NHS crisis: how bad is it? - expert explains

Victoria McDonald you are our Health and Social care editor today we're going to talk about the NHS the NHS in crisis what are you going to tell me I'm going to tell you that this is an AHS not just in crisis but in what one person described to me as a poly crisis across the whole system from GPS to hospitals to mental health to social care we are seeing staff shortages we are seeing record numbers of patients record numbers of elderly patients two we've got the problems of covert and flu combined with pneumonias that are just placing incredible pressure on an already stretch system we've read all the papers and seen the headlines we know that the NHS is quote in crisis and there are a whole host of facts and figures about that I mean what figures at the moment in terms of that crisis really jump out at you the NHS isn't just an a crisis it's in a poly crisis it's across a trust hospitals Mental Health primary care social care every part of the system is stretched Breaking Point the figures that stand out are the ambulance hand over waiting times the length of time that patients are having to wait in a e the number of patients who are having to wait on waiting lists for elective surgery I mean every bit of it Cancer Treatments that are delayed you name it there's almost nothing that isn't that it doesn't have a long waiting time attached to it now the Royal College of emergency medicine has claimed that the crisis is now so acute that it's caused hundreds of excess deaths every week well that is their claim and I've seen some very good statistical analysis of it to show that they are in the right ballpark this was denied by NHS England um who said that it was much more complex than that but subsequently the Royal College of emergency medicine and others have come back and said yes because if you have to wait in an ambulance to be handed over into the emergency department and you've had a heart attack or a stroke that is inevitably going to have consequences every hour of waiting time is going to cause further problems for those who are truly sick and then we don't know really what what happens once they're getting into Hospital there's all the issues with the low Staffing numbers particularly low numbers of nurses so yes probably in that ballpark if that excess deaths was true or it was somewhere near that how much of an outlier it really is that in terms of all the countless crises that you've seen in your reporting over the years you know there's always you know Winter's always a difficult time how extreme is it well it feels extreme and it goes back to my first answer which is it is a crisis across the whole Health and Care System um I mean data collection is so good these days that you can drill down into it and of course there have been other Winters where there have been excess flu deaths for instance but this is the first winter where we've had flu and covert and we've been seeing other issues with things like streptococcus a um although I'm not sure quite how much strain that's putting on the Health Service um as well as all the other things like um shortage of staff so it's that combination of things coming together that are that are likely to be causing these excess deaths and is it too simplistic to say it starts with it starts way back at the beginning where you know the waiting times for people to see their GP is so long that therefore means you know they wait a month or more which means that when they then get possibly referred to a in it you know what I mean it it if it goes along the system and because you're not seeing that first point in contact early enough it's letting all these other problems build up and eventually people have to be treated in hospital which is where you know the most resources and the most expense for the NHS it's partly it's it is not being able to see the GP but it's more complex than that I mean 25 of cancers are detected in the emergency department anyway so people are quite slow at going to see gp's Full Stop about their problems um but yes in some areas not in all in some areas it's hard for people to get in to see their GPS um and then you get to the emergency department and you have to wait hour upon hour the ambulance doesn't turn up to pick you up you know for hours all of those things brought together you've been reporting obviously on the on the health system for a number of years and you said that this winter it feels like it's a really difficult one and you've been to for example recently Warwick Hospital's A E I mean what did you see there in terms of how you saw you know all those stats all those stories actually in real life well the interesting thing about Warwick Hospital was when we were filming there it was on the ambulance strike day so typically it should have been a bit more quiet uh it didn't feel quiet to me uh certainly they weren't getting the ambulance drop-offs but the place was still full there were lots of kids in the pediatric department there were I mean it was just busy busy busy and um you thought well if it hadn't been an ambulance strike day I just don't know how much worse it could have looked this is the room with the data and it was only 8 30 in the morning and they were overstretched we can see um we've got two out of three recess cubicles so we have a rhesus cubicle available should we need it we've got nothing currently in miners we've got 19 out of 20 Majors cubicles so we know that we're under pressure in Mages already which is where the ambulances tend to come and we've got eight in our Majors waiting room and our Corridor I don't even know how you keep it flowing I feel exhausted for you and that's what 25 half dates in the morning there's often people who talk about it being a bureaucracy but it is a very flexible system isn't it that can adapt and find ways to deal with these numbers of people is that what you saw at Warwick well Warwick um like many other hospitals has an incredible number of