Derbyshire’s health and social care system is facing a “perfect storm” of problems with professionals under immense pressure and facing burnout and patients being harmed.
GPs are said to be concerned about sending patients to hospital due to the known wait times for them to be seen due to overburdened emergency departments and a shortage in social care support.
A combined set of pressures are putting serious strain on each of the individual parts of the system across the county and city, bringing it to the point of crisis – with a critical incident declared.
To date just 15 elective operations (surgeries such as hip operations) have been postponed as a result of the pressure with the Derbyshire system working hard to avoid cancellations.
There have been reports of oxygen supply issues in Derby but officials say these are being carefully managed and the county’s hospitals are continuing to receive supplies.
This comes as new figures show that in December alone staff at East Midlands Ambulance Service spent the equivalent of 74 12-hour shifts a day, or 888 working hours, just sitting outside hospitals waiting to complete handovers and therefore unable to attend to other patients.
Richard Henderson, the trust’s chief executive, wrote this week: “Patients [are] coming to harm as a direct result of these delays.”
NHS England data shows that in the two weeks up until Christmas (December 12-25), 607 ambulances waited for more than an hour outside Royal Derby Hospital and Queen’s Hospital in Burton, attempting to transfer patients, losing 1,288 hours of valuable paramedic time in which staff could have been responding to other incidents.
In the same time period, four ambulances waited over an hour outside Chesterfield Royal Hospital, losing 15 hours of paramedic time.
The flipside to this pressured situation is that of delay for discharge – patients leaving hospital – with Derbyshire regularly seeing in excess of 200 patients remaining in beds in the county’s hospitals each day despite being deemed medically fit to leave, either to their home or a social care spot, in a process known as “bed blocking”.
Staff and officials have told the Local Democracy Reporting Service about the ongoing issues.
Dr Shehla Imtiaz-Umer, a GP at Wilson Street Surgery in Derby, speaking to the LDRS, said Derbyshire’s healthcare system is facing a “perfect storm” of winter illnesses, a crippling waiting list backlog, a shortage of hospital beds and a lack of resource – through both finances and staff – alongside an already staggering caseload
She said there was an “unprecedented” amount of demand for general practice and the system finds itself in a “precarious” situation.
Dr Imtiaz-Umer said: “There needs to be a recognition that the whole system of the NHS is unfortunately failing and the services that bear the brunt of that are primarily general practice and accident and emergency departments, as we are witnessing first-hand.
“The Government clearly needs to step in, there is an increase in mental health demand, an increase in critical health demand and we have got nowhere to send these patients because there is just a backlog everywhere (hospitals and social care) and there seems to be a lack of recognition from the Government about that, unfortunately.
“There has to be more political willpower to do something. To say there are 500 excess deaths a week (three an hour) is entirely unacceptable. What does that say about us as a society? A single death that is unexpected should be unacceptable.
“Apparently the Government has just washed its hands of it and is leaving us to fend for ourselves.”
She said: “Patients are not getting into hospitals for heart attacks and strokes and as GPs we are now in the difficult situation of thinking ‘do we actually send this patient to hospital’ because we know it is going to be an eight-hour wait for an ambulance, and that should never be the case.
“I’ve heard of GPs transporting patients directly themselves because in one case a patient was so low on oxygen they had no other option to take them in themselves because the ambulance was going to come in time.
“On top of doing what we are trying to do on a daily basis along with this additional pressure is just a reflection of how the health system as a whole is simply not functioning currently.”
Dr Imtiaz-Umer says the situation is causing “moral injury” to health and social care professionals who are trying to provide the best support they can but know they are falling short – not through choice but as a result of the unmanageable situation they find themselves in.
She said: “We recognise that we as a whole are not being able to meet our patients’ needs in the way that we would normally like to do so.
“People are being affected psychologically by it, thinking I actually haven’t done the job i would normally like to do and that just leads to burnout.”
Dr Imtiaz-Umer spoke to the LDRS while on leave and also carrying out work in a bid to catch-up on her own backlog.
She said the stress is leading GPs to quit and at a faster pace than anticipated, saying: “There is just no-one coming in to save the day for us, we are just having to cope with fewer staff.
“We simply cannot meet the demand and having to send patients away because there are no appointments left and to seek other services is not a place we would like to be.
“It is incredibly difficult in all of general practice and I’m sure emergency department colleagues would share those sentiments.
