Pray you don’t get seriously ill this winter….

I do not write this piece lightly. One of the main premises of Big Up the NHS is that unjustified negative press is harmful to patients and staff. Stress and anxiety can affect the experience of treatment and even the outcome. I write this because I am deeply worried about the NHS and because I am very angry with government and its actions that have landed us in this mess.

My message will be frightening for patients and their families and for that I apologise sincerely – but it has to be said.

This winter NHS emergency services will be subjected to unprecedented pressure and in some parts of the country the service will fail. Quality will nosedive in many areas and the patients’ experience of treatment will deteriorate. Some patients who would normally survive will die – and there is precious little at this stage that anybody can do to avoid it.

I can say this because I understand how hospitals work and what causes the pressures on emergency services in winter. I have been a consultant physician for 20 years and for 5 of them ran the emergency services in one of the biggest trust in the county.  I have written more “winter plans” than I care to remember.

The causes of the problem are well understood – an aging population, the obesity epidemic, increasing public expectations, shrinking budgets, health inflation and inadequate training numbers. I have been banging on about it for ages.

This year is different though for two big reasons – the NHS financial crisis and the impending collapse of staff morale.

This week’s NHS hospital trusts budget statement shows an unprecedented overspend of pushing £1B in the first quarter. The NHS normally finishes the year with an under spend of several billion which is returned to government. Chief executives are required to balance the books. Their survival in post depends on it. So when faced with prospective overspends they normally take Draconian action such as vacancy freezes to regain financial control.

In reality the only way to reduce expenditure by the amount needed is to reduce staffing levels. Over two thirds of the NHS budget is spent on pay. However emergency activity is increasing so to maintain safety you need to cover the vacancies with expensive locums leading to a vicious downward spiral.

At present it looks as though nearly 80% of trusts will fail to hit the financial targets. These trusts will all be in financial turmoil as winter approaches.

Those staff still working in NHS front door services are under greater pressure than I can ever remember. They are doing more work with fewer people. Sickness is increasing and clinicians and managers alike are feeling the strain. The number of doctors applying to work overseas has reached record levels. I see it every day. Many are near breaking point.

This winter could go one of three ways.

  • The government keep up the pressure on trusts to achieve financial balance. Managers continue to slash staffing levels to try to balance the books. We hit the winter with a skeleton staff of very tired people who will collapse under the strain and the service will fall apart in dramatic fashion.
  • The government realise that financial balance is impossible when things start to get really bad and back off. This in some ways is worse. We spend a fortune on under-qualified, ill prepared locums, storing up troubles for the future. Waiting times in emergency departments go up and patient experience plummets. The service rumbles on with increasing numbers of patients spending 24 hours on hospital trolleys and it all fails more gradually.
  • The government realise the scale of the problem and pump in significant amounts of cash straight away. This is by far the best option if somewhat unlikely. Sadly though, however much money is thrown at the problem, it will not be enough. It is now too late to recruit the necessary trained staff and in many cases they do not exist because we have been cutting training budgets recently to save cash. We will still use under-qualified, ill prepared locums. It will help but we still need to be prepared for the carnage.

So that is why I am worried, but why am I so angry?

I am angry because all of this was entirely predictable. I have been writing about if for years. Whatever you think about the present government one thing is certain. They are not stupid people and they understand EXACTLY what is happening.

They have let this situation develop and they must have done so deliberately. There has been no attempt to put in emergency plans to tackle the deepening and completely foreseeable problems. Indeed they seem to want to make things worse by raising public expectation of a 7 day service in the full knowledge of the impending financial collapse which will make it unachievable. They have played politics with the NHS by picking unwinnable fights with doctors which can only lead to unrest and worsening staff morale.

CRGz5hiWoAADaliThe only rational explanation I can see for the current government approach is that they want to see the NHS collapse. It cannot be accident or incompetence. The governments stated aim is to increase involvement of the private sector in the NHS and they can do this more easily when it is failing. A privatised NHS is attractive to politicians of all colours as it gets them off the “funding” hook and actually generates new tax revenues. The conservatives also have their own ideological agenda and some possibly have personal financial motivations.

So it seems that we have a government that is prepared to see many millions of NHS patients suffer appallingly and even see some die in pursuit of their own political agenda.

That is why I am angry!

What can we do?

To be honest it is now far too late to do much that will fix the problem in time for this coming winter. There are things we should do now to help us come out the other side with half a chance of keeping a viable NHS.

  • NHS leaders all know and understand what is going on. They are silent because their jobs will be on the line if they speak out. It is about time they said something.  There are signs of this starting.
  • NHS staff must work hard to make savings and reduce waste but they MUST NOT ALLOW QUALITY TO BE DEGRADED in the name of cost savings. Giving up quality now is the equivalent if using the lifeboats for firewood to keep warm as the ship goes down.
  • NHS staff must look after each other. Things become frenetic when services fail and we can easily start to look for people to blame. We are all on the same side and must fight together.
  • NHS supporters must work together to spread this message. There are a lot of separate groups doing great things but they are disjointed and could be so much more effective.
  • The press need to realise that this is bigger than their individual political allegiances. They need to inform the public first and put their prejudices on the hold for the moment.
  • The general public must understand the problems facing the NHS and get behind us. Things will be bad this winter and the government will blame the staff as they have always done in the past.  It is not our fault and we will need your support and encouragement more than ever.
  • Politicians must listen to the public and to their own consciences – and then DO SOMETHING. At the end of the day it is only politicians who have the power to make the necessary changes to get us out of this mess.

