Staff shortages are threatening the NHS | Letters

The recruitment crisis shows just how badly the government is managing the NHS (Report, 4 February). The proportion of doctors joining specialist training in the UK – including general practice – has fallen for the fifth year running, with just over 50% of doctors who completed the foundation programme going on to enter British specialist training – compared with 71% in 2011, according to the figures from the UK Foundation Programme Office.

GP recruitment has slumped by 20% and a recent report by the National Audit Office warned that poor access to GPs during the working day could be fuelling Britain’s A&E crisis. It said that rising numbers of patients are being forced to wait a month to see a family doctor, with estimates of a shortage of up to 10,000 GPs by 2020.

Almost every hospital in the UK has a shortage of nurses, but the government has confirmed plans to end bursaries for student nurses and midwives from next year. At the same time the number of nurses from Europe registering to work here since the Brexit referendum has fallen by 90%. Janet Davies, chief executive of the Royal College of Nursing, said: “If this is the beginning of a long-term drop in the number of nurses coming to the UK from other parts of the EU, that’s a serious concern at a time when we’re already facing a crisis in nurse staffing numbers. With 24,000 nursing vacancies across the UK, the NHS could not cope without the contribution from EU nurses. Without a guarantee that EU nationals working in the NHS can remain, it will be much harder to retain and recruit staff from the EU.”

Without staff the NHS cannot function effectively and the march towards privatisation will become unstoppable.
Dr Richard Turner
Harrogate, North Yorkshire

• The government was warned when it removed nursing bursaries it was risking the future of our NHS. Now the reality is becoming clear – fewer people willing to train to work in our hospitals, putting our health system under even greater strain. We already have a huge shortfall in nursing staff, and now the government is making it even worse. At the same time, the government’s half-baked plans to crack down on EU immigration have left 10% of those working in our NHS in limbo. The government cannot go on telling people it cares about the future of the NHS while it cuts support for training, stands by while nurses’ salaries suffer a massive drop in real terms and allows spending per person to sink to dangerous levels.
Norman Lamb MP
Liberal Democrat health spokesman

• As cancellations, delays, and rationing of non-urgent surgery increase in the NHS (1,700 face long surgery delays amid cash crisis, 3 February) the government remains surprisingly unfazed. But if, as I assume, most of its members would buy themselves out of trouble through private medicine, why not?
Michael Sheldon
Norwich

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Staff shortages are threatening the NHS | Letters

NHS intensive care "at its limits" because of staff shortages

The NHS’s network of intensive care units is “at its limits” because they are overwhelmed by staff shortages and the sheer number of patients needing life-or-death care, senior doctors are warning in an unprecedented intervention.

Intensive care units (ICUs) are becoming so full that patient safety is increasingly at risk because life-saving operations – including heart, abdominal and neurosurgery – are having to be delayed, the leaders of the specialist doctors who staff the units have told the Guardian.

“Intensive care is at its limits in terms of capacity and struggles to maintain adequate staffing levels,” said Dr Carl Waldmann, the dean of the Faculty of Intensive Care Medicine (FICM).

“It is important that bed occupancy rates do not exceed 85% in order to ensure there is capacity for emergencies. The reality is that many units are quickly reaching 100% capacity whenever there is excessive hospital activity,” he added.

The Guardian can reveal that, in a stark example of the growing problems, Hull and East Yorkshire Hospitals NHS trust last week ran out of intensive care beds at its two hospitals and was struggling to provide normal care to the many patients needing treatment for life-or-death conditions.

In a letter to its nurses, it said: “The critical care units have been working under considerable and sustained pressure. This is as a direct consequence of both the high number of patients requiring critical care support, and the intensity of each patient’s needs. This is in excess of the established number of level 3 [intensive care] equivalent beds on both hospital sites.”

