‘We are not robots’: NHS crisis worse than last year, say doctors

Consultant physicians believe that NHS pressures have increased over the past 12 months, according to a new report NHS Reality Check Update 2018 from the Royal College of Physicians. 

To inform the report, over 1,500 doctors in England, Wales and Northern Ireland replied to the same questions they were asked in a similar time period last year, and their responses indicated that the situation had become worse in nearly all areas of care.

  • 64% of doctors believe that patient safety has deteriorated over the past year – 10% higher than last year
  • 93% experienced staff shortages across the team – 9% higher than last year
  • 84% believe that the workforce is demoralised – 2% higher than last year
  • 85% cite rising demand for their service over the past year – 7% higher than last year
  • 47% cite lower-quality care over the past year – 10% higher than last year
  • 80% are worried about the ability of their service to deliver safe patient care in the next 12 months – 6% higher than last year.

The only measure to have improved is a 4% reduction in those experiencing delays in transfers of care from their service – 56% down from 60% last year.

Overall, the picture painted by those responding shows a system pushed to its limit - doctors struggling against rising demand, the impact of an ageing population with increasingly complex medical needs, and the difficulties of maintaining morale when the NHS is underfunded, underdoctored and overstretched.

The anonymous free text responses revealed some upsetting anecdotes:

Staff simply cannot deliver what is expected of them under current circumstances.  We are not robots.  We are human beings with limits.’

I cried on my drive home because I am so frustrated and distraught at the substandard care we are delivering.’

‘…the delays in social care are causing a huge amount of institutionalisation and distress to our older patients and their families.’

Despite the dire situation, physicians worked incredibly hard to keep patients safe and prevent the crisis spiralling out of control.  Some commented on their own services and the importance of teamworking:

‘That I don’t think patient safety has deteriorated is a tribute to the Trust, its staff and their determination to maintain safety in the face of the usual winter crisis.’

Lots of innovation to manage the greater demand and better integration with social services.’

RCP president Professor Jane Dacre said:

It is extremely worrying and depressing that our doctors have experienced an even worse winter than last year, particularly when so much effort was put into forward planning and cancelling elective procedures to enable us to cope better.  We simply cannot go through this again – it is not as if the situation was either new or unexpected.  As the NHS reaches 70, our patients deserve better - somehow, we need to move faster towards a better resourced, adequately staffed NHS during 2018 or it will happen again.

The RCP’s recommendations are clear and urgent:

  • In the short term, we need to make the UK more accessible and attractive to doctors from other countries. The government must relax visa restrictions for the healthcare workforce and build on successful schemes such as the Medical Training Initiative.
  • In the long term, government, NHS organisations, royal colleges, professions, trade unions, regulators, higher education institutions and think tanks need to work together to make sure the NHS has the workforce and resources it needs.
  • Funding for health and social care must match growing patient need, and there must be more investment in public health initiatives that reduce that need.

In addition to the questions about standards of care, physicians were asked if they felt confident about speaking out – this figure rose only 4% from last year to 50%.  Many more doctors knew who their ‘freedom to speak up guardian’ was at their Trust, but only 31% felt the guardian had improved the culture of transparency and raising concerns.

Notes to editors

A copy of NHS Reality Check Update 2018 is attached to this email.  For interviews with Professor Dacre please contact RCP Head of PR and public affairs on 020 3075 1254, 07748 777919, linda.cuthbertson@rcplondon.ac.uk.

The survey was carried out between December 2017 and January 2018. Members of the Royal College of Physicians were emailed and 1,591 physicians responded, a response rate of 4.7%. 75% were consultants and 12% were at specialist training grades. Respondents were promised anonymity so we will not be able to identify individual physician quotes.