Category Archives: Rheumatoid Arthritis

Family doctors working ‘beyond safe levels’, says GPs’ leader

As doctors describe dealing with up to 70 patients a day, college warns of risks to public health

Waiting room of GP practice


Patients face longer waits to see a GP, says the Patients Association. Photograph: Alamy


GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.

Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.

The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.

Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”

One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”

Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.

It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.

“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”

Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”

He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.

Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”

Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”

Doctors should order more blood cancer tests, MPs say

TV presenter Simon Thomas, whose wife died from a rare form of blood cancer last year, is calling for better training of GPs

Sky sports presenter, Simon Thomas


The Sky Sports presenter Simon Thomas says doctors only diagnosed his wife’s acute myeloid leukaemia three days before she died. Photograph: Nick Potts/PA

The Sky Sports presenter Simon Thomas has revealed that doctors missed his wife’s blood cancer three times in the days before her death.

Thomas called for better training of GPs on the same day as politicians said doctors should order blood tests for any patient who shows symptoms of blood cancer.

Thomas’s wife, Gemma, died aged 40 in November, just three days after being diagnosed with acute myeloid leukaemia (AML), a rare form of the disease.

Gemma initially had flu-like symptoms and went to see a doctor three times over the course of six days before she was finally admitted to hospital, where her condition continued to deteriorate, despite intensive chemotherapy treatment.

Since then, her husband Simon has raised more than £30,000 for charity. The money has been divided between Maggie’s Centres, a charity which offers support to people affected by cancer, and a refugee project that Gemma had launched.

On Wednesday, Thomas tweeted: “Three times my wife Gemma went to the doctor in six days and three times she was sent home and told to rest.

“Four days after her final visit to the her GP she was dead. We have to help and train our GPs and to detect blood cancer earlier.”

Simon Thomas (@SimonThomasSky)

Three times my wife Gemma went to the doctor in six days and three times she was sent home and told to rest. Four days after her final visit to her GP she was dead. We have to help and train our GP’s and to detect #bloodcancer earlier. @bloodwise_uk is doing this. #hiddencancer https://t.co/V1uEz1HCLF

January 17, 2018

Simon Thomas (@SimonThomasSky)

Acute Myeloid Leukaemia took my wife Gemma and Ethan’s Mum just before Christmas aged only 40 years and just three days after being diagnosed. This is so important. @bloodwise_uk https://t.co/V1uEz1HCLF

January 17, 2018

Thomas, 44, has been tweeting and blogging about his grief following Gemma’s death from AML, which affects around 2,600 people in Britain each year.

Thomas said he doesn’t blame the doctors who initially saw his wife before she was taken to hospital, but has encouraged people to seek a diagnosis from medics if they continue to feel unwell.

Simon Thomas (@SimonThomasSky)

The darkness will hopefully not overcome. pic.twitter.com/umuBOT0TdW

January 2, 2018

The all-party parliamentary group on blood cancer said on Wednesday that many signs of blood cancer can be “misunderstood or misdiagnosed”.

In a new report, the group said that diagnosing blood cancer – such as leukaemia, lymphoma and myeloma – can be “complex”.

Highlighting one patient group, MPs described how some elderly myeloma patients reporting symptoms of back ache and bone pain are told their symptom is “part of the ageing process”.

In order to improve early diagnosis rates, they called on GPs to immediately order a blood test for anyone presenting with one or more symptoms of blood cancer.

Symptoms of blood cancers can be similar to the symptoms of feeling “run down” or flu, such as fatigue, night sweats, weight loss, bruising and pain, they said.

The chair of the patient group, Henry Smith, an MP whose mother died from acute myeloid leukaemia in 2012, said: “Blood cancer is the fifth most common cancer in the UK and someone is diagnosed every 14 minutes.

“Delays in diagnosis can have a severe impact on an individual’s chance of survival, as well as on their quality of life.”

Commenting on the report, professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: ““Each type of blood cancer can present in a varied way and GPs will base their decisions around what diagnostic testing is most appropriate on the symptoms being displayed by, and the unique circumstances potentially affecting, the patient in front of us.

“Any decision to pursue opportunistic testing must not be undertaken lightly as GPs need a good scientific evidence base before they order any investigations.”

‘Haemorrhaging nurses’: one in 10 quit NHS England each year

Data showing 33,000 nurses left in 2016-17 triggers warning of ‘dangerous and downward spiral’

Two NHS nurses


More nurses have left the NHS in England in the past three years than have joined. Photograph: Medic Image/Getty Images/Universal Images Group

One in 10 nurses are leaving the NHS in England each year, according to official figures, raising fresh concerns about staffing shortages in hospitals.

Data published by NHS Digital on Wednesday shows that just under 33,500 nurses left the service in 2016-17 – 3,000 more than joined and 20% higher than the number who quit in 2012-13.

The worrying figures come amid an ongoing winter crisis fuelled by rising demand, coupled with staff and bed shortages.

The data shows more nurses have left the NHS in England than have joined for the past three years, with the deficit highest last year. In each of those three years, the number quitting has been 10% of the total.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Janet Davies, head of the Royal College of Nursing, told the BBC, which initially requested the figures, that they were of great concern. “The government must lift the NHS out of this dangerous and downward spiral,” she said.

“We are haemorrhaging nurses at precisely the time when demand has never been higher. The next generation of British nurses aren’t coming through just as the most experienced nurses are becoming demoralised and leaving.”

Although 6,976 (21%) of the nurses who left in the year to September 2017 were 55 or over (the age at which nurses can start retiring on a full pension), just over half (17,207) were under 40.

The figures suggest Brexit may be having an impact, with more nurses from the EU leaving than joining in recent years. Last year, 3,985 EU (excluding the UK) nurses left, compared with 2,791 who joined. By contrast, in the last full year before the 2016 referendum (2014-15), 2,416 nurses quit the NHS, while 5,977 joined.