um things going on behind the scenes to try and alleviate those pressures so for instance we saw a um pilot project for teaching people to have intravenous antibiotics at home so sometimes somebody might need to be on IV antibiotics for six eight weeks sometimes even up to a year and that of course can take up a hospital bed so they had got these patients out and into their homes and taught them or their carers on how to deal with this so that was just one little way of trying to take some of the pressure off the thing that always strikes me about the NHS as we talk about it being a Breaking Point and yes it doesn't ever break but that's because of the Goodwill of the staff mainly it's because people will go over and above what they are expected to do often you know I see lots of uh young doctors writing about how they're three four hours over their shift and they're still there and they're still writing up notes or still seeing patients you know there is so much good will in the NHS and I've always thought that that's what stops it from well it will never collapse but from from becoming way worse than it could be when you're at Warwick Hospital how did the patients respond because obviously there are you know there are lots of reports about faith in the NHS and it being able to to work sort of diminishing but there are polls which also say the minute face to face with the NHS their satisfaction with it is very high so is that what you saw at Warwick that oh all the time always not just Warwick I mean in um November we were in Rotherham and um there I spoke to a patient who had been on a trolley for more than 12 hours by the time I spoke to her and she said yeah no I am in a bit of pain you know but she said um but it's the NHS and we're lucky to have it at Warwick I saw um I spoke to two patients who completely unprompted had said this gives me a chance to say how much I love the NHS I mean I hadn't asked what do you think of the NHS they just said while I'm talking to you I want to say you know I have had really good treatment sure I'm in a cubicle I'm sure I've been here for six hours but I've been seen by a lot of people or Consultants coming along at any moment now you know I am in good hands I have been seen by a large number of people I'm due to be seen by a consultant now it gives me an opportunity of saying that the treatment that I've received in this hospital now and previously first class and talking about the staff we have seen these unprecedented strikes from nurses ambulance workers Etc there's a broad range of discipline striking but are they all sort of coming at it with a common message it's about pay yes um different aspects of pay but essentially of course they're wanting more in the case of Junior doctors who are currently being balloted it's about reversing cutback and their pay the same with nurses actually that their pay has fallen in real terms um and then there are also the staffing issues so every time the unions have gone to meet with the health secretary and I think some of there have been about three meetings so far um at least the first two meetings the health secretary would only talk about productivity and Staffing and not pay but the unions have been very um explicit that that all of it needs to be put together you know yes the pay needs to be dealt with but so does there need to be a proper staff and plan which we haven't seen um and you know how are you going to deal with all of that put together and keep your staff keep the staff wanting to stay in the NHS because at the moment there are very very big gaps it you know I guess some critics would say the concern is that when these strikes happen that people put people's lives at risk I mean what's the response from those who strike well some people the government in particular has claimed that lives have been put at risk uh I can't answer that but um there isn't any evidence certainly in the first ambulance strike in December um we saw ambulance workers leaving the picket lines to treat um desperately ill people um in Warwick for instance they were still answering category one and Category 2 calls so heart attack stroke life-threatening um they they were being dealt with anyway some of the patient transport were still being provided for those who had emergency Cancer Treatments or needed dialysis and remarkably or maybe expectedly perhaps calls from the public the 999 calls from the public went down by more than 20 percent so the public themselves were being reasonably responsible about how they were making those emergency calls of course what I don't know um although we will find out probably in about a week is what the knock-on effect was for the next couple of days after the strikes there's a potential for more strikes do you get a sense at all if there's an end in sight whether the government's willing to move on this there are lots of reports that uh Steve Barkley the Health and Social care secretary has moved somewhat uh towards the idea that there needs to be some sort of settlement now what that settlement would be is um not clear there have been talks about a one-off payment or backdated payments but has moved towards the idea that something needs to give but is up against uh apparently the treasury um and number 10. so he is reported to have said at last week's meeting with the health unions you help me make the case to the treasury that we should be paying this I I mean if that's true that's a very powerful lobby but at the moment we're not seeing any movement from the treasury or number 10 on this so Victoria let's try and discuss about how we got here I mean in the short term the government would put forward this idea that this is to do with the backlog in appointments surgical procedures treatment after the covid lockdowns we've seen significant pressure on the NHS particularly over this period through a combination of a very high rates of flu persistent and high levels of covid continuing concerns particularly amongst many parents