An open letter to the government from a concerned doctor

As a GP, Dr Kath Fielder believes the NHS is facing a mounting crisis – and that something needs to be done urgently

Covid-19 is not wholly to blame – the NHS has been struggling for a while (AFP/Getty)

As a GP, part of my role is to advocate for patients. However, during my training I never anticipated that in order to do this I would be compelled to write a public letter to criticise the government.

I want to clarify that in describing examples of the gravity of the situation, I direct no blame at those people who are working in horrendous conditions to give the best care that they possibly can. Covid is also not to blame. It made things a lot worse, but I believe the destruction of the NHS was already under way well before the pandemic. In addition, I do not believe that the recent “musical chairs” surrounding the Conservative Party leadership has the potential to change anything fundamental about the core values of this government.

The combined service of social care and the NHS is just not working, and patients and staff are coming to unnecessary harm as a result. The fact that it doesn’t work is due to a chronic lack of resources and a huge increase in demand. I believe this is deliberate: the health service is already being privatised. The £34bn promised in the 2019 Conservative manifesto has not made it to hospital wards and community services. Combine this with contracts being given to private businesses and the deliberate dismantling of services, and the result is that good health – along with the ability to access care – is now directly proportional to income.

We are told that there is not enough funding for the NHS. I am convinced that there is enough to run core services effectively. But while we have a government that sees no value in investing in the health and wellbeing of the people of this country, the NHS will not survive. The endless deception and empty rhetoric are becoming increasingly difficult to take, and I wanted to share my experience of working under this government, and what it is doing to my patients and colleagues.

I work in the North East, and over the past 10 years, I have seen a huge deterioration in the services available and how well those services are run. I love being a GP, but it is heartbreaking trying to piece together some sort of decent service for my patients with the available resources. I frequently ask people if they can afford private counselling or physiotherapy.

Most of the time I’m furious that things are just falling apart. My colleagues are exhausted and frustrated; they are having to deal with increasingly distressed and angry patients, within a system that is absolutely not fit for purpose. So many staff end up going above and beyond every day just to try to get a decent outcome for patients, even though it often means staying later or going out of their way.

When I’m working, I keep getting a mental image of a machine in which the cogs have been replaced with gradually smaller and smaller ones, so that ultimately they just don’t fit together any more and nothing is moving, no matter how frantically the cogs are turning.

There is not enough money put into the NHS to run it effectively. Analysis from the NHS Confederation has identified that the NHS is facing a funding deficit of between £4bn and £9bn (depending on different inflation measurements). I didn’t have a decent understanding of how massive a billion is until I learned to picture it in a different way: a million seconds is 12 days; a billion seconds is 32 years.

This chronic lack of investment manifests in the reduced quality and number of overall services, with longer waiting times and cuts to the range of medicines available. We’ve seen the loss of initiatives such as exercise on prescription, and an increasing number of treatments are only available after successful individual applications for funding.

However, in recent months it has reached scary and unprecedented levels: ringing the hospital switchboard and being told you are number 13 in the queue just to speak to the operator. Making an urgent referral to the neurosurgeons for someone with an abnormal MRI, only for them to be offered an appointment in four months’ time.

Referring a young person – who has finally built up the trust to speak to me – to Child and Adolescent Mental Health Services, only to be sent an automated letter back telling me to send them to the school nurse (who, incidentally, is one nurse now covering four schools, and only attends one day a week). Patients waiting much longer than the required two weeks for a test for their breast lump, and, after a series of cancelled scans, finding out that their cancer has now spread.

So frankly put: if you are poor, you are more likely to be in poor health and to die younger. This is shocking. How often are we told that there just isn’t money to make things better?

Patients who work in the NHS presenting to me in crisis, as they simply cannot function due to the stress of the workload and the crippling anxiety and guilt as they can no longer provide the service they know they should. Managing patients who are very sick in the community, because they absolutely do not want to wait in A&E for 12 hours and I don’t want to add pressure to the service, so I see them daily until they are better.