Hospital bosses have called for the 62,000 EU workers in the NHS, who represent 5.6% of the total workforce, to be given reassurance about their status post-Brexit.

But it is not just EU nurses who are leaving. Davies said low pay and the pressures of the job must be addressed if retention were to be improved.

Last week, senior doctors wrote to Theresa May, the prime minister, warning that patients were dying in hospital corridors during the winter crisis because the NHS was so underfunded and short-staffed that it could not cope.

The percentage of patients being treated within four hours at hospital-based A&E units in England fell to its lowest-ever level (77.3%) last month.

A Department of Health and Social Care spokesperson said there had been a rise of 11,700 nurses on wards since May 2010, and an additional 5,000 training places would be available from this year.

‘Haemorrhaging nurses’: one in 10 quit NHS England each year

Data showing 33,000 nurses left in 2016-17 triggers warning of ‘dangerous and downward spiral’

Two NHS nurses


More nurses have left the NHS in England in the past three years than have joined. Photograph: Medic Image/Getty Images/Universal Images Group

One in 10 nurses are leaving the NHS in England each year, according to official figures, raising fresh concerns about staffing shortages in hospitals.

Data published by NHS Digital on Wednesday shows that just under 33,500 nurses left the service in 2016-17 – 3,000 more than joined and 20% higher than the number who quit in 2012-13.

The worrying figures come amid an ongoing winter crisis fuelled by rising demand, coupled with staff and bed shortages.

The data shows more nurses have left the NHS in England than have joined for the past three years, with the deficit highest last year. In each of those three years, the number quitting has been 10% of the total.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Janet Davies, head of the Royal College of Nursing, told the BBC, which initially requested the figures, that they were of great concern. “The government must lift the NHS out of this dangerous and downward spiral,” she said.

“We are haemorrhaging nurses at precisely the time when demand has never been higher. The next generation of British nurses aren’t coming through just as the most experienced nurses are becoming demoralised and leaving.”

Although 6,976 (21%) of the nurses who left in the year to September 2017 were 55 or over (the age at which nurses can start retiring on a full pension), just over half (17,207) were under 40.

The figures suggest Brexit may be having an impact, with more nurses from the EU leaving than joining in recent years. Last year, 3,985 EU (excluding the UK) nurses left, compared with 2,791 who joined. By contrast, in the last full year before the 2016 referendum (2014-15), 2,416 nurses quit the NHS, while 5,977 joined.

Hospital bosses have called for the 62,000 EU workers in the NHS, who represent 5.6% of the total workforce, to be given reassurance about their status post-Brexit.

But it is not just EU nurses who are leaving. Davies said low pay and the pressures of the job must be addressed if retention were to be improved.

Last week, senior doctors wrote to Theresa May, the prime minister, warning that patients were dying in hospital corridors during the winter crisis because the NHS was so underfunded and short-staffed that it could not cope.

The percentage of patients being treated within four hours at hospital-based A&E units in England fell to its lowest-ever level (77.3%) last month.

A Department of Health and Social Care spokesperson said there had been a rise of 11,700 nurses on wards since May 2010, and an additional 5,000 training places would be available from this year.

Mexico: 500 years later, scientists discover what killed the Aztecs

Within five years, 15 million people – 80% of the population – were wiped out in an epidemic named ‘cocoliztli’, meaning pestilence

Scientists identified a typhoid-like ‘enteric fever’ for which they found DNA evidence on the teeth of long-dead victims.


Scientists identified a typhoid-like ‘enteric fever’ for which they found DNA evidence on the teeth of long-dead victims. Photograph: FabioIm/Getty Images

In 1545 disaster struck Mexico’s Aztec nation when people started coming down with high fevers, headaches and bleeding from the eyes, mouth and nose. Death generally followed in three or four days.

Within five years as many as 15 million people – an estimated 80% of the population – were wiped out in an epidemic the locals named “cocoliztli”. The word means pestilence in the Aztec Nahuatl language. Its cause, however, has been in questioned for nearly 500 years.

On Monday scientists swept aside smallpox, measles, mumps, and influenza as likely suspects, identifying a typhoid-like “enteric fever” for which they found DNA evidence on the teeth of long-dead victims.

“The 1545-50 cocoliztli was one of many epidemics to affect Mexico after the arrival of Europeans, but was specifically the second of three epidemics that were most devastating and led to the largest number of human losses,” said Ashild Vagene of the University of Tuebingen in Germany.

“The cause of this epidemic has been debated for over a century by historians and now we are able to provide direct evidence through the use of ancient DNA to contribute to a longstanding historical question.”

Vagene co-authored a study published in the science journal Nature Ecology and Evolution.

The outbreak is considered one of the deadliest epidemics in human history, approaching the Black Death bubonic plague that killed 25 million people in western Europe in the 14th century – about half the regional population.

European colonisers spread disease as they ventured into the new world, bringing germs local populations had never encountered and lacked immunity against.

The 1545 cocoliztli pestilence in what is today Mexico and part of Guatemala came just two decades after a smallpox epidemic killed an estimated 5-8 million people in the immediate wake of the Spanish arrival.

A second outbreak from 1576 to 1578 killed half the remaining population.

“In the cities and large towns, big ditches were dug, and from morning to sunset the priests did nothing else but carry the dead bodies and throw them into the ditches,” is how Franciscan historian Fray Juan de Torquemada is cited as chronicling the period.

Even at the time, physicians said the symptoms did not match those of better-known diseases such as measles and malaria.

Scientists now say they have probably unmasked the culprit. Analysing DNA extracted from 29 skeletons buried in a cocoliztli cemetery, they found traces of the salmonella enterica bacterium, of the Paratyphi C variety.

It is known to cause enteric fever, of which typhoid is an example. The Mexican subtype rarely causes human infection today.

