A junior doctor’s story about anti-social hours and NHS funding

This is a 27 November 2015 facebook post from junior doctor Rachel von Simson, re-posted with permission

A story about anti-social hours and NHS funding.

I saw a patient with sepsis last night- at 2am to be precise (even though apparently we don’t have a 24/7 NHS). They had been flagged up as septic by the ambulance crew and you get the best outcomes if all investigations are done and treatment is started within the hour. Unfortunately we were short of phlebotomists so no one had taken their blood for tests or put in a cannula before I saw them. Never mind, I can do that. Unfortunately the hospital trust doesn’t give doctors the code for the in-departmental analysers, so I had to wait for one of the phlebotomists to be free to run the samples we can do in department, and the laboratory was swamped, so the other bloods took 2 and half hours to come back, instead of the 20 minutes they do when it is running well.

The patient needed an x-ray. Unfortunately we were short-staffed on porters to take them there (as the patient was too sick to walk and needed to go in their bed). Never mind, I can push them to x-ray- so I did. Unfortunately there is only one radiographer on at night and he was performing an emergency CT scan. So the patient was stuck in x-ray for 45 minutes, instead of the normal 10 minutes.

Finally the patient got back from x-ray. I know the diagnosis, he’s got a line in to receive the treatment and I prescribe it. However on the night shift, we are a nurse short. Despite Jeremy Hunt’s claims to care about patient safety, he has dropped the recommended safe staffing levels for nurses leaving the nurses on our shift covering too many patients. He has also decided to cap the amount agency staff get paid, and at the rates the hospital was now limited to offering in advance for the shift, no one came in to fill the shift. And Osbourne has cut bursaries to train new nurses this week, so the shortage is only going to get worse not better. The nurses who were on were doing a brilliant job, but they couldn’t give my patient the medications immediately and trust policy (plus a lack of access to the IV drugs cupboard) meant I couldn’t give them.

So, although delayed, the patient finally does get their treatment when the nurses are free to give it. I ask them medical doctors to admit the patient, which they are happy to do, but unfortunately there are no beds in the hospital for them. There are plenty of people in the hospital who have no medical problems and could be discharged, but thanks to huge cuts to social care in the community, we can’t promptly and safely discharge them.

The patient has to stay on their not particularly comfortable trolley in A&E, and because they are in that cubicle, I can’t start seeing any new patients yet as there is not a single free cubicle in the department to take a history from them or examine them in. I see some of the more mobile patients in the room we put plaster casts on (asking them to be careful not to get white dust on their clothes) but the older, frailer ones who can’t negotiate their way around buckets and onto the plastering couch, so they have to wait.

The current solution proposed by the government to the above problems is to make doctors work more anti-social hours whilst cutting their pay. In the story from last night I’ve just told, does it sound like having two of me would have helped that patient get the x-ray they needed faster? Got the drugs into them faster? Managed to generate a bed to admit them to? The NHS receives less funding than the OECD average for healthcare, but the current government likes to pretend it is an unaffordable money drain. Instead of funding it properly, it is instead trying to vilify groups of NHS workers and forcing “fixes” that will not benefit patients and will only alienate the existing demoralised and exhausted workforce further. This is why junior doctors will be taking industrial action on 3 days in the next few weeks. Please support us, because (unfortunately) one day almost everyone reading this post will be a patient on the trolley in A&E and we need a properly funded NHS to keep us safe when that happens.

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