“We came into this profession to care for our patients and provide a service to improve patients’ lives but we are trying to do that with our hands tied behind our backs. We have absolutely no support from where we should be getting it from.”
She said the situation is leading to more burnout and lower resilience, more retirements and a perpetuating recruitment and retention crisis.
Dr Komal Raj, a Wilson Street Surgery GP, said GPs were already carrying out double the number of consultations than the system is set up for, with fewer and fewer staff and facilities in which to do so.
He said more doctors were reducing their hours, going part-time or retiring due to the strain and finding that “work is just intolerable” and feeling “I just can’t keep going at this rate”.
Dr Raj said he works from 8am until 6pm each day and regularly works through the night and at weekends at home, and worked through the recent bank holiday in a bid to try and keep up.
He said: “At some point something has got to give, you can’t keep going at full pelt… you will burn out.”
Dr Raj said patients now need more intensive healthcare support and have more conditions, requiring more appointments, with a larger elderly population who may have six ailments requiring 15 medications – all of which has to be handled in 10-minute sessions.
He said there is also a stark increase in mental health issues affecting the 18-40 age group requiring a vast amount of support.
Dr Raj said: “It is just everything exploding, you’ve got the elderly and the complexity, you have got the younger patients and mental health support, all of that just means it is much more difficult to get an appointment.
“We all deal with it differently and effectively you try not to think about it because it is really stressful.
“You feel like you are chasing your tail constantly just to keep up and you haven’t’ got the headspace or the time to really plan for the future and the upsetting thing is knowing that there doesn’t seem to be a national plan to manage this demand, no national plan to make things easier.
“A lot of doctors are thinking of throwing the towel in and that compounds the problem. It is not a great place to be. There just seems to be no plan or direction on how to solve this and how long this is going to go on for and that is what we need an answer to.”
He said deprived communities such as those served by the Wilson Street Surgery look after patients who have a higher level of required support for health issues, but that surgeries in deprived areas also get less support – compounding the problem.
EMAS chief Mr Henderson wrote that the staggering number of effective limbo shifts were “equivalent to crews coming on duty but being detained at hospital for the full shift, caring for patients on the back of ambulances or in hospital corridors”.
He said: “During these periods unfortunately many patients in the community waited a significant time for a response from us because we did not have the resources to attend to them.”
Reports from EMAS detail that the trust is received nearly 600 more 999 calls a day in December – more than 4,000 – with around 130,000 total calls in the month, up from around 110,000 in December 2021 and 90,000 in December 2020.
They detail that the trust responded to 366 more incidents a day in December than expected, which is 663 more than in November.
Dr Chris Weiner, executive medical director for NHS Derby and Derbyshire, said: “By declaring a critical incident we are able to introduce extra support, focusing on frontline care and discharges and we are monitoring the situation hourly.
“Ensuring the safe care of patients is our main priority and staff continue to work tirelessly to provide this.
“Our message continues to be that we are here for anyone who needs us and it is important that people needing medical help consider self-care where this is appropriate, or contacting NHS 111 online, their GP, or going to an urgent care centre first and to only call 999 if their condition is life threatening.
“We would like to thank members of the public who are supporting us by making the right choice of service for their condition, and also our colleagues across the health and care system who are going above and beyond to ensure that we continue to provide our patients with the best care we possibly can.”
A Department of Health and Social Care spokesperson said: “We recognise the pressures the NHS is facing following the impact of the pandemic and are working tirelessly to ensure people get the care they need, backed by up to £14.1 billion additional funding for health and social care over the next two years.
“This winter, the government has provided an extra £500 million to speed up hospital discharge and free up beds – and the NHS is creating the equivalent of at least 7,000 more beds to help reduce A&E waits and get ambulances back on the road.
“We’re supporting and growing the health and social care workforce through training and recruitment campaigns at home and abroad, and there are record numbers of staff working for the NHS, including 9,300 more nurses and almost 4,000 more doctors compared to September 2021.”
The spokesperson said the Health Education England has a mandated target to train 3,000 paramedic graduates nationally per annum from 2021-2024.
They said that since 2010, there are now more than 34,100 further doctors and an extra 44,800 more nurses working in the NHS.
The spokesperson said there are also more than 21,000 further primary care staff supporting patients – including nurses and pharmacists – since September 2019 and that the Government is on track to meet its target of 26,000 additional staff by March 2024.