Many salmonella strains spread via infected food or water, and may have travelled to Mexico with domesticated animals brought by the Spanish, the research team said.

Salmonella enterica is known to have been present in Europe in the middle ages.

“We tested for all bacterial pathogens and DNA viruses for which genomic data is available,” and salmonella enterica was the only germ detected, said co-author Alexander Herbig, also from Tuebingen University.

It is possible, however, that some pathogens were either undetectable or completely unknown.“We cannot say with certainty that S enterica was the cause of the cocoliztli epidemic,” said team member Kirsten Bos. “We do believe that it should be considered a strong candidate.”

Achoo! Why letting out an explosive sneeze is safer than stifling it

Following the case of a man who ruptured this throat, medics say holding in a sneeze can cause ear damage or a brain aneurysm

Although it is rare, the report’s authors say blocking the nostrils and mouth when sneezing is dangerous.


Although it is rare, the report’s authors say blocking the nostrils and mouth when sneezing is dangerous. Photograph: Peter Jordan/PA

In a season where colds are rife, holding your nose and closing your mouth might seem like a considerate alternative to an explosive “Achoo!”. But doctors have warned of the dangers of such a move after a man was found to have ruptured the back of his throat when attempting to stifle a sneeze.

Medics say the incident, which they detail in the British Medical Journal Case Reports, came to light when a 34-year old man arrived in A&E with a change to his voice, a swollen neck, pain when swallowing and a popping sensation in his neck after he pinched his nose to contain an expulsion.

The team took scans of the man’s neck to investigate and discovered bubbles of air in the tissues at the back of the throat, and in the neck from the base of the skull to halfway down the man’s back.

That, they say, suggested a tear had occurred at the back of the throat as a result of increased pressure from the stifled sneeze, leading to air collecting in his soft tissues.

“For reasons of propriety and etiquette, one sometimes stops a sneeze. However on unfortunate rare occasions it might lead to potentially serious complications,” said Dr Sudip Das, co-author of the report from the University Hospitals of Leicester NHS Trust.

The authors warn that blocking the nostrils and mouth when sneezing is dangerous, noting that while tearing of the throat tissue is rare, it could result in a ruptured eardrum or even a brain aneurysm.

“Spontaneous perforation of the throat with leakage of air under the skin is very rare,” said Das, although he noted that there had been cases before.

Mr Shahz Ahmed, an ENT consultant and skull base surgeon at University Hospital Birmingham who was not involved in the case, added that such complications from sneezing were so uncommon that there was no evidence in general that individuals should not hold one in.

Das and colleagues add that similar complications canoccur if the lower portion of the oesophagus tears, a serious and potentially fatal situation that can be triggered, among other causes, by retching and vomiting. “Any cause of increase in pressure in a closed throat, viz severe coughing or vomiting, can cause the symptoms,” said Vas. “A known weakness in the wall of the voice box, throat, gullet or the lung may predispose the patient to such complications.” But, he added, “even then the condition is rare.”

The patient was admitted to hospital and given intravenous antibiotics to prevent infection and was tube-fed to aid healing, with scans a week later showing no signs of air bubbles. “The patient was subsequently discharged with advice to avoid obstructing both nostrils while sneezing,” they write.

As a GP, having my heart surgery cancelled gave me a new perspective on NHS underfunding

I am a GP partner in Oxford. I have worked in the NHS in Oxford for 20 years, barring two years in a post in rural Canada. In July 2017, we returned to the UK and a friend of mine, who’s a cardiothoracic anaesthetist, commented on my bounding neck pulses as we were chatting over a beer. A little later that day, I had a listen to my heart and even I, a GP, could hear a loud murmur. I asked one of my colleagues to have a listen, just to check I wasn’t being paranoid. I think he was trying to make me feel better and reassured me: “It’s probably just a flow murmur.”

Nevertheless, I saw my GP that day. With detached, mildly mounting alarm I registered the abnormal findings she discovered. High blood pressure, wide pulse pressure, mild tachycardia and, of course, The Murmur. Her worried expression made me more alarmed than the findings, and I found myself trying to reassure her that everything would be OK.


It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night.

I saw the cardiologist in October and as soon as he mentioned he wanted to get the medical student, I knew I was in for some bad news. He told me I had severe aortic regurgitation, where blood flows in the reverse direction from where it’s supposed to as the heart pumps. He said he’d see me in six months and by that time I would have a new aortic valve. My reaction was silence, followed by expletive-laden surprise, not least as I had had no symptoms at all. Also, doctors never get sick.

It’s funny how that kind of news affects you – for a week or so, I was mentally crossing things off the list of things I could do with the rest of my life, and confronting the possibility that I might not see my daughter grow up.

In December, I was very relieved to get a date for my operation in January 2018 but my urgent surgery was cancelled when I called in at 10am on the day of admission. It’s difficult to describe the sense of loss that I felt. It came as a surprise, even for someone who works in the NHS every day. I really did not know what to do with myself.

As doctors in the NHS, we are trained from an early stage to soak up punishment, not to complain and to always carry on. But with my patient’s brain, I idly wondered how other people might be coping with similarly disorientating news all over the UK. About how they might be thinking how unfair this was, and what would they do now. Lives put on hold, terrible feelings of uncertainty, resignation and finally acceptance. After such news they must love, fear and hate the health service all at the same time. Nevertheless, the NHS is so beloved that it would never cross their minds that the government would have deliberately underfunded it for the last seven years. Some people might think it’s pretty decent of ministers to apologise for all the disruption, and that the government, to its credit, is forward-planning for a winter crisis.

