Melody Redman: A junior doctor’s perspective of winter NHS pressures

Winter pressures are proving to be a major headache to the NHS.

Winter pressures are proving to be a major headache to the NHS.

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IN part two of a mini-series on the NHS, Melody Redman writes about ‘winter pressures’ from a junior doctor’s perspective.

A PEACEFUL snowy scene, a roaring hot fire, a comforting cooked dinner; these are some of the nicer images we may associate with winter. Look through the windows of the many hospitals across the country however and you are unlikely to find such serene scenes.

Indeed, if you have paid a recent visit to A&E, you may have noticed doctors running around between patients, scribbling notes at the nurses’ station and updating colleagues with plans and requests for treatments to be administered. Staff have been unfairly tasked with having to strike the delicate balance between giving as much attention as possible to each patient whilst managing the significant queue forming behind them.

If you have visited a loved one on a ward this month, you may have observed staff desperately trying to prepare beds in between patient visits to ensure that as soon as someone leaves, someone else can be moved up from the Emergency Department to a bed. A cubicle acts as an appropriate space for patients who are particularly vulnerable or who carry a risk of infection. If one of these becomes available, the nurse-in-charge will breathe a sigh of relief for they are in high demand.

Christmas holidays do not mean a holiday for NHS staff that must organise their family life around unsociable shifts. Despite the busy environment, we will be working tirelessly around the clock trying to do our best for our patients.

Recently I went to see nine-year-old Tim in A&E. Midway through a noon-midnight shift, I was carrying an emergency pager. Each time I enquired about Tim’s problems, I received a bleep on the pager which I had to leave to answer.

This happened three times before I got past some of Tim’s basic problems. Tim’s mum looked understandably frustrated, whilst Tim’s dad kept offering empathetic smiles as I explained needing to answer the pager. Despite doing my best to give that patient my undivided attention, I could not prevent the disruption caused by leaving to go to the nearest phone three times. Whilst I was working to see and treat Tim, I was acutely aware that more patients were being referred to be seen by the paediatric medical team, more patients were arriving at A&E. 

Winter, in hospital terms, lasts far beyond the season. This year, the situation seems to have worsened throughout the country. The latest figures released from NHS England (for October 2016) show that A&E attendances were four per cent higher than they were the previous year. Alongside this, more patients are being admitted as an emergency, more diagnostic tests are being used, and there are a record number of patients who are well enough to be discharged but are delayed, largely due to insufficient social care resources.

The cumulative effective of pressures across the wider health service and a widening deficit is pushing the NHS to crisis point. As a result, much of the elective surgeries, which can help to reduce this deficit, are being postponed.

While it is common for some reduction in elective surgeries this over the Christmas period, NHS England have pushed to reduce the amount even further so as to focus the already thinly stretched resources on managing emergency patients.

In the Children’s Hospital, we have an additional season: ‘bronchiolitis season’. Bronchiolitis is a condition which peaks between October to February and is a particularly busy period. Lots of babies become unwell with a virus affecting the lower respiratory tract and sometimes need oxygen or tubes for feeding. It can be a very scary time for parents as they see their delicate young babies unwell. 

For parents and carers, it is an intensely frightening time when their children sometimes need to be escalated to intensive care. The situation has been not been helped as the national crisis in Paediatric Intensive Care Units has seen some seriously unwell children in some areas of the country wait up to nine hours for a bed or being transported over 100 miles from their homes.

This impact of winter pressures is evident in the wider community. Indeed, a recent survey by the British Medical Association revealed that eight in ten GPs believed that their workload was unmanageable and was having a direct impact on the quality of patient care being delivered. GPs in Yorkshire and the Humber were amongst those with the highest workloads and many of us will be familiar with the frustration of struggling to book a GP appointment. GPs are struggling with the impact of increasing workloads and staff shortages becoming evident.

At the end of what has been a challenging year for many NHS workers, the added winter pressure is another mountain to climb. While rest assured that my colleagues and I will be out there working our hardest this Christmas trying to give patients the best care possible, I can only hope that the Government will take action so we are not in an even worse situation this time next year.

Patient names have been changed to preserve anonymity.

Tomorrow: Hopes for 2017.

Dr Melody Redman is a junior doctor at Sheffield Children’s Hospital.

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