The waiting room was ram, I've never seen it like that.
It's like a really horrific board game and you can never quite get past one place
on the board.
Yeah, the NHS is on its knees.
We've got another busy day ahead of us,
so let us start with ED please, Dan.
Staffing wise, so we're six nurses down today
currently we've got 58 people in the department.
The cardiac patient in ED that's 12 hour breached is Covid positive.
So we are under pressure this morning,
if anyone needs anything to help expedite discharges please let me know.
Thank you.
This is everybody that's in ED waiting for a bed.
I cannot remember the last time there was no one on this board.
So this is the new normal?
It is I'm afraid, yeah.
We're in an absolute kind of cycle at the moment
where we just cannot release enough beds in a day
to pull patients through the emergency department in a timely manner.
I think the difference this winter is people didn't have a break in the summer,
so there was no let up in work and also we are coming off the back
of two Covid winters.
We lost a lot of staff,
so I think people are tired and I think there is a natural
dread is the wrong word, but I think people are –
I'm anxious and I manage the site and I'm anxious about what winter might bring
and how much worse all of this could look.
What's on the menu today?
Nothing interesting, jacket potato and beans
and who don't like a bit of cake and custard?
I'm in hospital a lot, I'm in like three or four times a year sometimes
and this is the first time that I waited as long as I did
and I'm prioritised because of how severe my breathing is
and I've had intensive care admission.
The waiting room was ram,
I've never seen it like that.
Trolleys we're just piling up in the hallway.
I was in A&E well over, I'd say about 16 hours before I got a bed on the ward.
The NHS needs to be given a bit of a break,
you know they are working hard and I think they're amazing.
Emergency ambulance is the patient breathing?
And was anyone thrown from the vehicle?
Is the patient awake?
We're going to have to get her an interpreter.
But you can call the police if you'd like, but we are going to let them know as well.
The average at the moment between 30 minutes and 40 minutes.
We'll be there as quickly as we can.
Unconscious, near fainting, in-effective breathing.
We're busier than we've ever been, we are worried,
we're worried because we're not able to give
the care to all of the patients that come through that we want to.
We've got increasing numbers of patients coming to the emergency department,
some absolutely have life-threatening needs and need to be here,
some who just aren't sure where to go when they need help.
We don't keep them in the back of the ambulance,
but sometimes we have to hold the crews with them
because we have no trolley to offload them.
While the team are desperately trying to make a bed in the hospital
to get a patient out every day.
In the 10 minutes that we've been talking, another four ambulances have arrived.
I'll need to head back in now and see what we're doing
about pulling patients out of the department to offload those ambulances.
Good afternoon everybody let us start the 12:30.
Still got busy department in ED and ambulances to offload.
So we've got 106 in the department at the moment and the longest wait is two hours.
We need to move at some significant pace,
it's Tuesday afternoon we know that we're going to be ramed.
We have got four in ED to place, two that will be going out imminently,
no one's going to theatre yet.
As an industry, you know, we're chronically short staff like all of the NHS is.
There is a national shortage
of operating department practitioners and anaesthetic nurses.
You would really want a waiting list not to have anything significant on it,
you certainly don't want a patient coming to harm on a waiting list.
Obviously shutting down over covid meant that we had an increase in the waiting list,
because no one was treated at all.
Yeah.
What we're doing is
putting an awful lot of extra elective lists in order to deal with backlogs
and asking the staff to step up and take those on as extra work,
so it's over time.
Now we don't have anyone who's waited over two years,
so we've cleared those and we're now concentrating on the groups below,
but I foresee that happening for years to come.
I don't think this is something that's going to go away.
I've never seen so many people walk through the door.
Take care, stay warm.
Hiya.
Hi, how are you?
I'm fine, how are you?
We're getting people coming into us when they're struggling to get appointments with their GP,
we're getting people coming to us because they're frightened to go to the hospital
and actually they're very seriously ill but they just want some advice.
So I almost felt like we became a sort of mini A&E in our pharmacy,
we're seeing lots of different types of people with lots of different elements.
Sometimes it's minor illnesses, sometimes it can be even more serious things,
they've got chest pain, they've got an ulcer or a wound that they're worried about.