The fact is, of course, that it is not, and that the crisis was entirely avoidable and is down to consistent underfunding. Doctors and the Kings Fund predicted it, even the head of NHS England predicted it. It’s quite difficult to describe the strangled sense of anger as I watched Jeremy Hunt on the news that night. I’m not sure how much more short-notice my surgery cancellation could have been, and yet here was my ultimate boss telling me that this was being done to avoid just such upheaval.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

I was back to work the next day and I have my game face firmly back on, but I can’t deny it has been disruptive and upsetting. I’m determined not to let any of these developments compromise my patient care and commitment to the NHS. I am sanguine, but waiting hopefully for another appointment. I understand that this situation may well occur again. In that circumstance, I look forward to a time when the apology from my health secretary and prime minister will be replaced by sustained hard investment in the NHS. Platitudes and short-term measures will not save or improve it. And yet, as many commentators have already suggested, perhaps that is this government’s point.

Surgeon who signed livers is punished but managers let off | Letters

I am an altruistic kidney donor and am appalled at the treatment of Simon Bramhall, the surgeon who initialled two livers in transplant operations (Surgeon fined £10,000 for signing his initials on livers of two transplant patients, 12 January).

I am particularly incensed at the comments of the judge and the whingeing of Patient A. For the judge to call it “an abuse of power and betrayal of trust” borders on the ludicrous.

If anything, they were acts of elation after two very difficult successful operations – the equivalent of a footballer pulling off his jersey after scoring a great goal.

And for Patient A to suffer an “overwhelming feeling of violation” is beyond ludicrous. Mr Bramhall had just saved your life! He did nothing to you. It was not your liver. It was the liver of a dead person who bequeathed it to you: a final act of great generosity. Where is your generosity?

If my brilliant Sheffield surgeon, Mr Shrestha, had initialled my kidney I would have been delighted. It would have been a celebration of a successful partnership between a gifted doctor and a donor to give someone a better life.

What has happened to this country that people take exception so easily, and any deviation from the norm draws so much approbation?
John Carlisle
Sheffield

In sentencing former Queen Elizabeth hospital surgeon Simon Bramhall, Judge Paul Farrer QC described those actions, which resulted in no physical harm, as “conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour”.

Less than two years ago, your newspaper highlighted the Care Quality Commission’s damning report into cardiac surgery at the Queen Elizabeth hospital in Birmingham, estimating that 17 patients may have died unnecessarily as a result of the hospital’s failure to heed repeated patient safety warnings.

Yet no member of the hospital’s executive team has been held to account for their failings.

The contrast is striking: we are forced to conclude that, even where patient safety is at stake, there is one rule for the individual clinician, another for his or her organisation.

Less than five years since the publication of his report of the Mid Staffordshire NHS foundation trust public inquiry, the words of another QC, Robert Francis, appear to have already been forgotten.
Dr Richard Horton
Wolverhampton

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Why does America still have so few female doctors? | Elisabeth Poorman

When my friend was in her fourth year of medical school, she and her boyfriend sat down with their dean to discuss their residency applications. They were entering a “couples’ match” where partners rank programs together in order to end up in the same city.

The match is a nerve-racking and opaque process. Both have since gone on to have successful academic medicine careers, but on that day in the dean’s office, they were nervous. My friend asked the dean for reassurance.

“I’m sure it will all work out,” she recalled the dean saying. “After all, in 20 years your boyfriend will be running his department and someone has to take care of your kids.”

Medicine has long been a career path in the US for women in science, with women entering the field in nearly equal numbers to men for 20 years. But along the way, many women fail to advance and to earn the same recognition and salaries as their male counterparts.

These differences are often framed as “individual failures”, in spite of the robust evidence of gender discrimination. Women are told to advocate for themselves, to be better negotiators, and, in private, not have children if they are going to succeed.

The medical profession must confront this sexism if we are to address why women have double the rates of burnout as male colleagues, and among the highest levels of suicide in the country, at 2.5 to 4 times the rate of the general population.

As a culture and a profession, medicine continues to systematically disadvantage women physicians at every stage of their careers, causing many to leave. As a result, we are losing some of our most talented doctors.

When I decided as a young girl to become the first in my family to go to medical school, the road ahead was daunting, but no more intimidating because of my gender. Since 1992, women have made up at least 40% of medical school students, peaking this year at more than 50%. Back then, many ascribed to a theory of “critical mass” where women would transform a culture created by and for male physicians through numbers alone.

But the top leadership positions in medicine remain predominantly male. Only 15% of department chairs are women, and 16% of medical school deans are female. For the past 10 years, according to an Association of American Medical Colleges report, women in academic medicine have received only 30% of new tenured positions.

If female doctors were on even playing field with their male colleagues, we should have reached parity long ago. As Dr Julie Silver, associate professor at Harvard Medical School, told me: “Medicine should be leading the way” in gender equity. Instead, women are at a disadvantage beginning in medical school.

The most important part of our education involves interacting with patients and winning their trust. If patients do not wish to talk to us because they mistrust women or minorities, this has serious consequences for our education.

According to a survey by Stat News and Medscape, 41% of women in medicine reported a patient making an offensive remark about their gender, compared with 6% of men. About 1 in 5 physicians reported a patient making an offensive remark about their race.

As Dr Huma Farid, a South Asian obstetrician at Beth Israel Deaconess Hospital, explained: “When people look at a white woman, they think she’s a nurse. When they look at me, they think I’m there to collect their tray.” We are rarely given any forum to discuss that doubt or even open bias and discrimination.

Our medical educators are also affected by gender bias. Male medical students are more likely to be labeled as “quick learners” than women, and that gap actually grows through medical training

Dr Vineet Arora, associate professor at the University of Chicago, says that “because we don’t talk about gender bias openly, students may not believe that it exists.” They will therefore interpret their individual failures and successes as due to their hard work and merit alone, ignorant of the ways some students are at an inherent disadvantage because of who they are.

Evaluations in residency also favor men. One study found that at the beginning of the residency, women residents were rated as slightly better on average than their male peers, but by the end of training were on average 3 to 4 months behind their male counterparts.