Dr Liam Brennan, the president of the Royal College of Anaesthetists, voiced similar concerns. “In order to care for acutely unwell patients, surgery is being postponed because of lack of ITU [intensive therapy unit] beds. The combination of inadequate staffing levels in intensive care units together with a shortage of high-dependency beds is having a very real impact on patients, which are needing to have critical surgery such as major abdominal or chest surgery, or neurosurgery, delayed for their own safety,” he said.

“I’ve had reports from anaesthetists and intensive care specialists across the country of 100% occupancy rates in intensive care units and of major surgical cases, including cardiac cases which are potentially life threatening, being cancelled because the beds required for the post-operative care are needed for other critically ill patients,” Brennan added.

Steve Jessop, the trust’s nurse director, added that as a result, “at this time the service is currently unable to deliver critical care services to the high number of patients that require treatment resulting in: cancellation of life-saving operations for patients requiring critical care support, including neurosurgery, cardiothoracic surgery, vascular surgery and cancer operations.

“Currently the critical care units are caring for patients which are significantly above the number of patients we are resourced to care for.” Jessop offered nurses increased pay for working extra shifts to help relieve the pressure in its critical care units in Hull and Cottingham in east Yorkshire.

Doctors working in intensive care have told the Guardian how ICU bed shortages have become even more acute during the NHS’s “winter crisis” and forced patients needing life-or-death treatment in an ICU to wait many hours before getting a bed. One told how a patient with sepsis, the blood infection that kills an estimated 44,000 people a year, had to wait more than 12 hours in A&E for an ICU bed to become free. Another patient, an elderly man who was known to be dying after a cardiac arrest, ended up passing away in an A&E unit rather than in a side room in the hospital’s ICU as doctors hoped because it was so full.

Waldmann and Brennan also fear that patient safety is at risk as a result of ICUs becoming overloaded. “Multidisciplinary teams have maintained patient safety, but in future years this may increasingly come at the expense of quality of care,” said Waldmann.

The disclosure that ICUs are under such intense strain challenges both Theresa May’s recent insistence that the unprecedented problems seen in hospitals are in line with normal winter pressures and the claim by the health secretary, Jeremy Hunt, that the NHS is “performing well”. Copious official data shows that hospitals, GP surgeries and ambulance services, under the heaviest pressures on record, are routinely breaching NHS-wide targets for seeing and treating patients fast enough.

NHS-wide shortages of specialist doctors and nurses means ICU beds often lie unused because there are no staff to care for patients, added Brennan. One in three of the 220 ICUs across the UK have a vacancy for at least one consultant, according to new survey data collected by the FICM. “Bed capacity figures still do not give a true reflection of the situation on the ground. A number of seemingly empty beds have to remain empty as there are not sufficient doctors and nurses in place to support them,” said Waldmann.

Jonathan Ashworth, the shadow health secretary, said: “Reports that intensive care is at capacity and without adequate staffing should set alarms bells ringing in Downing Street, but instead we have a prime minister utterly lacking in her response to the NHS crisis.

“The truth is problems are getting worse and more widespread than in previous years with even life-saving cardiac, abdominal or neurosurgery operations being cancelled. Theresa May needs to get a grip of the crisis and explain what action she’s going to take to make sure that hospitals can get in place the number of staff they need to keep patients safe.”

NHS England denied there were any serious problems. “At this time of year it’s not unusual for specialist intensive care units to become busy, but tracking data on occupancy rates show hospitals have teams in place to ensure the right care is available. This can include moving patients to other hospitals or bringing in extra staff where necessary,” said a spokeswoman.

NHS intensive care "at its limits" because of staff shortages

Hospital doctors ‘miss signs of illness’ because of chronic staff shortages

“Dangerous” medical understaffing in hospitals is so rife that signs of illness are being missed, blood tests delayed and newly qualified doctors left in charge of up to 100 patients.

Chronic shortages of medics are also leading to those with little experience of some types of illness taking responsibility for wards full of medically needy patients, or with complex issues, whose conditions they know little about and do not feel qualified to give proper care to, including in intensive care and stroke and surgical units.