Lots of mental health problems are really coming into our pharmacy
in a way that we've never seen people come in before and ask for our advice.
How are you with needles and things like that?
Do they bother you?
Community pharmacy has faced a funding squeeze since about 2015
and in the last three years we've had a contract that had no inflationary increase.
So about a quarter of pharmacies at the moment in England are facing financial deficit.
So we've never been busier, yet we can't afford to keep going.
Can you hold that up for me.
I've got this here, pop this on your finger.
Well I think there's an obvious and apparent decline in the service,
the NHS as a service, as a whole.
What we're seeing is more difficulty for patients so you can get just a basic appointment.
Good.
To see what's happening now is actually really more than a tragedy,
it's actually I think it's criminal the way it's been ...
Left to deteriorate, you know, it's a political decision as well.
I could say a lot more, but I won't, because I know I'll get really angry.
The main stress in general practice is time.
Over the last 10 years or so the number of GPs hasn't gone up,
but the complexity and the sorts of work that we're doing as GPs has gone up massively.
Pop your chin forward, how does that feel?
Yeah.
Pop your head back as far as it will go.
And here.
The bottom line around pressures for GPs has actually made the job impossible to be full-time
and we have no full-time GPS at this practice at all.
That's okay, up here.
Yeah, yeah.
That's where it's sore isn't it?
A lot of my colleagues retire early simply because they just cannot keep up with the pace
and they're worried, they're frightened that they might miss something serious.
Delays for patients in being seen undoubtedly doesn't just have a psychological toll on them,
it can have a physical toll on them, in that their condition can worsen
and in some cases may even be untreatable by the time they're seen.
It's a real concern this winter,
because you can see the number of infectious diseases going up and up and up
and I can see us getting up to you know red alert and what we call black alert,
sometimes when, you know, we're actually overwhelmed with patients.
We need more doctors, we need more nurses we need more allied health professionals,
there needs to be more give in the system otherwise it simply can't go on.
Good news.
Good news, exactly.
Yeah I've been in this room now for about, 3 months.
It would be nice to get out, yeah.
I went through a [unclear] and collapsed.
So I was taken into the intensive care unit,
where they diagnosed my [unclear].
How are you feeling today?
Well as well as I can, frankly.
I mean it's a bit of a blow up isn't it?
You know, I've always really been healthy,
but now I'm more of an invalid really.
We haven't got a day for me going home, but there's a lady in today observing.
She's from the care company, she's about the fourth person to come in.
It's imminent but it's not quite there yet.
Did you know much about the social care, you know, the crisis in getting care?
No.
No, all this is new to me.
Yeah.
We're following up for the first time.
My breathing wasn't very good and then it turns out that I had covid.
I had the three vaccinations,
but I did have the flu the flu jab as well.
That saved my life really.
When they said to me I had to come here and go on a ventilator, I was horrified,
but, you know, they said that was the way to save me.
They had to collapse my lungs down and let the ventilator do the work.
And do you have any sense of how long you're going to be here?
No, not at the moment.
But I don't think it's a five minute recovery.
Let's start 4:30, so Richard, medicine.
I'm afraid our numbers are very poor.
The challenge is about people getting out to match our demand.
I joked about it, you know, we need to get the army to open the Excel because ...
Yeah we are already struggling.
Beds wise we have very little.
Our community services is sort of come to a standstill
and obviously if we could push people waiting for care homes and things to move,
we then we could manage.
But in our care of the elderly at least we've got over 40 patients,
that shouldn't be here, but obviously there's no where for them to go.
So we've got 137 patients in the department at the moment.
We haven't managed to clear enough beds to manage the emergency patients coming in today.
Some days it works, just and some days it doesn't work at all
and today is one of those days.
Neurosurgery is full, stroke definitely one.
I mean it's a horrible juggling act, you know,
to do this day in day out for people it is really really tough.
I mean we're gonna have a tough old morning tomorrow aren't we?
Based upon what we've got tonight so we will do it all again in the morning.
Have a hearty breakfast.
Discharging is still open until 10 otherwise we'll see you all in the morning,
thank you very much.