"The worst conditions in memory": NHS doctors describe their week in A&E

The Guardian asked a number of doctors working in A&E departments across the country to explain how their departments have coped over the past seven days, said to have been the worst week ever for NHS emergency departments. These are some of their responses:

‘We are devastated by underemployment’

It’s been like an absolute war zone recently. The government at the moment, not to mention my regulatory bodies, are ignoring the worst hospital conditions in my memory. We have a brilliant team, but are devastated by underemployment and underinvestment. We have two permanent registrars on a rota of seven places.

On a recent shift, I walked in to patients waiting four and a half hours to see a doctor. This means every patient has failed the “breach” target by the time they’re seen. A diligent staff nurse asked me to take a look at a patient she was a ‘bit worried about’. The woman was devastatingly ill with a perforated bowel, and could have easily become fatally unwell. She survived thanks to the observational diligence of my colleague, and later our excellent surgical team.

The London ambulance service is similarly overwhelmed. They couldn’t provide me with a transfer ambulance for another emergency case, and 11-year-old with a sight-threatening infection, in less than 70 minutes. The target is eight minutes. It is a miracle the child didn’t lose an eye.”

‘Nothing can be done’

Our hospital is crumbling and is unsafe on a daily basis. On Thursday, there were 75 patients in an department that has 18 majors’ beds. Thirty-five of those were medical patients awaiting beds, 20 hadn’t been seen as there was nowhere to see them or no staff to triage them.

We have expressed our concerns verbally, via formal emails to trust, incident reports etc, but nothing can be done as it can’t elsewhere either. Medical professionals are talking about quitting as they believe soon someone will die on our watch … [It is] completely out of control. Maybe it has already happened and we just don’t know. I’m talking about a cohort of 11 doctors. God knows what people feel nationally. It scares me what we are heading for.

When a family member got admitted last weekend I panicked, not because it was that serious but I actually felt they may not be safe in hospital.

I am angry that it is being ignored and swept under the carpet. I am angry that we are left to pick up the pieces and apologise for a system we’ve put our hearts and souls into, but now have no control over.

‘It’s not acceptable to practise medicine in this way’

This past week in A&E has been horrendous. There are no beds in this busy teaching hospital. There are more than 20 patients queueing in the corridor at any given time. We’re seeing, treating and discharging patients in the queue. It’s undignified to ask a miscarrying pregnant woman about her blood loss in a queue, never mind in one filled with loud drunks. It’s just not acceptable to have to practise medicine in this way, but what choice do we have?

Patients in the queue have a substandard quality of care. Fact. So much for calling 999 in an emergency, then waiting an age for the crew to arrive because they’re all waiting in the corridors of A&E to unload patients. Even once you arrive at the department with said emergency, you’ll be waiting hours for any sort of assessment or treatment. My collusion in this depravity is solely in an attempt to keep my patients as safe as possible, but mistakes are being made and this is not sustainable.

‘We were truly swamped’

I was on call at night for the last week at a small district general hospital. We had to put the hospital on divert. There were 15 ambulances waiting for entry and consultants doing their assessments in the back of them. On surgery, despite phenomenal work from the registrar on call, we were truly swamped.

‘These are just some of my experiences this week in A&E …’

A four-bedded resus unit expected to make capacity for eight patients; leaving a shift to come back 24 hours later and finding some of the same patients still in resus; being in charge of the emergency department [ED] overnight with rota gaps; and requesting a divert for a few hours to allow us to catch up, only to be told that the policy has changed and capacity issues now had to be dealt with internally.

‘Everybody is terrified’

In the accident and emergency department where I work there is provision to keep up to 12 people overnight in case the wards are too full. On Tuesday night there were 27 sick patients all requiring hospital treatment who were kept on corridors and in the laundry room, being cared for by three nurses and one doctor.

It’s normal at the moment for 20 to be there overnight. We are having to send patients home we would rather admit, with little to no access to social care. Everybody is terrified. Everybody is waiting for something terrible to happen, because no matter how hard you work, there are too many cracks that are widening for patients to slip through. Stafford is where everything went down a few years ago. It seems the same situation is now happening on a nationwide level. I hope desperately that nobody I love or care about needs to be admitted to hospital right now. I just can’t believe how bad it is compared to last year.

‘The entire system is crumbling’

There are not enough staff and 12 ambulances regularly sitting in the corridor. There are designated corridor nurses. In this ED the patients can wait for eight hours. The emergencies do get seen first, as do the strokes, and the triage nurses pull the sickest out the corridor but sometimes they are seen in the corridor. A consultant is designated for the corridor to ensure safety.