Differences in residency evaluations have real consequences for physicians’ careers. They affect their selection in competitive fellowships, research awards, and even the licensing process. Nonetheless, I am aware of no systematic effort at any institution to address bias in these evaluations and help evaluators give trainees a fair shake.

Gender also plays into our ability to work with other professionals in the hospital. Dr Andrea Christopher, a physician at the Veterans Affairs Medical Center in Boise, Idaho, noted that in residency nurses were more likely to help her male colleagues, but did not know how to address the discrepancy.

“I would put in orders, and the male residents would put in orders, and theirs would be done and mine would not,” she said. “And a senior nurse came over to me and said: ‘You just have to do your own EKG, set up your own IV, and collect urine, and eventually they’ll notice.’ I was afraid to discuss this with my superiors because I thought if I complained, it would reflect poorly on me.”

Though we rarely address this prejudice head on, studies have found that in simulated cases, nurses were less likely to help women physicians with procedures, and more likely to view women physicians negatively than male physicians for the same mistakes.

Of course, nurses are dealing with their own issues of gender discrimination. Nurses report rates of sexual harassment of around 70%, comparable with rates reported by female physicians. Male nurses are also paid more than female nurses for comparable work, and are more likely to be promoted.

After residency, institutions continue to overlook women physicians’ accomplishments. From the portraits hanging on an institution’s walls to the names of medical societies to the number of women giving lectures, women are consistently under-represented.

Pay is the clearest indication of whom institutions value. One study of academic medical centers found women physicians earn $ 51,315 less, on average, than their male colleagues. With adjustments for factors such as faculty rank, years in practice and graduation from a top medical school, women still earned $ 19,878 less. This salary gap appears to be widening.

Many have asked women to become better negotiators to overcome this disparity in pay, but this discrimination is an institutional choice, and institutions have to be responsible for solving it.

Dr Jen Gunter, a San Francisco based obstetrician gynecologist, left academic medicine in part because of persistent gender discrimination that she faced in her career. After years working at a Midwestern institution, she found out that her male colleagues were “making more money for doing less work.” When she spoke with administrators, they told her that the men “had families to support and she didn’t.”

Later, at a different institution, she had a complicated triplet pregnancy with her children requiring medical care in the ICU. “I was the primary breadwinner,” she said in an interview, “but my children needed a mom and a doctor.” She found herself overwhelmed by her family responsibilities as she was applying for tenure, and under-supported by her institution.

Though she had spent her entire career in academics and had four different board certifications (when most physicians have one), when she asked for help she was told “maybe academics are just not for you.”

She found herself overwhelmed by her family responsibilities as she was applying for tenure. When she asked for help, she was told by her dean “maybe academics are just not for you.”

Reproductive choices weigh heavily on women physicians, who face opaque, inflexible and generally abysmal maternity leave policies. These policies range from 12 weeks of paid leave to only 6 weeks of federally mandated partial pay for new mothers, to no separate maternity leave for trainees. Nearly one in three physician mothers reported experiencing discrimination because of pregnancy or breastfeeding. Many have trouble following the same recommendations they give to new mothers because of these policies.

More open forms of sexism and sexual harassment are rampant in this profession. Many were afraid to go on the record, but a few women did agree to speak about harassment they had experienced.

Dr Meredithe McNamara, a pediatrician at the University of Chicago, told me that in medical school, a surgical fellow told her to “get on your knees and suck my dick” during a surgical case when she couldn’t answer his question. She was asked to write up the incident when the rotation ended, but did not, in part because none of the other half dozen people in the room reported it.

Dr Sarah Candler, an assistant professor at Baylor College of Medicine, told me a prominent colleague groped her during a dinner at a leadership conference. She tried to get the help of a male peer who remained oblivious. He continued to touch her bottom until she got away, and apologized the next day “if he did anything wrong.” “I didn’t even know who to report it to,” she told me.

Gunter had a similar experience at a different national leadership meeting.” A few years ago, a very prominent person in academics, at a medical conference, I could not get his hands off of me,” she said. “Literally, I’m peeling his hands off of me. I asked two male colleagues for help, and they said, ‘What should we do? We can’t control him.’”

Sexism can be overcome, but it must happen at an institutional level. All of these issues of discrimination, from sexual harassment to paltry maternity leave policies to salary discrepancies are an institutional choice. Leaders who make a concerted effort to combat gender discrimination can advance women, and in the process, retain the widest pool of talent in their organization

Discrimination, from sexual harassment to paltry and penalising maternity leave policies to salary discrepancies are institutional decisions which institutions are responsible for changing.

Female medical leaders like Silver and Dr Lauren Thorndyke at the University of Massachusetts Medical School are tackling discrimination by promoting and mentoring women and minorities. Their efforts are more effective when they are explicitly supported by their institutions. At Massachusetts Medical School, for example, women now make up 26% of the faculty, compared to 17% at Harvard Medical School.

Like other professions, we need to address sexual harassment head on and not place the burden on victims to speak out. We need policies to promote and pay women and minorities so that we can continue to benefit from their talent and professional dedication.

Think of the patients that we could treat, the diseases we could cure, the innovations in our dysfunctional healthcare system women could innovate if institutions stopped thwarting our talents.

  • Elisabeth Poorman is a primary care doctor in Everett, Massachusetts and a clinical instructor at Harvard Medical School.She is on twitter at @drpoorman

Doctors and nurses: ‘When May and Hunt tell the public the NHS is not in crisis, that is a lie’

An 81-year-old woman with chest pains dies while waiting three hours and 45 minutes for an ambulance. Patients are photographed lying on the floor of an A&E unit that has run out of beds, trolleys and chairs. Memos from inside another hospital reveal that its doctors “have been on their knees with workload pressure”. Over six weeks more than 90,000 emergency patients get stuck in the back of an ambulance outside a hospital, waiting to be transferred into the A&E.

