Is the NHS really facing a humanitarian crisis?

The NHS is hitting the headlines daily at the moment. This is not surprising given that we are in the midst of winter, which always seems to bring bad NHS news stories and is a time when photos of patients waiting on trolleys in A&E corridors crop up more frequently in the news and on social media. Even the Red Cross, which seldom speaks up about the NHS, has warned of a “humanitarian crisis” following trusts reporting overcrowding in their A&Es.

There is no escaping the fact that the NHS is under immense pressure and this winter feels slightly more wearing than any other. Comments such as “unprecedented” and “record” levels of demand are correct, and reflections from clinicians that pressures in A&E are “the worst I can remember” ring true.

It is therefore right that we acknowledge and raise these concerns, but we should also be wary of frightening patients and undermining public confidence. The four-hour A&E waiting time standard is widely known but the reasons behind a breach of this standard are complex and, as our recently published briefing explores, if taken in isolation does not necessarily paint an accurate picture of the standard of care being delivered.

One thing is definitely clear – trusts are treating a record number of patients. More than 60,000 people attended A&E departments on 27 December 2016 – the second highest level for a single day. Some trusts are even reporting increases in A&E attendances of more than 20% compared with this time last year.

The reasons for this rise in demand are well reported and widely acknowledged – patients who are often more ill at this time of year, ongoing and worsening pressures in social care, restricted access to GPs and other parts of primary care, insufficient funding, workforce shortages – the list could go on. But how trusts are dealing with this rapid increase in demand is often clouded by official statistics based on the rather simple metrics.

While official data does show that as a collective hospitals are not meeting the four-hour waiting time standard, if you look beyond these figures and at the actual numbers, trusts are admitting, transferring or discharging more patients under four hours than ever before (5,462,464 patients between July and September 2016 compared with 5,350,952 in the same period in 2015).

We must therefore recognise the outstanding effort being put in by frontline NHS staff and managers, often working beyond the call of duty, to cope with record levels of demand. We should also celebrate and promote the progress being made by local health and care services across the country to keep patients well, at home and outside of A&E, for example:

• Trusts are implementing new protocols that help improve patient pathways, by placing clinical expertise at the doors of A&E departments.


• Some trusts have successfully put in place new arrangements where specialist clinicians from other hospital departments are based in A&E, so patients can be treated quickly and discharged, rather than needing to admit them to hospital to receive this care.


• Others have developed “discharge to assess” schemes that allow patients to receive care assessments at home rather than on an acute medicine ward.


• In many areas trusts have developed “trigger tools” that give staff a prediction with several hours notice on whether patients are likely to breach the waiting time standard based on early warning indicators, meaning there is sufficient time to call in additional staff and resources to support patients being admitted in a timely fashion.

Alongside the above interventions, there has been a renewed emphasis on local communication to improve public awareness of the increased pressure at A&E departments and how to proactively self-manage conditions and illnesses. Local urgent and emergency care system boards, often chaired by acute trusts, have also been established to oversee improved system-wide A&E planning and delivery, focusing on ensuring appropriate primary and social care capacity is available for patients who need it.

Demand management, however, must be a joint effort and cannot just be addressed at a local level. There is a need for a national debate on what is expected of our A&E departments, as well as the NHS more widely. We welcomed the health secretary’s recent comments about the need for an honest discussion with the public about the purpose of A&E and the need to avoid inappropriate attendances.

It is right that A&E services should be focused on those with most urgent care needs and the public needs to be aware of that, but patients won’t always have a choice. So there must also be alternatives available to those who are turning to A&E because other local health and social care services are unavailable to them. This will either require national investment or an honest recognition that, despite the commitment and hard work of frontline staff, the NHS will struggle to meet all its existing priorities and performance standards.

In reality the NHS is neither “breaking down” nor “coping well” – the vast majority of trusts are delivering a good service and high quality care to patients, despite the pressure they are under.

Some may even say the NHS is “just getting by”. And we shouldn’t underestimate how difficult this level of performance is given the unprecedented pressure the health service is under.

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Is the NHS really facing a humanitarian crisis?

Secret aid worker: Is the NHS really comparable to a humanitarian crisis?

In 2015 I left the UK to provide humanitarian medical care to a refugee camp stuck in the midst of a civil war. The camp’s population quadrupled in the space of four months while I was there and the onset of the rainy season led to a demand for care that exceeded all expectations.

Hundreds queued to the door of the hospital with an official capacity of 90. Patients shared mattresses and sat in corridors. Where else could they go? They were sick and needed treatment and sending them home without medical care would often have been a death sentence – there were no other hospitals within hundreds of miles.