A consultant has been staying overnight often lately due to the safety concerns, but that is unsustainable and they are burning out. No one is bothered about breaches anymore, it’s the 12-hour trolley waits because the CCG [clinical commissioning group] has to know then and trust board get involved. The entire system is crumbling. On New Year’s Eve our hospital asked for a divert when the wait was eight and a half hours with only 14 ambulances left on the roads in Merseyside. This is not uncommon. The divert was denied because the wait was not the longest, and every other department was in the same situation.

‘We have a daily lack of beds’

I’m a registrar in one of the busiest emergency departments in the country. This past week saw our busiest day on record with nearly 200 people waiting in our department at one point. There was a five-hour wait just to be seen, and a 14-hour wait for beds. I have people queuing to get a space in resuscitation and it regularly becomes dangerous. We have a daily lack of beds due to poor flow of patients out of hospital backing up to the emergency department. Patients are coming to harm and there are undoubtedly deaths arising from the current state of emergency medicine.

"The worst conditions in memory": NHS doctors describe their week in A&E

"It was manic": patients describe meltdown at Worcestershire hospital

The ambulance arrived swiftly, and within an hour of suffering a stroke early on Monday, 66-year-old Pauline Freeman was on a hospital trolley at the Worcestershire Royal hospital.

From then on it went less smoothly. “My wife woke me up at 4.30am and said she couldn’t feel her left side,” said her husband, John. “The ambulance was there in record time and she was on a trolley at the hospital by 5.30am. And there she stayed.”

For 54 hours.

“It was horrendous,” he said. “The nurses did all they could but the place was in meltdown. It was manic. There were at least 20 people on trolleys. It was very difficult to manoeuvre around them. A porter told me they were putting some patients in a decontamination room – basically a big shower room – to cram in more beds. They ran out of pillows and blankets.”

John, from Worcester, said his wife was close to a doorway and was woken every time it opened. At one point she was moved to the plaster room so she could get some peace. He said they struggled to get enough for her to eat. “I went and got her a sandwich and a flask of tea.”

He said he had written to the hospital and his MP to complain. “They should kick the executives out of their offices and put in more beds,” he said. Pauline eventually made it to the stroke ward on Wednesday. Her husband said recovery would be a long process. “What she has gone through will not help.”

The difficult conditions were echoed by others. One woman who was at the hospital on the evening of New Year’s Day said the corridors looked like a war zone.

Another, Sharon Shepherd, said it looked as if the hospital was dealing with a disaster. She had a six-hour wait overnight on Wednesday after her daughter Mollie, 12, injured her foot in a gymnastics session.

“The corridors were lined with patients, with elderly people being treated. The place was rammed and ambulances kept coming,” Shepherd said. “The doctors and nurses were brilliant but they were rushed off their feet. We counted 10 to 12 trolleys on one corridor alone. It was horrendous. It was if there had been a major incident.”

Shepherd said she would have taken Mollie to the minor injuries unit near her home in Tenbury Wells, but it shuts at 9pm. “We had no choice but to go to Worcester.”

Other patients and relatives described their experiences on social media. Sharon Reeves said when she went to A&E with her son they saw elderly patients crying for help on the corridors. Liz Morgan said her mother was in severe pain but could not even get from the ambulance into the building because it was so busy. “I get the nurses are doing what they can but we need another hospital,” she said.

Keith Gormley, 74, has spent many hours waiting in corridors at the Worcestershire Royal. At the end of last year, his wife, Jackie, said he had to wait for 27 hours to be seen. On Thursday it was a more manageable three hours after he had problems with his pacemaker.

Jackie, 72, a retired social worker, said: “We came in at 8am and had a long wait in the corridor to be seen. We were worried it was going to be like the last time we were in hospital on 29 November, when we had to wait 27 hours to be seen. On that occasion we told the staff about his heart problems but he was just left in a corridor.

“Something needs to be done to address the issue because it has been an absolute nightmare.”

Worcestershire Acute Hospitals NHS trust said the trolleys were not hard metal contraptions but A&E beds on wheels, and insisted patients were treated and monitored while on the trolleys, not left to wait.

It said the corridors in question were within the enclosed emergency department, not general corridors. The level of care was not what it would like to provide, it said, but the alternative would be to turn patients away.

A spokesperson said: “Our focus continues to be on providing safe emergency care, however we do recognise that long waits in our A&E departments can cause distress and for this we apologise. We would reiterate that A&E patients continue to be seen and treated in order of clinical priority.”

"It was manic": patients describe meltdown at Worcestershire hospital