These events, which have all happened in England since late November, graphically illustrate the winter crisis tightening its grip on the National Health Service in recent weeks. Worrying, but at the same time predictable. Similar things happen every winter. Flu, bad weather and people struggling to breathe is a recurringly risky combination.

But what is different this year is the intensity of the strain on the NHS. Official NHS figures show that record numbers of patients have been directly affected – by delays in their care, by being diverted to a different A&E than that originally planned, or having their operation cancelled, for example. The proportion of A&E arrivals treated within the supposed four-hour maximum has hit a record low. Doctors have voiced their most acute concern ever about the risk of such conditions leading to poor care. A letter to Theresa May signed by 68 A&E doctors complained that patients have died prematurely after prolonged spells spent in hospital corridors.

As pressures have intensified the prime minister has stuck with impressive doggedness, though increasing implausibility, to her script, on television and when answering questions in parliament. The NHS is the best prepared it has ever been for winter. Health services always come under extra strain at this time of year. We are putting record sums into the NHS.

She did feel obliged to apologise to patients affected by the NHS’s unprecedented cancellation of tens of thousands of operations in December and January for the pain, worry and inconvenience that would mean for them. But then she told the BBC’s Andrew Marr Show last Sunday that that unexpected move was all “part of the plan” to help the NHS withstand a demanding winter.

But a crisis? Definitely not, she insisted.

If anything, she suggested, the NHS itself was part of the problem, for not doing enough to keep people well so that they don’t need hospital care in the first place.

Jeremy Hunt, her health secretary, loyally conveyed the same message – at least until 3 January. Then, in one of the growing number of tweets he may quickly regret posting, he subconsciously gave the game away by asking, with reference to Tony Blair: “Does he not remember his own regular NHS winter crises?”

The interviews that follow capture some of all this chaos and also NHS staff’s feelings – frustration, powerlessness, despair, sadness, rage – about the inability of the teams they are part of, and of the visibly underfunded, chronically under-staffed service they proudly work for, to respond adequately to all those needing their help. Denis Campbell, health policy editor

Dr Adrian Harrop

Junior doctor, A&E, Scarborough hospital

Dr Adrian Harrop photographed in SCarborough


Adrian Harrop: ‘We are not managing.’ Photograph: Gary Calton for the Observer

I’m a relatively junior doctor, but I’ve sampled emergency care in many different parts of the UK, and I’ve seen five winters in A&E departments. The staff in Scarborough are among the most hardworking, kind-hearted people I’ve ever had the pleasure of working with, from the executive board and the consultants to all my fellow junior doctors, nurses, healthcare assistants. This crisis has nothing to do with the shortcomings of frontline staff.

However, when the hospital is placed under the degree of pressure it’s been experiencing in the past few days, it becomes unsafe. And the services we’re able to provide are simply inadequate for the needs of the population.

Typically, a bay within a hospital ward would have three beds down each side. This week, we’ve activated the maximum-capacity protocol, which means we’ve put a bed in the middle of each bay. But even after that, when we’ve got as many staff working as possible, yet again the department is completely full. Every single cubicle is filled with a patient on a trolley, every single part of the corridor has patients down it. We have to have what’s called a “corridor nurse”. Then the assessment area of A&E is full of patients on trolleys, and the resuscitation area – which has three bays for the sickest of the sick patients, people with major traumatic injuries – that room is filled with patients too. I’ve then got a queue of paramedics with patients on stretchers going all the way down the corridor to the main entrance of the hospital. The department is entirely full: I’ve not got a single space to take another acutely unwell patient.

The number of ambulances covering this area of Yorkshire is frighteningly low, particularly at night, and they have to spend half their time in a queue in our A&E. I’ve heard their radios going off, and the person on the other end of the line is pleading with all the crews saying: “Please, is there anybody who can respond to this call?”

Last week, we had a patient who dialled 999 twice over a period of four hours stating in clear terms: “I can’t breathe.” An ambulance didn’t arrive, so their family had to come and drive them up to the hospital, and they collapsed on to the front desk of our A&E reception area, unable to breathe. They had to be rushed immediately to an operating theatre to be intubated to keep their airway open. The patient’s windpipe had narrowed to the size of a pinprick, and if that patient had arrived at hospital 10 minutes later, he would have been dead. That is a reflection of how critically low the capacity within the system is.

This crisis is not a bolt out of the blue – all year we’ve been expecting it. Acute respiratory disorders such as pneumonia, COPD [chronic obstructive pulmonary disease] and asthma flare up in winter. Influenza is also an enormous problem – genuine, diagnosed influenza is a very, very serious illness. On top of that, each year we’re seeing an ever-increasing number of what I’d call the frail elderly: people of advanced age, who have multiple co-morbidities and are dependent on carers. Their problems are complicated by increasing rates of dementia.


The government either needs to get these resources in place, or admit that it wants this health service to fail

Last year was slightly worse than 2016, which was slightly worse than the year before, and so on. The difference in 2017, I think, is that things reached a tipping point. The demands on our service outstrip our ability to provide care.

The government seems to love publishing figures saying we’re spending more on the NHS than ever before, but that’s a meaningless statement. Every year, the total number of patients requiring admission to hospital has gone up, the total number of beds has gone down, and, year on year on year, the total amount of money that we’ve had available to spend – in real terms – has gone down.

This conversation can become personal and party-political, and it’s important to remember that the current problems within the health service are not solely the responsibility of the Conservative party. We’ve been mismanaging the health service for an awfully long time. But the facts speak for themselves: the amount of money available per person is significantly lower than it was last year, or the year before, or the year before that. And I would place the blame for that squarely at the feet of the Tory government. They have opted to spend, effectively, less and less as a proportion of our GDP, and less per capita, than in previous years. Among healthcare professionals, this is almost a universally held view.