As the death toll rose in our camp, an emergency was declared. Last week the British Red Cross declared that the NHS is facing a “humanitarian crisis” too. Dr Mark Holland, president of the Society for Acute Medicine, admitted that this was strong wording but “not a million miles away from the truth”. We may not have thousands of people suffering on shared mattresses, but we do have thousands of our sick and our elderly and our children needlessly suffering in corridors around the country.

We have intensive care units that have to ship patients to distant hospitals in search of capacity. One month ago we ran out of intensive care beds for children throughout Leicester and the whole of London.

It may not be a civil war, epidemic or earthquake causing this crisis, but a hurricane of political ineptitude, denial and poor funding. There is an over-reliance on the compassion, blood, sweat and tears of NHS staff around the country. Staff that are already working 24/7, despite the suggestions we need a seven day NHS.

The symptoms are already visible, NHS workers are stretched. In a humanitarian crisis, people work to breaking point, burning themselves out in their endeavour to save people, often in the knowledge that they will go home to recuperate and resume their “normal” job. In the UK, NHS staff don’t have that luxury. This is their life and they are at breaking point.

The mantra we repeat to drivers that “tiredness kills” seems to be easily forgotten. Mistakes will happen. In Worcestershire, two poor souls died waiting for beds in a corridor, forgotten and lost amid the tsunami of other people waiting to be admitted.

I challenge any nurse or doctor to maintain that in the current environment the same could not happen in their own A&E department. From our state-of-the-art trauma centres to our small district general hospitals, we are overwhelmed. Suggestions by the health secretary that 30% of people attending A&E do not need to be seen in A&E does not solve the fact that 18,000 people in one week required A&E and waited over four hours to be admitted to a ward.

When the death toll in our refugee camp exploded, my organisation responded by providing more resources and staff. The levels of death and suffering began to drop. We know the costs of not responding quickly to a medical crisis. In 2014 the initial alarms raised by health professionals in response to the number of reported cases of Ebola in west Africa went largely ignored. They were further downplayed for months. This delay ultimately led to the unwarranted death of thousands of people and a panic on a global scale.

The problems faced by the NHS are complex and there is no easy solution, but perhaps the British Red Cross’s recent declaration is not wholly inappropriate. A humanitarian crisis is defined as a singular event, or a series of events that are threatening in terms of the health, safety or wellbeing of a community. This isn’t some faraway country seeing a civil war, epidemic or flood. But a slow-burning, manmade disaster of our own governing. The death toll I pray will not go in the thousands, but thousands are already suffering.

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Secret aid worker: Is the NHS really comparable to a humanitarian crisis?

Theresa May denies "humanitarian crisis" in Britain"s NHS

Theresa May has rejected claims by the British Red Cross of a “humanitarian crisis” in the health system but acknowledged there were “huge pressures” on the NHS.

“I don’t accept the description the Red Cross has made of this,” the prime minister said.

“Yes, there are huge pressures on the NHS, but first of all we should thank all the dedicated professionals in the NHS who have been working so hard over what is always a difficult period in terms of the number of people using the NHS – the Christmas and New Year period.”

Theresa May interviewed by Sophy Ridge on Sky News. Photograph: John Stillwell/PA

She told Sky News’ Sophy Ridge on Sunday programme: “Yes, there are significant pressures, but we recognise those pressures. We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need. They did that, we gave them that funding, in fact we gave them more funding than they required.

“So funding is now at record levels for the NHS, more money has been going in.”

May added: “There are pressures in the NHS, we see those pressures. We have an ageing population, this brings pressures, particularly in the interface between the health service and social care.

“We have taken some immediate steps in relation to that issue but we are also looking to ensure best practice in the NHS and looking for a long-term solution to what has been a problem that has been ducked by government over the years.

“The NHS is facing the pressures of the ageing population, that is why it is important that it is the NHS that has produced its five-year plan and is now putting that plan into practice.”

Labour has called for May or the health secretary, Jeremy Hunt, to make an emergency statement on the NHS when parliament returns on Monday.

Theresa May denies "humanitarian crisis" in Britain"s NHS

NHS boss rejects claim of "humanitarian crisis" in hospitals

The NHS has rejected claims it is facing a “humanitarian crisis” as it deals with winter pressures after it emerged that two patients had died on trolleys in one accident and emergency department in the last week.

The Red Cross said it had stepped in to help the NHS in England deal with the increased demand put on the service over the colder months. The charity’s chief executive, Mike Adamson, said extra cash was needed for health and social care to make the system sustainable.

“The British Red Cross is on the front line, responding to the humanitarian crisis in our hospital and ambulance services across the country,” he said. “We have been called in to support the NHS and help get people home from hospital and free up much-needed beds.”

