The daily pressures of working in the NHS
Amid reports that the NHS is at crisis point, one doctor who wished to remain anonymous has written to ITV News about their experience.
He has been a doctor for over 20 years, and a consultant for more than ten, and says that doctors are regularly forced to make decisions about which ill patients they must move.
Each year, those that work in the acute sector for the health service say "this is worse than last year", and this has certainly been borne out in this week, from my own personal experience and from talking to colleagues both regionally and nationally.
Once again, the combination of public holidays and colder weather has caused a complete system-wide failure in the provision of emergency care.
I have worked late shifts every day this week, and the pressure has been unrelenting.
On a daily basis we are faced with Emergency Departments (EDs) that are full beyond capacity.
Of course, we expect cold weather to make the departments busier, and we can, usually, cope with this but this year we are seeing other factors negatively affect the departments.
EDs can be considered the barometer of the health service - if the ED is working well and achieving its four hour target, it usually means all the other facets of health provision are performing well too.
The converse is true - when the EDs fall of the cliff in terms of performance, it is often as a result of many other factors struggling too.
The huge and growing issue that we're facing is the lack of social care due to under funding and/or cuts. This results in the "back door" of the hospital remaining closed.
If patients are not able to be discharged back to the community when medically fit, it causes huge "knock-on" problems to the ED and also to the ambulance service
In my hospital, approximately a quarter of the in-patient beds are currently occupied, through no fault of their own, by medical patients that no longer require any medical treatment and are deemed medically fit for discharge.
Delays can take many forms: alterations to stairs, adding hand rails, moving a bed downstairs, providing a commode, or providing carers to come in and assist with daily living, to name a few.
The overstretched social services cannot provide all of this quickly enough for us to clear our back door, and actually, don't have big incentive to do it as the patients are safe, whilst hospital.
This means that after patients have been seen and assessed in the ED and need medical treatment and admission, there are no beds in the system to accommodate them.
These patients, most commonly, are our frail elderly. These are the patients that spend hours upon hours on trolleys in cold public corridors, parked wherever there is physical space to accommodate them.
I have seen departments having to label walls with numbers so that the staff can keep track of where each patient is.
The knock-on effect continues - during my time in the department this week, we have never got below 20 and have often had over 30 patients waiting for a bed. These don't sound huge numbers, but our department is built to hold 22 trolleys.
This has resulted in patients having to be doubled up in cubicles, sacrificing privacy and dignity, but a desperate measure to ensure that there is physical space to see the patients that are still arriving.
Our four-bedded "resus room", which deals with the most seriously ill patients, has carried more than five patients at once for much of the week.
Patient care is not as good as anyone would hope for, as the staff try to maintain basic safety as they're overwhelmed with the numbers (bear in mind, if there are 30 patients waiting for beds, that is essentially a whole ward's worth of patients).
These patients waiting for the ward have medical needs,/treatments and comfort needs including food and drink, and the nurses do their best for them, but in the meantime, the new patients with their "acute" and emergency needs keep arriving.
Whilst our four-bedded resus is full, the alert phone keeps ringing, bringing in critically unwell patients with strokes or sepsis, and we have to make the decision as to who is the least poorly patient in resus and make the decision to move them out.
Patients with chest pain are directed into the department with chest pain, but there is no physical space available to lie the patient down to perform an ECG.
Ambulances are unable to unload patients in a timely fashion - they're pressured by their control to leave patients on the corridor, so that they can be released to answer the next 999 call.
During this week of unremitting pressure, I have witnessed patients and relatives being angry and upset at the conditions. I no longer feel that it is in my power to apologise for this as the circumstances are beyond my control, and the causes for this lie elsewhere.
I have seen staff cry both during and at the end of the shifts - this is down to pressure, and also because they feel that they're not doing a good job with patients waiting longer than we would like for painkillers or vital antibiotics.
I have witnessed staff work through 12-hour shifts with no breaks, staying well beyond the hours that they were meant to, and working harder than they can do in a safe and sustainable manner
The frustrating part of this is that it's entirely predictable and there seems to be lack of political will to deal with the problems that the NHS and social care is facing.
The upsetting part of this is that its our frail elderly patients who often can't speak up for themselves who suffer.
Published figures suggest that overcrowded EDs are associated with a 30% increase in mortality, and we don't yet know which of these patients that are currently in the department will be affected.
Have you been affected by delayed discharge in hospital? If so, please get in touch with health producer Jade Liversidge on Jade.Liversidge@itn.co.uk.