around strop a and that has combined over that period with a time when primary care services and community services are also much more limited so that surge in flu and covert cases has put massive pressure in terms of the NHS services is that fair to say that this is holy perhaps or is it just partly what happened because of the the three lockdowns we went through no that's really not fair this was happening well before covert um the waiting lists were going yeah covert did not help by any stretch of the imagination but this was happening and it was and it's to do with the way the NHS has been funded um over the past decade or so um because funding has gone down and the consequences of of reduced funding um are that you are going to get backlogs and you're going to get staffing issues now the government has put in more money recently into the NHS but it is not enough to cover what happened before sort of towards the end of the labor term and the beginnings of the of the conservative government and what's happened subsequently and I guess in some ways you know that sort of Amnesia some people have about covid also means that we forget NHS staff a bit more paid to say thank you for what happened yeah the Clapping for carers has come up quite a lot um on the picket lines it's uh people saying yeah well you did that then and what are you doing now you've certainly stopped clapping for us now there's quite a lot of bitterness about that I mean there was a degree of unhappiness at the time about this clapping for carers because they like you know sure you're going to stand on the steps of Downing Street and clap for us but are you going to give us more money are you going to give us at the time PPE all of those things but right now it's the the irony is not lost on a lot of health workers is it simply to say that ever since in the last 12 13 years with austerity this has become about austerity and its impact on the NHS over time yes a lot of people would argue that because of course everything that's happening and or most things that are happening in the Health Service um can be judged from the community that they've come from in a way you know so if you've got cut packs and public health if you've got poor housing if you've got problems in the education system if you've got kids on um free School meals all of those things build into uh into a pressure on the Health Service because you have sicker people and a lot of people would argue that with austerity that that um there were many people who fell through the Gap and the consequences are ill health and disability but what we haven't even talked about is social care so if there are 13 000 patients A Day in England in hospital when they could be moved out when they're well enough to go back into the community and they can't because there aren't places for them in the community in care homes or back into their own home and that's because not enough money has gone into social care and that has a direct and obvious impact on the Health Service along with poor housing stock along with um uh you know poverty in the communities all of those things that impact but we keep looking at hospitals because that's the most obvious sign of where the pressure is but actually the pressures are all down you know further back down the chain if you like I know Amanda Pritchard said chief executive NHS England that the NHS had not planned for the long term and especially in Staffing it was now over-reliant and foreign-born doctors and nurses yeah well that's another issue again is that um there have there has been quite a lot of criticism of successive governments failing to have enough Medical School places enough places and nursing enough social care training all of that um and these are things that take you know years that you you need to plan ahead for years to get the right numbers and the UK has often relied on medical staff from abroad of course some of that was upset by brexit some of that was upset by the pandemic where people raced home and haven't come back they are increasing the numbers in medical school but we won't see that you know for a long time getting rid of the nurses bursaries had an impact because some then people couldn't afford to go into nursing some of that's been dealt with to a degree but um yeah it will be a long time looking long term at what needs to be solved Staffing social care what about just the fact that we are a growing population and the average person in the UK is now living for much longer than before does that also play into it yeah very much so I mean you you go into any Hospital you go into any GP waiting room and you're going to see people who are really quite elderly but it's not it's not just an upward line at some stage the population will start to grow slightly younger again so it's it's it's sort of the trajectory it's on now yes because the older you are the more likely you are to have different health conditions sometimes multiple health conditions you know it's not unusual for me to go into an emergency department filming to see to have you know more than a couple of people over the age of a hundred in there certainly the large majority of them are often over the age of 80. in terms of solutions if there are any short-term long term Rishi sunaka said that he will make cutting NHS waiting lists one of his key pledges NHS waiting lists will fall and people will get the care they need more quickly those are the people's priorities they are your government's priorities and we will either have achieved them or not no tricks no ambiguity we're either delivering for you or we're not [Music] what change have we seen from the government and and do we think it's going to have an effect I know that they've said that they will block by thousands of Care Home beds they're going to have Porter cabins in hospital car parks are those just quick fixes the block buying the um Care Home beds is short term yes because that's literally going to last until March um and