I’m an NHS doctor and my first word to patients is this – sorry

In all my years as a doctor, waiting lists have never been this bad

The NHS does some incredible things and is nothing without its staff, but the buck must stop with government

“Hi, I’m the doctor. First I need to apologise for how long you’ve been waiting.”

An apology is now the default way I introduce myself to patients in the busy emergency department where I work as a consultant. An apology for the shortage of beds, an apology for the shortage of staff and most importantly for the person in front of me, an apology for how long they’ve waited, in pain and distress, to be seen.

When I began my training in emergency medicine in 2007 I never saw a patient waiting in a corridor. The four-hour wait target – where we aim to admit or discharge a patient within that time frame – was a minor source of stress, but we hit it. Nearly all of our patients were sent home or in a ward within four hours. But that target doesn’t seem to exist any more. It’s a distant memory. Hell, we don’t even hit the 12-hour target now.

And that’s not just my hospital. In January, the number of patients waiting longer than 12 hours in England’s A&Es hit 17,000 – a record high and seven times more than before the pandemic in December 2019.

It’s not uncommon at the start of the day in emergency medicine to walk into a department that’s full of people on trolleys waiting for hospital beds, who have been waiting there all night. You start the day completely gridlocked, with your entire A&E at a standstill.

In the meantime, more patients are coming through the doors, and so the waiting times go up and up. And then, when you’re short-staffed on top of that, you just feel like you’re climbing uphill in treacle, and you’re never going to reach the top.

The National Institute of Clinical Excellence recommends one nurse to four patients in A&E. Our department aims to have 15 or 16 working at any time, but it’s not uncommon that we only have 12 trying to look after 100 patients at a given time – double the NICE recommendation. Likewise, we try to have 15 doctors on a late shift, but we are always one or two short. Just last week there was one evening where we were four doctors down, a third fewer than our safe staffing target. When you consider these targets themselves are outdated, based on historic demand, and not reflective of the pressures in our hospitals today, you realise how deep the NHS workforce crisis runs.

This week the Lords will debate an amendment to the Health and Care Bill that puts a legal duty on the government to produce regular independent assessments of how many staff we need in the NHS and the care system to meet the needs of the population in England. Workforce planning cannot be done in the dark – without a shared national picture of the numbers of staff we need, we won’t know whether we are training enough healthcare staff to meet demand. The need for this amendment is evident by the almost 100 expert organisations backing it, including the British Medical Association, the medical royal colleges and dozens of charities and thinktanks.

But as those in the corridors of power discuss this issue, it is staff and patients in the corridors of hospitals who bear the brunt of chronic workforce shortages.

No doctor or nurse goes to work to provide bad care. We turn up every day to do the best job we can for the people that need us. And so it’s horrific when we’re looking at people queued up in corridors, sometimes for hours and hours, knowing we can’t do anything to help them because each doctor can physically only see one patient at a time. And we have to prioritise.

But it can be hard to differentiate between people who are all very sick, and who needs seeing first. There’s always this worry that you’re going to miss something or you’re not going to get to somebody quick enough. For people who’ve had strokes, heart attacks or might have sepsis, these decisions are the difference between life and death.

The Royal College of Emergency Medicine recently put out a document called “Crowding and its Consequences” which estimated over 4,500 patients a year die because of overcrowding in A&E. My colleagues and I have all read that report and we go into work with it in the forefront of our minds, wondering who will be impacted today.

During the pandemic, we’ve had to be very careful about not mixing patients who have Covid and those who don’t, and so A&E departments have been split into “red” and “green” areas, making the whole situation worse. When you have queues of ambulances outside you have to decide who you’re bringing in first. My decision at that time has to be based on who is potentially not going to survive the next few hours? And on one occasion, one of the patients I left outside in an ambulance was a five-year-old boy, because I had another patient with Covid who was elderly and therefore less likely to make it. Leaving a small child waiting in ambulance like that is far from appropriate care.

The word “safe” is banded around a lot in the NHS. People will frequently say during a shift that it feels unsafe. That is a strong word. How many people willingly would choose to do a job where they regularly feel unsafe?

This leaves a marker on you as a clinician. We are people too, and facing these kinds of awful dilemmas each day, while working gruelling hours and covering the work of two or three people at once, leads to burnout and people walking away.

But we mustn’t let politicians blame this on the pandemic. Things have been growing increasingly worse for the NHS over the last decade – just look at the Red Cross being drafted into hospitals in the winter of 2017 – but Covid-19 has accelerated the crisis. The situation we are seeing right now is what happens when a pandemic hits health system that is operating at 100 per cent capacity with no let up in the system.

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And so if we are to fix this – recovering from Covid-19, tackling the record and growing backlog in treatments and delivering the levels of care people need – we need to prioritise recruiting and retaining enough staff. With unsustainable workloads, attacks on our pay and pensions, and plummeting morale, it’s no wonder England has 50,000 fewer doctors than it needs – and a recent analysis estimated 400 healthcare workers are leaving the NHS each week. My colleagues are voting with their feet, either by reducing their hours, retiring early or departing for sunnier climes and higher salaries in the likes of Australia.

The NHS does some incredible things and is nothing without its staff, but the buck must stop with government. Ministers are ultimately responsible for ensuring the safe staffing of our most revered public service, and it’s time that they sent a strong message that they are willing to be held accountable – starting by dropping their solitary opposition to Baroness Cumberlege’s amendment when it is given the chance to become law this week.

The writer is an emergency medicine consultant at a busy hospital trust in the north of England