Keith Willett, director of acute care for NHS England, said the health service had worked with the charity over recent winters, funding and supporting its “excellent service at home and ambulance service”.

“But on the international scale of a humanitarian crisis, I do not think the NHS is at that point,” Willett said.

More details soon …

NHS boss rejects claim of "humanitarian crisis" in hospitals

NHS faces "humanitarian crisis" as demand rises, British Red Cross warns

The NHS is facing a “humanitarian crisis” as hospitals and ambulance services struggle to keep up with rising demand, the British Red Cross has warned, following the deaths of two patients after long waits on trolleys in hospital corridors.

Worcestershire Royal hospital launched an investigation on Friday into the deaths and did not deny reports that they had occurred after long waits on trolleys in corridors over the new year period.

On Friday, doctors’ leaders warned that more patients could die because of the chaos engulfing the NHS.

The deaths prompted claims that the health service was “broken”, and long waits for care, chronic bed shortages and staff shortages were leading towards what the head of Britain’s A&E doctors called “untold patient misery”.

It is believed that one woman died of a heart attack after waiting for 35 hours on a trolley in a corridor, and another man suffered an aneurysm while on a trolley, and could not be saved.

It is also believed that another patient was found hanged on a ward at the same hospital, which admitted that it was under serious pressure, partly as a result of the extra strain hospitals face during winter. The deaths are said to have happened between New Year’s Day and Tuesday 3 January.

Many other patients who visited Worcestershire Royal hospital this week told the Guardian of long waits in A&E, corridors lined with patients, and overstretched staff doing their best to cope.

Dr Mark Holland, the president of the Society for Acute Medicine, said: “For a long time we have been saying that the NHS is on the edge. But people dying after long spells in hospital corridors shows that the NHS is now broken.

“We have got to the point where the efforts of staff to prop up the system are no longer enough to keep the system afloat. We are asking NHS staff to provide a world-class service, but with third world levels of staffing and third world levels of beds.

“That so many other hospitals in England are facing the same pressures as the one in Worcester means that other fatalities could occur. I would suggest that the same thing could happen in other hospitals, because lots of hospitals are under the same pressures.”

It is also possible that mainly frail elderly patients admitted to hospital over the festive period may have died because they received inadequate care on wards where staff were ill-equipped to deal with their conditions, Holland added.

“At the moment, we have lots of patients in the wrong beds in hospitals. That is, patients admitted as an emergency, but who do not need an operation, being looked after on wards that usually look after patients with surgical care needs,” he said.

“They may not have nurses with the right skill mix or the same level of dedicated medical cover [as general medical wards], so we know that these patients often don’t get the same level of care. Therefore I fear that during the Christmas and new year period, people in non-specialist beds may have come to harm.” Holland added that he could not estimate how many may have died as a result.

Fifty of England’s 152 NHS acute hospital trusts were forced to declare an alert last month, and sometimes temporarily scale back the level of care they offered to patients, because they could not cope with the number of people seeking medical attention, according to analysis by the Nuffield Trust health thinktank. Every hospital in Essex has had to go on “black alert” – the NHS’s highest level – in recent weeks.

In December, seven trusts had to declare the highest level of emergency 15 times, meaning they were unable to give patients comprehensive care. Paramedics have told the Guardian they have had to wait for up to eight hours at a time outside A&E units to discharge a patient into the care of hospital staff, because emergency departments cannot accept any more admissions, thereby lengthening 999 response times.

Dr Taj Hassan, the president of the Royal College of Emergency Medicine, said figures it obtained from hospitals across the UK showed some were treating as little as 50%-60% of A&E patients within four hours, far below the 95% target.

“Figures cannot account for untold patient misery,” he said. “Overcrowded departments, overflowing with patients, can result in avoidable deaths.” Hassan and Holland blamed the government’s underfunding of the NHS and social care systems for contributing to hospitals becoming worryingly full.

“The emergency care system is on its knees, despite the huge efforts of staff who are struggling to cope with the intense demands being put upon them. The situation is intolerable for both staff and patients, who are all too often left in the undignified position of waiting on a trolley in a corridor for a bed to become free,” said Hassan, who is an A&E consultant at two hospitals in Leeds.

Separately, the London Ambulance Service is looking into the possibility that problems when its IT system crashed on New Year’s Day contributed to the death of at least one patient. Staff had to make paper records of 999 calls in what one ambulance crew member described as “a shambles”.

The latest official NHS performance figures, released on Friday, showed that A&E units across England were forced to divert patients to nearby hospitals 57 times over the Christmas period. In addition, 34 hospitals said they had experienced major problems coping with demand.