I don’t want to make this a personal attack on Jeremy Hunt. In fact, during the cabinet reshuffle, I was really hoping that Jeremy Hunt wouldn’t get taken off health, because then everyone might think “Hallelujah! Problem solved!” I’m glad he hasn’t gone, actually, because it allows us to continue this conversation. When May and Hunt tell the public the NHS is not in a crisis, that is a lie. It’s an ongoing crisis, and it can’t be allowed to continue any longer.

The thing that got to me today was a patient who came in with an acute, sudden-onset heart problem. They’d thought about calling an ambulance, but because of everything they’d seen in the media, they didn’t want to come to the hospital and bother anybody. Eventually, they drove themselves in and sat in the waiting room for over two hours. This person was in tears saying, “Doctor, I’m so sorry, I didn’t want to cause a nuisance.” I said to them – and I was nearly crying myself – “You are what I’m here for. Please don’t ever be made to feel like you’re inconveniencing me.” The fact that people with severe, emergency medical problems are feeling that they have to apologise to me – that’s sickening. We should be welcoming these people into our hospital with open arms, saying: “This is what you paid your taxes for: so that when you’re 80, and you need us, you can come to hospital.” We want to give people the treatment they need and deserve, and we can’t. We can’t because we haven’t got the resources to do that now. And if that is not a crisis, then I dread to think what a crisis looks like.

Up until now, we’ve just about managed, we’ve been able to claw our resources together. But we’re not managing now. The government either needs to get these resources in place, or admit that it wants this health service to fail. If we’ve got enough money to pay off the DUP, to pay for Brexit, to pay for Trident, we’ve got enough money to make sure that an 80-year-old woman with pneumonia has got a warm hospital bed to spend the night in. Interview by Kit Buchan

Molly Case

Cardiac nurse, King’s College hospital, London

Molly Case 29 Nurse at Kings College in London 09/01/18 Photographer ; Sonja Horsman


Molly Case, at Kings College in London: ‘My job is a pleasure and a joy. It’s only difficult because of starved resources.’ Photograph: Sonja Horsman for the Observer

I work on a high dependency unit: our patients might require organ support, invasive monitoring, or immediate care after surgery. These are big, major operations, life-changing and life-saving. We have a lot of people rushed in by air ambulance, people who have suffered a heart attack, and also people from the area who have been stabbed. On a normal day I wake up at 5.30am and it’s a 12-hour shift; night shifts start at 7.30pm. It’s an absolutely fantastic job. I’m hugely passionate about cardiac nursing – it’s amazing what the heart can do, but when it goes wrong it’s frightening, and everything can deteriorate quite quickly.

Being on a specialist unit in some way we’re shielded from the winter crisis, but something that has had a knock-on effect is beds. We’re running at 98% capacity and you can’t necessarily hold a bed free in case a person comes in with a heart attack. But if somebody does come in, they will need a level two bed, with all the equipment. What that means for our unit is that sometimes patients are too quickly identified as stable enough to be stepped down to the ward or discharged too early, and that puts them at risk.

Something that nurses live by is Florence Nightingale’s words: “The very first requirement in a hospital is that it should do the sick no harm.” And when you’re stepping down people inappropriately, through no malice or ill intent, it feels like you’re putting somebody at risk. If there were more beds it just wouldn’t be a problem. This isn’t me being self-deprecating, but our jobs are not hard – they are a pleasure and a joy. They are only difficult because of the starved resources.


It’s a vicious cycle: if we can’t get patients home because there’s no social care then nothing will get better

The most difficult moment for me this winter was when my dad, who’s 80, broke his hip, and I saw first-hand what A&E was looking like in the midst of everything. So many elements of the winter crisis affected him. He lay on the floor for hours at home after calling an ambulance, which breaks my heart. When he got to A&E he stayed there all night: there simply was no bed to go to and his pain was absolutely immense. When he did get his hip fixed there wasn’t a level two bed for him to go to after the operation, where he could have been monitored more closely.

Every winter NHS staff ready themselves for all the classic things – trips and falls, fractures, flu. But this year it’s reached its peak. The NHS is under enormous strain, and feeling the effect of chronic underfunding. Morale is low. Nurses don’t necessarily want to be paid more, they want to be appreciated. I’ve seen so many of my colleagues joining private agencies on top of their NHS job to boost their salaries, because they have to.

I’m confused as to why the government let it get so bad before they’d even talk about doing something. We need less talking, more doing. We are at breaking point. The behind-the-scenes dismantling of the NHS is no longer a secret: people are well aware of it. It’s frightening – it’s affecting people’s lives, their careers, their health, and the government are 100% entirely responsible. I think that once the NHS has gone, which is the way it’s going, we will be in a very sorry state.

I think it all begins with social care, which is often overlooked. If there was more support in the community – more district nurses, mental health services, GPs, specialist nurses looking after the elderly at home – people wouldn’t be coming into hospital in the first place. Social care is absolutely pivotal to saving the NHS, but there’s no money in it. It’s a vicious cycle: if we can’t get patients home because there’s no social care then nothing will get better.

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Molly Case performs a poem at the Royal College of Nursing, 2013.

But what I’d like to say is that NHS staff just get their heads down and get on with it. I will forever be thankful to them for looking after my dad and all of us. They make sure that patients are laughing and comfortable and pain-free, and if operations are delayed they keep people updated. They’re so good at making people feel better even when they’re at their most vulnerable – I think it’s the best job in the world and a real privilege. The small things we do as nurses make such a difference, and people remember what you do for them in hospital for the rest of their lives.

When I first started my career three years ago I was so frightened at the way [nurses and NHS staff] were perceived in the media. We were so demonised off the back of the atrocious things that happened in Mid Staffs. But the tide has turned: public trust in us is at an all-time high. The public is starting to see that this is a systemic failing to do with underfunding, under-staffing and devaluing of staff.

