I’ve never seen the NHS pushed so hard. It’s not the system that’s breaking now, it’s the people

The Secret Consultant – The writer is an NHS respiratory consultant who works across a number of hospitals. www.theguardian.com 

This week, the chair of the General Medical Council offered an extraordinary message of support to doctors. What was striking about this was not its tone, but its content. Nowhere was anything said about how to do our jobs, or how to be better doctors; the message was simple. It asked us to be compassionate and to be kind, to ourselves and to one another.

We will need that compassion. This Christmas period promises to be awful, just as tough in some ways as the worst of Covid, and this is what has moved me to write this.

Winter pressures are a feature of life in the NHS. Circulating winter viruses – flu, RSV etc – cause disease spikes each year and result in large numbers of admissions and often deaths. Hospitals fill up.

It has been obvious for months that this would be the case – the “twindemic” of flu and Covid was always going to hit hard – but I’ve been shocked by how unwell patients are, including the young and otherwise healthy, and how our wider immunity has dropped during the pandemic.

There are so many factors combining this year that cumulatively the system is pushed harder than I’ve ever seen it before. There are massively more emergency attendances than usual, with a recurring theme of how unsupported patients feel by their own GPs, even when this is often not the case.

Social care and community mental health provision is wholly inadequate and we are unable to discharge well patients for many days or weeks, leaving patients who do need to come on to a ward waiting in A&E for hours or days at a time.

Ambulances are then unable to unload or respond to new calls, and the patients they do bring in are often sicker after their long wait outside.

In the last few weeks we have been on the highest alert level 4 at least every few days. This usually signifies more than 40 sick patients stuck in A&E, usually for more than 24 hours, all needing urgent treatment but with no ward beds to put them into.

To my knowledge we have not been below alert level 3 since early summer. What used to be a relative rarity even in winter is now depressingly normal. And to add to this situation, we are now facing unprecedented strike action.

Nurses are already striking. In A&E they soak up stress, abuse, staff shortages 24 hours a day; on the wards they are told to take an extra patient here or open up another bay there with no extra staff and no way of closing those beds once they open.

And all of that without anywhere near adequate respect or recompense for what they do.

And our junior doctors will also soon go to a ballot. Their pay on qualification is woeful, given the degree of training and responsibility they carry. Covid disruption and the current pressures mean they are often denied the mentorship, teaching and camaraderie that cemented my love of medicine, and as a result their job satisfaction has plummeted.

I have seen a marked deterioration in their mental health and I hear about their financial worries much more than I ever used to. More and more of them are taking career breaks. I would be amazed if they did not vote for further industrial action.

And how does NHS England suggest we respond to these strikes?

They suggest that hospitals move patients out of emergency departments in preparation, or open extra beds. Oh, and try not to cancel any planned care while you’re at it.

To say I find this insulting is an understatement. It shows a total lack of understanding of what things are like in the average hospital and how hard we work, every day, to move patients onwards and protect planned care.

Do you not think we’ve already thought of that? It deflects responsibility for the problems back to individual teams and implies we’ve not already been doing everything we can. If only we would stop being so sluggish then it would all be fine. I found that statement as notable for its lack of compassion towards the workforce as the GMC’s one was for its warmth.

We are told that the NHS is at “breaking point” and has been for years, underfunded and poorly planned by successive Conservative governments.

But this is different. What is breaking now is not the system, but its people, and in a rapid, tangible way.

I regularly see colleagues in tears. Every few weeks I hear of someone else I know who is leaving, retiring early, going part-time, moving to a less stressful area.

All the time I hear how things have changed, that the pressure is too much now, that we wouldn’t recommend our children to do the jobs we do.

The pandemic has accelerated this and we need compassion more than ever. While I regularly see this from our patients and the public, it is notably absent from our leaders.

Most of all, though, we feel taken for granted. The expectation seems to be that we should just continue doing what we do – without proper appreciation or support – because we are the NHS heroes and that our work is some noble vocation that should sustain us regardless of how hard it may be.

And so these strikes are not just about pay. They are also a cry for help, a critical symptom of a stressed and failing workforce. Perhaps, if we were shown a little more kindness by those in charge, there would be a way forward.