All we know is that the victim is young, female and unconscious. Hit by a lorry, we’ve been told, while walking through town. We’re poised and waiting in gloves and gowns when the paramedics burst through the swing doors. We descend as one and, in a matter of seconds, we’ve cut her clothes away. She’s naked but for her underwear, a tangle of wires and tubes, and the stiff plastic collar protecting her neck. There’s no blood, no bruising, no twisted limbs.
Unless you noticed the trace of clear fluid from her nostrils, you’d never guess a collision with a 12-tonne truck has delivered her here, to A&E. But that liquid – the cerebrospinal fluid that bathes and protects the brain – signals a blow to her head of such force, it has fractured her skull into pieces.
As I set about stabbing her veins with needles, her flawlessness unnerves me. Her 15-year-old body has the suppleness and beauty of the very young. She should be gossiping with friends, sitting GCSEs, dreaming big for her future, anything but lying on cheap cotton sheets with, as her scans would go on to reveal, catastrophic brain damage.
Nothing brings home the capriciousness of life to a junior doctor like me quite like A&E. Road traffic collisions, falls from rooftops, drownings. The accidents strike without reason or mercy and no one is spared. But there is one kind of death that hits harder than most. The kind that – far from being a random act of chance – has been foreseen, and that might have been prevented.
The death toll from Grenfell Tower – put at 80 to date – is so shocking in part because of earlier warnings from residents, fire experts and MPs alike that our tower blocks are vulnerable to disastrous blazes. Until we know the precise causes of the blaze, we cannot conclude for certain that any deaths were avoidable. But there are disturbing parallels between Grenfell and the state of the NHS. Like the residents of Grenfell Tower, NHS staff have warned repeatedly that the government’s drive to cut costs will end up costing lives. Arguably, this has already happened. Yet ministers continue to ignore our warnings
The British Red Cross described a “humanitarian crisis” unfolding in the NHS as overcrowding and understaffing led to thousands of patients lying marooned on trolleys in hospital corridors this winter, with at least two patients known to have died there. Although I wasn’t working at the time, I know well the shame and guilt that come with being forced to treat patients in corridors, not to mention the distress and indignity for those patients themselves.
The government seeks to airbrush away what those of us at work on the NHS frontline have observed. The health secretary, Jeremy Hunt, insisted that the problems were confined to “one or two hospitals” with the “vast majority” coping better this winter. However, official NHS statistics flatly contradicted this claim, revealing that 40% of England’s hospitals had declared an alert because they were experiencing major problems caused by having too many patients and too few spare beds.
The NHS is enduring the most draconian squeeze in funding since its inception in 1948, with £22bn “efficiency savings” demanded by 2020. Yet simultaneously, Hunt insists he wants the NHS “to offer the safest, highest quality care of any country in the world for you and your family”. That aspiration is fatally undermined by the government’s failure to address endemic gaps in doctor and nurses rotas, with thousands of unfilled posts across our hospitals and general practices. The NHS is short of at least 6,000 doctors and 40,000 nurses, with one in 10 junior doctor posts unfilled. Medics like myself often face workloads in which superhuman effort is required just to keep patients safe, let alone provide excellence of care.
Although it was residents rather than professionals who repeatedly raised the alarm about the potential for a fatal disaster at Grenfell Tower, the similarity to the situation in the NHS is that no one is listening to the warnings. This begs the uncomfortable question: are NHS patients waiting for a tragedy even as doctors and nurses repeatedly raise concerns?
The dangers to patients of understaffing are well-documented. A decade ago, thousands of patients at the Mid Staffordshire NHS foundation trust were subjected to callous, demeaning and unsafe care after the trust decided to save money by cutting the size of its wage bill. Elderly and vulnerable patients were left unwashed, unfed, soiled and in squalor, with the death rate greatly in excess of the national hospital average. A group of nurses wrote in despair to their managers: “We are all exhausted, mentally and physically. We are fed up with tackling unmanageable workloads … the environment is neither safe for patients or staff. As registered nurses we are professionally obliged to raise our concerns. We feel compromised, bullied and disempowered.”
The Francis inquiry into the scandal described “appalling and unnecessary suffering of hundreds of people” at the hands of overstretched doctors and nurses. “They were failed,” he said, “by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.”
Robert Francis’s conclusion has grim resonance for doctors and nurses today. It encapsulates for many of us the NHS we feel we inhabit – despite all the government avowals that never again would finances be allowed to come before patient safety. Yet just three months ago, a senior coroner’s inquest linked understaffing to the avoidable death of a man from a pulmonary embolism while in intensive care at the Royal London hospital. An intensive care consultant witness described the detrimental impact on patient care in the unit of chronic understaffing and rota gaps. In order to prevent future deaths, the coroner concluded, the trust needed to take “any steps deemed necessary in order ensure staffing resilience in intensive therapy units.”
It is difficult to convey how gruelling and demoralising it is to strive your best for your patients in a desperately overstretched workplace that breeds corner-cutting, indifference and excessive haste. Francis recently weighed into the debate with a stark warning. “Let’s make no bones about it, the NHS is facing an existential crisis,” he said. “The service is running faster to try and keep up, and is failing, manifestly failing.”
It is the chasm between politicians’ spin about the NHS and the hard reality I witness every day at work that drove me to start campaigning. Writing, speaking out and organising direct action protests to highlight the precarious state of the NHS are, I believe, a professional imperative when your first duty as a doctor is to put your patients’ best interests first. Keeping quiet cannot be an option when lives are potentially at stake.
Frontline staff today feel every bit as disempowered as those Mid Staff nurses did 10 years ago, and our warnings to government are ignored. Only last week, data published by the Nursing and Midwifery Council revealed that, for the first time in NHS history, the numbers of nurses leaving the profession are outstripping those choosing to enter it. The General Medical Council’s 2017 survey of junior doctors exposed that more than half of them regularly work in excess of their rostered hours, with a fifth of doctors experiencing working patterns that leave them feeling sleep deprived at work.
Little wonder then that a report published last week in the medical journal Anaesthesia revealed that more than half of the 2,000 trainee anaesthetists surveyed have had an accident or near miss while driving home after a night shift due to sleep deprivation. Doctors described falling asleep at the wheel, swerving across motorways, crashing into other vehicles, and being stopped by the police. Small wonder mistakes have been happening that cost patients their lives like the errors made in the emergency department of the seriously understaffed North Middlesex hospital that contributed to the deaths of four patients in 2014 and 2015.
I cannot begin to imagine the pain of losing a loved one in Grenfell Tower. But as a frontline NHS doctor, I can identify all too strongly with the frustration of fighting to have your warnings about safety heard. It is not an exaggeration to say that understaffing, unless addressed, may be the NHS’s Grenfell, a disaster waiting to happen.