Crisis hobbles UK emergency wards

When Safiya Malik slipped and fell at her home in London, she called an ambulance and was taken to her nearest hospital. She is 92 years old, and the fall caused intense pain. She suffers from arthritis, osteoporosis and numerous other age-related conditions. She was taken to her nearest hospital, St Mary's in Paddington, where she waited in accident and emergency (A&E) for four hours. When she was finally seen by doctors, they decided to admit her for monitoring, but it was a further eight hours before they could find a space for her on a ward. During this time, she stayed on an A&E bed in a side bay.

The long delays were indicative of a crisis in the National Health Service (NHS) across the UK. The same week Malik was admitted to hospital, more than 20 hospitals in England declared a black alert after becoming so overcrowded they could no longer guarantee patient safety and provide their full range of normal services. Figures released by the NHS in January revealed that more than 40 percent of hospitals in England had to declare an alert in the first week of the year because they had too many patients and too few beds.

"There's no doubt the NHS is facing huge challenges," Phoebe Dunn, a researcher on the policy team at the King's Fund, a healthcare think tank, told DW. "NHS performance against several of the key targets and indicators are at the worst we've seen for more than a decade. One of the key things underlying that is increasing demand for services. The NHS is treating more patients now than it ever has before - as in lots of western countries where there's a growing ageing population - and more people with multiple complex conditions. This is piling on the pressure to NHS services which are struggling to maintain standards of care."

Broken targets

In 2004, Tony Blair's Labour government introduced a target that 95 percent of patients at A&E must be seen and either admitted or discharged in under four hours. So far, 2017 has broken the record for delays, with more than 60,000 people waiting between four and 12 hours for a hospital bed in January and more than 780 waiting over 12 hours.

Ted Evans (not his real name), a London-based doctor, recalls how strictly this four-hour target was observed when he started as a doctor in 2008. "We almost lived in fear of breaking the target when I was a junior doctor: We were all warned that the hospital would get fined otherwise," he said. "Now we simply can't move people out of A&E as there's nowhere for them to go - so hospitals have to break the targets and get fined anyway."

For many doctors, the pressure is untenable. "You still do your best for the patients you see, and our bosses tell us not to let the crisis influence our decisions, but the reality is that you can't not take it into account," said Anna Johnson (not her real name), a psychiatrist. "We strive to put the patient first, but in the knowledge that mental health services are particularly badly affected. If I know someone will be waiting up to four days for a bed, I have to weigh up the psychological impact that will have."

Politicized debate

The debate over the NHS is highly charged in Britain - and highly politicized. While the increased demand on services caused by an ageing population is one driving force behind the crisis, another is the impact of seven years of austerity budgets from the Conservative government. Since 2010, the cost of healthcare has been rising by 2.2 percent but funding only by 2 percent. "Efficiency savings," introduced after 2010, have also increased hospitals' reliance on expensive agency workers. This has been accompanied by cuts to associated services.

"The impact of cuts to other budgets, particularly social care, is making itself known," said Dunn. "We've seen a real rise in the number of delayed discharges - which is where someone is in hospital and medically fit to leave but they're not yet able to because they are waiting for community care, such as a care-home place, to become available. The big increase in people being delayed like this adds to the pressures on A&E and other hospital services."

This was certainly the case for Malik. After several days of being monitored for different health problems and given physiotherapy to recover from the fall that brought her to hospital, she was ready to go home. First, doctors wanted to make sure that her social-care package was set up: carers to visit her home daily to administer her medication. This took a further four days: She was physically well enough to leave, but was nonetheless using a much-needed ward space.                         

"If you cut away every leg that supports a stool, you can't be surprised when that stool wobbles and falls," said Johnson. "That is what we are seeing. Despite a formal commitment to the NHS from politicians, everything around is it being hacked away. It's a political choice."