Checking the online system for results for patients who have been to A&E, as so often blood tests are taken but not chased up or communicated in the discharge letters. Patients not being listened to because clinics are overrun, and the staff are just trying to get through the workload. Patients being discharged home when they are simply not ready, because the hospital needs the bed, only to be readmitted a day later.

We are now at a record high for waiting times for routine procedures. NHS England data for September 2022 states that more than 350,000 people are waiting more than a year to start treatment. This is leaving patients in pain and often unable to work. It’s not uncommon to develop depression or anxiety when you are unable to function for such a long time, which then has a knock-on effect in terms of recovery and future ability to work and be well.

Ambulance waiting times are getting significantly worse. The last time I rang 999 I was on hold for five minutes before I spoke to the ambulance operator. Data from NHS England for August 2022 shows that the ambulance wait for a category 2 ambulance (serious condition, eg stroke or chest pain) was 59 minutes. The target is 18 minutes. Recently in my area, they have been taking two to three hours. A great credit to the service is that despite the chaos they are working in, ambulances achieved an average nine-minute response for life-threatening conditions such as heart attack or stroke, with the target being seven minutes.

A huge factor in these delays is that paramedics taking a patient to hospital by ambulance must stay with the patient until they are seen, so there are a lot of paramedics stuck in hospital waiting for patients to be seen instead of being on the road.

As well as people queueing to get into hospital, they are also often waiting far too long to leave. Due to the reduction in social care services in recent years, there is a lack of care home beds and carer capacity in the community to allow patients to be discharged safely with the extra support they need. When I worked in a community hospital 10 years ago, we would arrange home visits with patients and the occupational therapist to make sure they were safe in their home environment and to highlight any additional aids that could be put in to help them when they got home. There is no longer funding for anything like that now.

Council leaders are warning of a £3.7bn shortfall in funding for social care over the next 18 months. Care providers are handing back contracts as they are unable to fulfil the demands because of a lack of staff and increasing costs.

Carers do a vital job on woeful pay. They are working under huge stress, doing the best they can on extremely tight schedules, leaving our most vulnerable with a service way below what they need and care staff feeling anxious and distressed by the workload. I’ve heard of people leaving the posts for supermarket jobs, which have higher wages and related perks such as free food.

As well as chronically under-resourced services and a service struggling to function; we are experiencing the highest level of demand ever seen in the NHS. People are living for longer, and with that comes more complex medical conditions that are being increasingly managed by the GP rather than by hospital specialists.

After the collective trauma of the pandemic, we have so many people suffering from mental health difficulties, significant trauma and grief reactions, as well as delayed presentations because of difficulty accessing their GP and worries about Covid. The reduction in available resources also means that too many patients are inadequately treated with a service that takes months for them to be seen and may well just be a telephone call. Patients are feeling dismissed and let down.

The NHS is losing staff, and almost 10 per cent of permanent NHS posts are vacant. I have seen many patients and colleagues who have had to leave their jobs because it was genuinely making them ill. Nurses are doing the job of four people without any reflection of this in their pay. Their workloads are growing, and patients are becoming angry at the delays and cancelled appointments.

There has been a call for help with the cost of living crisis for NHS and social care staff, and government action is needed.

The then prime minister, Liz Truss, was in possession of all the above data when the plan was made to cut taxes for the richest in our society. This decision was withdrawn following a widespread outcry. Not because of a change in ethics or values, but because of opposition. Truss eventually resigned.

When the NHS was founded, it was based on three ideas: first, that the service would help everyone; second, that healthcare was free; and finally, that care would be provided on the basis of need rather than the ability to pay.

