View from A&E: Cracks are showing on the NHS frontline

An elderly patient arrives by ambulance. The doctor or nurse who meets them tries to find a spare cubicle, but none is free since there are already eight patients in the emergency department waiting for a bed on the wards. Some have been there for several hours.

At the same time, one of these patients calls the staff member over, saying they feel sick. Meanwhile, another two ambulances have arrived. Everyone is busy.

What does the staff member do? These needs are immediate. The ambulance crews can’t leave for the next emergency until space becomes available to hand over the patients. This may involve moving other patients into the corridor. Nobody wants to do this, but what is the alternative?

As an A&E doctor – or nurse – you go home exhausted and frustrated that you couldn’t deliver a high enough standard of care because of overwhelming pressures on the system.

I have worked as a consultant in emergency medicine for 10 years. I couldn’t be more proud to work in the NHS. But I’ve seen huge changes and a relentless increase in the challenges facing frontline staff.

We’ve made remarkable advances in healthcare. Survival rates for diseases that in the past were seen as death sentences, have increased dramatically. That people are living longer is, of course, to be celebrated, but it also means more people living with life-long conditions and increasingly complex medical needs.

The NHS has coped well, so far. But cracks are beginning to show. In emergency medicine, we’re used to “winter crises”, but we’re now seeing a spring, summer and autumn crisis in our emergency departments.

No doctor or nurse wants to deliver less than the best care; but what do you do when your department is understaffed and overcapacity?

Many find this daily scenario unsustainable and move to work in a less stressful speciality, or even abroad.

If NHS national strategy continues to be driven by short-term five-year plans, rather than 10- to 20-year plans and long-term investment, then the service and patients will suffer the consequences.

Dr Walsh is a consultant in emergency medicine in London and the speciality lead for emergency medicine, BMA Consultant Committee