As T.S. Eliot said, “This is the way the world ends. Not with a bang but a whimper.” Recently, much whimpering has come from the thousands of infirm people waiting in England’s overcrowded, understaffed hospitals. The sick lay on stretchers in hallways for entire days, or on the floor. Some wait for hours in the ambulances that brought them to the hospital.
For the London Review of Books, James Meek examines the crisis that has struck England’s National Health Service. Preparing for a surge of aging citizens with various ailments and a dependence on caretakers, NHS initiated a transition from an old hospital-based system to a new ambitious system centered around home health care. Unfortunately, the transition has not been smooth, and the future looks uncertain. The reform also has people asking what kind of country they want England to be: one of solidarity and publicly funded health care, or one of privately funded care where, like the United States, everyone fends for themselves.
A whistleblower told the Health Service Journal that ambulance delays in the east of England had led to the deaths of at least 19 patients and serious harm to 21 more. On 1 January, an 81-year-old woman in Clacton, Essex, dialed 999, complaining of chest pains. The ambulance took three hours and 45 minutes to arrive. It was too late. A few days later, a 52-year-old man in Norfolk collapsed with severe chest pain and vomiting. He was taken to the Norwich and Norfolk Hospital, but had to wait in the back of the ambulance that took him there for four and a half hours before being seen by a doctor inside the building. He was told to go home and collapsed again when he got there. Two ambulances sent to get him were diverted to other calls and by the time he returned to hospital, his life couldn’t be saved.
One doctor in a major A&E department in the east of England told me he’d witnessed short cuts taken by staff under pressure. For a time, ambulance crews had been allowed to leave patients in a hospital area that wasn’t technically A&E reception. One elderly patient with abdominal pain was diverted within the hospital from emergency medicine to a GP-style consultation, sent home, returned to the hospital a few hours later, and died. “What I’ve seen is the relentlessness of the shifts,” the doctor said. “The intensity. The feeling of higher and higher accountability. And then a lack of investment in staff. Asking them to do more and more and more, to cover more and more patients. There’s no give and take. The staff they should be investing in get more and more demoralized. You’re at risk of creating a Mid-Staffs environment where people don’t really know who they’re working for and start accepting risk that previously would have been deemed unacceptable. They stop reporting things because they reported them before and nothing happened. It’s creating a dangerous culture.” What should be done? “Stop decreasing capacity. Build capacity and build staffing. The party line is always ‘it doesn’t affect patient care.’ Of course it fucking does.”