it doesn't resolve the fundamental problem of of how you get people out of hospital and back into the community Port cabins yes um that is again a sort of winter fix um the waiting lists well the waiting lists were already due to come down anyway there's been a lot of emphasis particularly on the long waiters and actually in in the last set of figures that just came out last week which were for December there was a very small drop in the number of people waiting so it was sort of um it was an important Pledge on the prime minister's part but it was one that he probably will see fulfilled um it doesn't deal with the fundamental issue that there aren't enough staff another thing we haven't talked about is you know the capital spending you know actually having hospitals that need a lot of money put into them to try and improve their infrastructure in order to get the flow through better and you know the labor party at the moment is high in the polls it clearly thinks that it has a good chance of winning the next election as most commentators think whenever that may be we're treating the shadow Health secretary came out and talked about tearing up the contract with GPS you know family doctors being salaried NHS employees a greater role for pharmacies and giving out vaccinations for example even allowing people to refer themselves to Specialists rather than going to the GP what's their thinking there and what's the reaction been yeah I wish I could tell you what their thinking was and I am a little bit perplexed I don't know why they've taken on the GPS unless they're polling as showing them that people are really concerned about not getting face-to-face appointments but again that's variable across the country uh so actually face-to-face appointments are back up to pre-covered numbers and some people say they prefer the phone consultation so I'm it feels to me as if they came up with this bright idea and actually over the past few days there have there's been such an outcry against it not just from the people you would expect like the British Medical Association or the Royal College of GPS but so and a number of different places that um that they really don't need to have this fight pharmacists or pharmacists already do vaccinations um and that's actually been a big part of the current government's um pledge to take some of the pressure offers to make much more use of community pharmacists the labor leaders are here starmer um last weekend was talking about the bureaucracy of the NHS and he didn't really elaborate on it except to say for instance If people could um refer themselves for physio appointments or if they had internal bleeding so is the argument therefore the criticism is that this is a a non-solution to the non to not the real problem I'm intrigued as to why they've gone for that and not for other parts of the health system and I would actually like to hear them talking about public health about preventative medicine about how they're going to um to ensure that uh you know people are living in safe environments you know that aren't filled with mold and damp that then therefore increase their asthma that therefore send them to the GP that therefore send them into the hospitals with this talk of the NHS in its most profound crisis and it's 75-year history whether this is an existential crisis in a sense of does the system itself need reforming to other models in other countries do you think that's actually serious discussion or is that just you know again politics I would be very surprised if there are too many people who want to get rid of the NHS um I mean there are always there is always a small cohort who thinks that would be better off privatized reforming the system is is always a government's way of saying you know I need to be seen to be doing something the the NHS has gone through a lot of reforms over the past 20 years and I don't think it needs any more reform personally of course things need to change it needs to be encouraged to become more Innovative and one of the criticisms I've often had of the NHS is I will go and film an amazing project or um you know way of doing something in a hospital and you think why aren't they doing this right across the NHS and somehow it never seems to spread out and and gain traction elsewhere I would like to see more um sort of sharing of innovation and and I know there are a lot of people who who are trying to make that happen but if you don't have the staff you know if you don't have happy and well staff I mean it's a moot point isn't it you could you could change the turn the system on its head and it's still going to face the same problem so I think any government really should be dealing with that first and foremost in some ways that's the essence of where we are that idea of this overstretched staff have just gone through two years if not more of covered and now they're in this crisis and that really is at the heart of this is the staff just being pushed and pushed and pushed I think so three years of covert yeah um I really think so and and you know there are a lot of vacancies and there's a lot of trouble with retention um so you somehow you need to lure these people back in and and make it a good place to work you know even small things like making it more Child Care Friendly or making sure that people are being rewarded and I don't just mean monetarily but recognized for their hard work I don't think you've talked to me thank you

Channel: Channel 4 News

Views: 63,083

Keywords: Channel 4 News, NHS, crisis, nhs crisis, UK news, UK, hospitals, Rishi Sunak, Steve Barclay, health care, UK healthcare, UK health system, c4 news, news, news podcast, GP, tories, tory government, conservative government, UK prime minister, uk politics, labour, wes streeting, healthcare, health secretary, hospital waiting times, hospitals uk, hospital, health service, nurse strikes, nursing, NHS strikes, strikes

Id: 5syw-ZTNurc

Length: 26min 25sec (1585 seconds)

Published: Fri Jan 20 2023