Related: A&Es are closing and doctors are leaving. It should be Jeremy Hunt who goes | The Secret Doctor

A survey of UK doctors, the results of which have been given to the Observer, reveals widespread concern that gaps in rotas were risking patients’ safety. Doctors said they were left stressed and in tears at being “pressurised” by managers to work more shifts to help hospitals cope with rising demand and said their relationships with patients were suffering.

One trainee surgeon said shortages meant a colleague in his first year of training was the only doctor in charge of more than 100 surgical patients overnight.

An elderly care registrar said: “I was the only medical doctor covering medical emergencies [and] cardiac arrests in the whole hospital, medical admissions, referrals from A&E [and] GPs, and the whole hospital for a medical opinion. It was frankly unsafe.”

Another doctor said: “I feel out of my depth.”

Pete Campbell, a hospital doctor in the north-east who undertook the survey with the assistance of the British Medical Association, said: “This survey is just a snapshot of medical understaffing, which is going on on a significant, worrying and dangerous scale. Doctors believe that these rota gaps pose a direct threat to patient safety because the time-critical work they do is put under pressure.”

Doctors’ leaders said the survey reflected worsening medical understaffing across the NHS. “The findings are yet another stark warning of the fragility of our health service. A demoralised, stressed and struggling workforce is not going to stay in the NHS for long. This situation is unsustainable,” said Professor Neena Modi, president of the Royal College of Paediatrics and Child Health.

Professor Jane Dacre, president of the Royal College of Physicians, said: “Patient care is being compromised by gaps in trainee rotas. This is a major challenge for the NHS and it is having a detrimental effect on the morale of both trainees and consultants. We need more doctors.”

One medic said that hospitals’ growing inability to have a full complement of doctors on duty meant “we don’t have time to review patients properly. [I am] constantly fighting fires as covering three people’s jobs, so never have time to think about a patient properly.”

In the survey, 395 doctors below the level of consultant described how rota gaps were affecting care. It also found that many medics fear the quality of care they could give patients was declining because so many are often so busy. The findings paint a stark picture of doctors having too little time to talk to patients about their conditions, discharge others, do routine checks on babies, or seek patients’ consent for procedures as quickly as they should.

The survey found that many medics feared that the quality of care they could give patients was declining because they were often so busy that they had less time to engage with them.

“Delayed care, sick patients getting unwell due to this, long waits, histories being taken too quickly to compensate and speed up the process, meaning critical pathologies have been missed,” said one. Doctor shortages are now so acute that, in some areas, emergency ear, nose and throat clinics and non-urgent operations have had to be cancelled at short notice, said respondents.

The survey found that 21% of rota gaps were not covered by any doctor, even a locum. Unfilled gaps result in the doctors on duty on wards becoming responsible for far more patients than usual. Another 18% of gaps were filled by staff agreeing to provide cover, often on top of an already heavy schedule.

The findings come soon after Grantham and District hospital in Lincolnshire closed its A&E unit overnight because it had too few doctors. In April, Chorley hospital in Lancashire downgraded its A&E unit to an urgent care centre for the same reason.

Last week the RCP, which represents many hospital doctors, warned that shortages of many specialist medics meant the NHS was “heading into an extremely difficult autumn”.

Anaesthesia and intensive care are facing particular shortages of doctors.

Unfilled slots are also jeopardising hospital finances and have caused the NHS’s bill for agency staff to hit £3.3bn a year in England.

The Department of Health declined to respond directly to the findings. A spokeswoman said: “We expect all parts of the NHS to make sure they have the right staff, in the right place, at the right time to provide the very best care for patients that is both safe and sustainable. That is why we have invested in the frontline and there are already 25,000 extra clinical staff on our wards since May 2010.”

Hospital doctors ‘miss signs of illness’ because of chronic staff shortages