It’s the government we’re battling now. Even though it’s a monolithic institution to have as an opponent, I prefer it to be this way than for the public to perceive us negatively. It is hugely important to me and my colleagues that the public see us for what we are – caring and compassionate. Interview by Kathryn Bromwich

Dr Helgi Johannsson

Anaesthetist, St Mary’s hospital, Paddington, London

Anaesthetist Helgi Johannsson photographed at St Mary’s Hospital, Paddington


Helgi Johannsson at St Mary’s Hospital, Paddington: ‘Despite the comradeship there’s a lot of anger.’ Photograph: Karen Robinson for the Observer

Essentially, my team and I look after patients having operations and keep them alive during those operations. We also keep patients on the intensive care unit (ITU) alive. We are involved in the resuscitation and treatment of critically ill patients throughout the hospital, from the operating theatre to ITU. So we’re there manning the life support machines and looking after those patients at the worst time in their lives.

St Mary’s is a major trauma centre. It covers all of northwest London right out towards Watford, the M25 and beyond. In the past two years, we have seen a 40% increase in Blue Calls – the most seriously unwell, ambulance-delivered cases. Why? The closure of two small emergency units in north London has definitely contributed to the increase, but I wonder if it’s also just down to an older, sicker population. Plus, tourism in London is booming since the pound fell and we’re the catchment hospital for Oxford Street and the West End, so you can imagine how many tourists we get.

We’re limited as to how much we can expand to accommodate this rise in patients because one third of our buildings are more than 100 years old and by no means fit to be modern hospitals. The Cambridge Wing at St Mary’s is 147 years old and, like many of the other Imperial Trust buildings, it is crumbling and very difficult and expensive to maintain. I pray for a new build every day but the cranes don’t seem to be moving in yet. Last summer the ceilings in two of our medical wards were about to fall down and needed urgent repairs, so we had to move our patients out into other wards, which put a lot of pressure on the rest of the hospital. The wards are back up and running now and I am grateful for that because if they weren’t this current black alert would have tipped us over the edge.


These past few years have been a sustained period of famine – there’s no other word for it – and it shows

The combination of having to do the emergency work and trying to get through some of the more routine work – cancer surgery, vascular aneurism surgery and so on – as well is a major headache at the moment. Patients on the routine operating lists are our biggest problem. They have been waiting for their surgery, they have worked their lives around the date of their operation, made childcare arrangements, psyched themselves up and then on the day they have their operation cancelled because we don’t have a bed. That really affects us. Those patients are human beings just like you and me. It’s been a major decision for them to undergo this operation and then at the last minute it’s put off. The uncertainty is a real killer. It’s really upsetting, actually.

Recently, there was a woman in her 50s who was due to undergo a weight-loss operation, which is quite high-risk surgery. She had made a lot of arrangements, it had taken two years to get to this stage and she had come from a long way away, at least 100 miles. She got up at four in the morning, drove all the way into London and we thought we were going to be able to do it but at the very last minute her bed got taken by an emergency and we had to send her home. It was just so galling.

She was very understanding. Our patients always are and it makes me even more angry that they are so reasonable and they understand the pressure we are under. Obviously, she was very upset: she was in tears and I was close to tears myself because I really felt for her. It was heartbreaking. Those situations are a daily occurrence.

On New Year’s Day I was doing a junior doctor’s shift because we had gaps on our junior rota. It was a really busy night. The conditions in A&E were just awful. There were patients everywhere. Patients on trolleys in corridors. There weren’t any seats for the walking wounded. There were people standing around, sitting on the floor. The whole system was absolutely paralysed. It wasn’t lack of staff in the emergency department that was the problem: our Trust has been very good at providing adequate staffing. It’s the bed blockade: we cannot get our patients to where we need them to be – on the wards – because of the lack of beds. And that’s immobilising the emergency department. You can’t find anywhere to see your patients and you can’t just do your normal job.

We are pretty good at processing our patients but the TV news does not lie and it’s a very familiar sight these days to see the whole of the ambulance park completely full with ambulances and us having to clear the way for the most urgent cases. On top of this there is a real problem getting our critically ill patients into ITU because we are unable to get the patients who are already in there out on to the wards. Lately, we were getting to the stage where we couldn’t actually do emergency operations because we had too many patients waiting for intensive care beds.

None of this is helped by George Osborne’s disastrous cut to social care funding, which means we cannot get the patients who are ready to leave us but still need some help back to their homes.

The atmosphere at the hospital remains good. There is a definite camaraderie among the staff that’s a direct result of feeling embattled. We were involved in some of the major incidents last year, including the Westminster Bridge terrorist attack and the Grenfell Tower fire and, although these events placed a lot of strain, both practical and emotional, on the hospital, they also brought us closer together. They made us realise how important it is that we support each other during periods of difficulty.

Despite the comradeship, there’s a lot of anger about the way the NHS has been treated in the past five to eight years. We’ve always gone through peaks and troughs in funding but these last few years have been a sustained period of famine – there’s no other word for it – and it’s really beginning to show now. But I’m optimistic for the future. I am very much a glass-half-full person. I don’t think the British public will allow things to get worse than this. This is a wake-up call. The fifth richest nation in the world can do well by its old people and can do well by its sick people. It cannot get any worse now.

I knew when I went into medicine that it was not going to be a clock-in at 9am, clock-out at 5pm kind of job. I wouldn’t want that. Nor is being a doctor in any way glamorous. On my night shift on New Year’s Day one of our patents vomited all over me and the nurse working with me: it went literally everywhere, head to toe, even in our hair. Luckily we were able to shower and change into fresh scrubs and to have a laugh about it. But I wouldn’t change my life. I love the variety, the excitement, the unpredictability and the fact that you are training the next generation of doctors. That’s why I stay in the NHS – you just don’t get that kind of job satisfaction in the private sector. It’s a real giving thing for me. I’m so proud to be in the NHS. Interview by Lisa O’Kelly