My patients on lower incomes are actively punished by the current system. Apart from the obvious financial barriers to accessing care and living healthily, there are other issues, which are seen far more frequently in areas of deprivation. Many patients simply do not have enough money to pay for transport to attend scans and appointments, or to pay for prescriptions. I have had patients who are working at least two jobs and still need to use food banks. The very fact that universal credit takes weeks to come through illustrates that it has been designed by people who have never had to worry about paying monthly bills.

The government and sections of the press have been cheerily deriding any form of empathy, and not only scapegoating the vulnerable but actively encouraging public blame

Recent data from the Office for National Statistics reveals that being born in the poorest areas of England reduces your healthy life expectancy by nearly 20 years (19.3 years for females and 18.6 years for males), with women in the poorest areas dying on average eight years earlier than in the richest areas.

So frankly put: if you are poor, you are more likely to be in poor health and to die younger. This is shocking. How often are we told that there just isn’t money to make things better? They tell us the funding isn’t there.

In response to the anticipated comments about payment of benefits: it is vital to understand the discrepancies in psychosocial functioning that are also related to income and deprivation. Repeated studies show that the burden of trauma is much higher in those from lower-income backgrounds.

I don’t think many of us are aware of the realities of daily life for many British people, and the extent of trauma or poverty in some areas. I have had a patient who was born after their dad kicked their mum down the stairs when she was pregnant. Young people who have had to live in constant fear of violent parents, and never feel safe or loved. Children needing multiple teeth removed in their early teens due to widespread dental cavities from neglect.

The mental health services in the NHS are also just not able to provide effective trauma therapy or addiction support to patients in need. I would never suggest that these events are only seen among more deprived populations. Tragically they occur throughout all social groups; but from the evidence, and my repeated experience, they are significantly more common among those living in poverty.

Plans were under way for a long-overdue white paper on health inequalities. With all the changes in government, the future of this paper is in doubt – but it is vitally important it is not scrapped.

This systematic de-functioning of services has been occurring against the backdrop of what I see as an insidiously growing culture of blame and selfishness. The only thing to trickle down effectively from this government is the belief that compassion is a form of weakness, and social justice a childish notion to be derided. We have been encouraged to believe that resources are scarce; to see our fellow countrymen as competitors, and to take whatever we can for ourselves while hissing and sneering at anyone who is struggling and seeking their fair share.

The government and sections of the press have been cheerily deriding any form of empathy, and not only scapegoating the vulnerable but actively encouraging public blame.

We are repeatedly told that the funds for core health services aren’t available, and jokes are made about money trees. The money is always there when they want it. A report from the parliamentary committee of public accounts in the summer said that the Department of Health and Social Care was still in dispute with PPE suppliers on 176 contracts worth up to £2.7bn, having spent billions more on the equipment during the pandemic.

The amount that would have been lost to the Budget, with its proposed tax cuts for the richest, would have been billions more. Why aren't we prioritising and protecting NHS services above all else? Support for the vulnerable should be the absolute last thing to lose funding, held above our heads as the water creeps up.

People often say that all political parties are the same. This is simply not true. I believe we have never had a government so destructive to the NHS and other public services, or one that shows such contempt for the British people.

If the Conservatives win the next election, I believe it will be the death of the NHS as we know it. Don't be fooled by the bewilderingly rapid changes in the face behind No 10; I have no faith that anyone in this party can change that path. Through what I see as the deliberate defunding and dismantling of the NHS and social care, we already have a two-tier healthcare system, and they are on the brink of privatising it fully. Look to the state of the dental industry to see where things are headed if nothing changes. Their actions over the past 10 years have already shown us where their priorities lie.

As I said at the beginning, I am not blaming any of us working in the NHS or social care for this situation. I genuinely don’t know how we could manage things differently, and I know everyone is doing their best.

I write because I want to explain, to share my experience, and to communicate how desperate it is. But I also want people to know that I see the inadequacy, and the suffering, and that I am so sorry. You absolutely deserve better than this.

Dr Kath Fielder is a GP and a spokesperson for the advocacy group EveryDoctor