are going to emergency departments up and down the country at a time when providers are already having to tighten their belts.
“Some providers appear to have managed the financial pressures better than others. We are working closely with those providers whose financial position has deteriorated seriously to ensure that they grip their problems while delivering the best possible care for their patients.”
He added: “It would be unrealistic to assume the demand which has been building for a number of years is going to reverse. Local health systems need to work together to plan for capacity in future years that can meet the increasing levels of demand that we will continue to see.”
British Medical Association chair Dr Chaand Nagpaul said: “These figures paint an extremely worrying picture, with NHS performance in decline in several key areas. Waiting times targets are not being met, the deficit is much greater than anticipated and there are significant staff shortages.
“It is clear from these figures that the health service just doesn’t have the resource nor capacity to meet rising demand.”
The NHS Confederation said the system was facing “intolerable pressure.”
Chief executive Niall Dickson said: "Our members are at the end of their tether. It is simply not realistic or reasonable to expect the NHS to go on delivering a comprehensive universal service with inexorably rising demand and demonstrably inadequate funding.
"We have lurched from budget to budget with one futile bail-out after another. We think there may be signs that some figures in government and opposition are listening – we hope so, because it is now time for the political class to wake up and tackle the long-term funding of both health and social care.”
Richard Murray, from think-tank the King’s Fund, said: “While NHS Improvement is right to point to increases in demand for services as the reason for the financial difficulties, these are not pressures that have sprung up in the last few months and show no sign of abating. Although the Treasury has provided more money to the Department of Health and Social Care, these pressures raise the risk it will breach its own budget.
“This underlines yet again that after the biggest funding squeeze in NHS history, the service does not have enough money or staff to do everything being asked of it.”

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