Please spread this message, support your hospitals and their staff, lobby your MPs, join Big Up the NHS or any of the other NHS groups and above all pray you don’t get seriously ill this winter!



  1. A typical consultant.

    It’s everyone elses fault, management, nurses, administrators, politicians.
    You lot are so out of touch and are part of the problem. You all walk around with big ego’s with incredible arrogance oblivious to the bigger picture thinking the NHS revolves around you.

    It’s laughable that a consultant talks about not blaming other NHS staff, especially just a few lines after criticising NHS leaders who are themselves NHS staff. Would you grow balls and speak up knowing your job was on the line?

    Seriously size up.


    1. Are you serious?! You are the exact example of an ignorant and brain washed idiot. He isn’t blaming staff- we all work our bloody socks of in the NHS not just the doctors! Year upon year the population grows, people get sicker and the money should be going up in proportion to this but funnily enough it doesn’t, it gets cut. Therefore regular staff are reduced or leave and at times of crisis (all of this year it seems) hospitals are forced to pay through the nose to cover the gaping gaps in their clinical staff numbers.
      Have some bloody respect please for people that work tirelessly- and yes, for far less money than they deserve, who will no doubt one day be there when YOUR life is on the line- because if anything is guaranteed it is that we all get sick and old.

      Liked by 1 person

    2. What is the “bigger picture”?

      So it’s all the staffs fault is it?
      Nothing possibly to do with the annual reduction in numbers of doctors being trained and employed into permanent posts? Or reduction in front line nursing staff, so even when there are beds in hospital there is no one to nurse them. And bed pressures have nothing to do with systematic reduction of social services so that discharging patients takes longer and longer.
      No it’s not that at all, silly us, it’s all our big egos. Well that’s that problem solved then.

      Liked by 1 person

    3. This is a reply to Freddy. Are you connected with the health sector? Are you a SpAd at the DoH? Is it McKinsey, KPMG or some other type of Consultant (you know the sort, the useless, money grabbing private vulture that only survives by sucking off the teat of taxpayers) that has led you to write some a vile and stupid attack, lacking completely in any form of constructiveness? In fact, don’t bother too respond. You’re marked out and laid on the floor totally transparent and ready for squashing flat.


  2. The public can do a lot by exercising simple common sense: If you’re eligible for a flu jab, get one! Contrary to popular misconception, they do not/ cannot cause flu. And they CAN save your life. And if you have a flu jab, it also helps protect the elderly and otherwise vulnerable around you from it too.
    If you have a cough/cold /sore throat, don’t use up valuable gp appointments: See your pharmacist. They’re more likely to be able to help, and if they think you really need to see a GP, they’ll tell you.
    Don’t call 999 or go to a&e unless you have a genuine emergency: Broken bone, chest pain, bleeding etc.

    Liked by 1 person

  3. I am one of those locum nurses you talk of and far from being under skilled I am highly qualified. Like many of my fellow locum nurses I have left because of NHS politics and an inability, or more likely, unwillingness, of managers to address staffing levels which reflects in patient safety.

    I used to be a Nurse Practitioner with high level skills including ALS and ALS, trauma and Intensive Care. To day that my patients receive poor care from me is wrong. Indeed I believe that they receive the best care I can provide and sometimes better than other patients I see being cared for by permanent staff.

    I would gladly return to the NHS if priorities were rearranged to deliver safe care with adequate staff. In the meantime, I know a small amount of patients will receive good care and that is all I can do for the NHS and the public.


  4. Thank you for this- it’s exactly what I’ve thought all along but I cannot claim to be an expert because I am not involved with hospital management (yet). It’s a very sad situation but “new labour” did unfortunately start the downward spiral of privatisation and PFI. Staff morale is already rock bottom – never enough staff and resources but there are small things we can do to be cost-effective.


  5. A very powerful and cogent blog post. All my (frequent) contact with NHS bears this out. Two suggestions to add to the discussion:

    1. British university trained doctors must work in the UK for 10 years or repay their tuition fees in full if they leave the country to work elsewhere. I think this is only fair.

    2. GP and consultant salaries hold be revised down to save the NHS vital cash: I believe doctors (rather than nurses, or porters) are the big strain on the NHS budget – some of my GP friends are on breathtakingly large salaries.


  6. The big strains on the NHS budget are:

    1) Allowing for a budget that is too small in the first place

    2) Forcing the NHS to make do with that while intentionally asking them to do more to make them break

    3) Wasting an increasing percentage on private profit.

    It’s not about resources, but political priorities. Cutting NHS budgets is a purely political choice, for purely commercial ends.


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