NHS faces "humanitarian crisis" as demand rises, British Red Cross warns

Indigenous suicide is a humanitarian crisis. We need a royal commission | Dameyon Bonson

The right of self-determination of all people is a fundamental principle in international law, yet within the prevention of suicide for Indigenous Australians, that has been obstructed. Until now.

Recently it was announced that Black Rainbow will become the first peak Indigenous LGBTI body. You want to know why this is important? Let me tell you.

5.2% of Indigenous Australian lives are lost to suicide but as yet, there is no Indigenous organisation driving policy to combat this devastating problem. I estimate that there are between 10,000 to 15,000 same sex attracted Indigenous Australians. Same sex attracted people in Australia are up to 14 times more likely to die by suicide. So as Indigenous same sex attracted Australians, we rank at the highest of the highs in terms of suicide rates.

Related: Indigenous suicide rates in Kimberley seven times higher than other Australians

Our indigeniety is not the cause of these suicides. From my lived and from my professional experience, I can tell you the drivers of suicide for Indigenous people are many, and they are multi-factorial, multi-faceted and multi-layered. Therefore, our suicides cannot be viewed or treated just within the scope of a pathogenic paradigm, or in other words, we cannot medicalise the suicide and thus the person too. As this approach continues, and if we let it continue, Indigenous people will continue to be seen as the bearer of the problem and not the holder of the solution. We need to be more about franchise than empowerment – or at very least invest in both.

As an Indigenous Australian gay male I know that when it comes to the suicide of gender and sexuality diverse people (LGBQTI), our solutions are not pathologised. Efforts instead are made to combat what we call the drivers of suicide ideation and elevated risk of psychological distress. These drivers are bigotry and hatred. It is not our diverse genders and sexualities that cause us distress – it’s the homophobia, transphobia and the social exclusion.

The same goes for us, as Indigenous Australians. It is not our indigeniety that causes us distress. It is the drivers of racism, whiteness and social exclusion. Over many years, I have witnessed the whiteness in suicide prevention and its imagined white supremacist ideology that excludes Indigenous Australians. This year I experienced heterosexism. Heartbreakingly, this was from within my own mob. Heterosexism works on the assumption all people are straight (heterosexual) – because the majority of people are straight, the needs of us whom are diverse in sexuality and gender can unintentionally be viewed as secondary.

But I want to give you an example of whiteness in this space. Suicide Prevention Australia (SPA) and its subsidiary, the National Coalition of Suicide Prevention (NCSP) both proclaim to be national representatives, ie for all Australians. But did you know that there is not one Indigenous Australian as part of the executive or leadership of either of them?

There are 30 organisational members of the NCSP, and not one is an Indigenous peak body or representative. That both SPA and the NCSP are cognisant of this exclusion but have done nothing about it is a classic example of systemic racism.

Recently I was told that “SPA doesn’t have representatives of ‘other’ high risk groups either”. Indigenous Australians are first peoples of this country – we are not we are not an “other”. Conflating our plight against colonialism with the plights of all marginalised/high risk groups cloaks the specific needs of Indigenous people and the humanitarian crisis of Indigenous suicide. As stated earlier, 5.2% of Indigenous Australian lives are lost to suicide. We are not another high risk group. We are the highest risk group in the country; 12th highest in the world.

With our new status, Black Rainbow will be able to provide expert advice at the intersection of racism and homophobia and how they affect our lives. We’ll advocate for a more inclusive suicide prevention space. But most importantly, we will seek out solutions to the high rates of Indigenous suicides, using a method not of pathogenesis. This current pathogenic approach is not doing our mob any favours: hetero, homo or trans.

Black Rainbow will take formation in the coming months and soon we will be inviting peak Indigenous organisations to form our own coalition for the prevention of Indigenous suicide.

Related: Health service calls for royal commission into Indigenous suicide rates

If my years on the frontline preventing suicide and tic-tacking 35,000km plus across the remote north west, have taught me anything, it is that self-determination is an essential factor in the fight against suicide.

I hope that together the peak bodies of Aboriginal and Torres Strait Islander health can unify and collaborate to address the core drivers of these suicides. Of course, non-Indigenous peak bodies are more than welcome to join, but their function and role will be as advisory members. We may or may not match the cost of having to join the NCSP, because as Indigenous people we know that capitalism is not the friend of the impoverished.

I am laying down the new rules of engagement in Indigenous suicide prevention and they begin with: “Nevermore, will something proclaim to be for us, without us. That stops today”.

Bring on the Royal Commission into Aboriginal and Torres Strait Islander suicides.

Dameyon Bonson is a human rights award winner and founder of Black Rainbow.

Indigenous suicide is a humanitarian crisis. We need a royal commission | Dameyon Bonson