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As an emergency doctor, I know the “engine fail” light on the NHS is flashing

When you arrive in the morning, you’ll find your night shift colleague looking shell shocked, or in tears.

I’m an emergency physician. My duty of care is not understood by many of my colleagues.

It is being able to provide, at a moment’s notice, the emergency treatment anybody in my catchment area might need. That anybody could be a blue baby rushed out of a car, to someone having a stroke or a heart attack. Or it could be the more mundane things – the injuries, fractures, and mental and social crises. I take professional pride in dealing with each case well, by which I mean humanely, quickly, efficiently and safely.

For the past two weeks, however, my Emergency Department has been struggling to do this. Our space in the hospital is finite, yet we are expected to turn it into a magical Tardis to solve the problems of increased demand, sicker patients and yes, the fact that large parts of the health and social care workforce have had two bank holiday weekends, if not an entire fortnight off.

The magic, unsurprisingly, doesn’t work. Instead, our department is full, too full to perform its primary duty of care.

The Emergency Department is the only part of the healthcare system which is completely open access, 24 hours a day. There is an assumption it will cope with anything thrown at it. That assumption is only held by those who don’t work there.

If you did work here, you will wonder how long old people could seriously be asked to use a commode behind a curtain, in an eight-person observation bay, as they wait 16 hours to get to a proper ward and bed. You will wonder how, if there are six patients who need to be placed in the resuscitation room, reserved for those who need the highest levels of care, how they will all fit. You will be angry, because three of them should have been in a ward six hours ago. You will be worried you will end up resuscitating someone on the floor, as it is the only space.

When you arrive in the morning, you’ll find your night shift colleague looking shell shocked, or in tears. You may even give them a hug, before you send them home. You’ll start on the 10 patients who have been waiting overnight and if you’re lucky you’ll spot the mistakes that have been made by overloaded staff and correct them without any harm occurring. Then you’ll hear management declare your department “safe”.

You’ll wonder if the patient who is terminally ill will, in their last hours, get the dignity of a side room to be with their family, or if, as has happened before, it’s going to be in earshot of a drunk brought in by the police, who is swearing..

You will also wonder why there are so few complaints from the patients and their relatives. Possibly there is a misplaced fear of retribution. When they do complain about these inhumane delays, they are often very clear that the staff work like Trojans and are not to be faulted.

The Emergency Department is a place with a finite capacity in space and time. It cannot be allowed to be congested, because the only certainty is that more patients will arrive.

We emergency workers are the “engine fail” light on the dashboard. If we’re in trouble, it’s because the entire health and social care system is failing. If there are patients stuck in our corridors, waiting on a bed, it is usually due to delays elsewhere in the institution.

Caring for acutely unwell patients is a continuous process, occurring all seven days a week with predictable peaks and troughs. Imagine a busy restaurant. The owner turns up at 5pm, tells the dish washers and waiting staff to go home, and asks the chefs to take over because “they’re there anyway”. Of course, there would be an outcry when the plates were dirty and no one could get served.

Unfortunately, though, what is happening in the NHS is more serious than a snappy analogy. It has been proven worldwide that patients in such a badly blocked system will encounter harm, and yes, avoidable mortality.

When a system cannot move a patient from accident and emergency to an in-patient hospital bed, we call it Exit Block. This is hardly unique to the NHS. The causes and consequences of Exit Block have been analysed worldwide and found to be consistent, whether you are in London, Glasgow, Sydney or Baltimore. The problems of long waits and crowding are found all over the UK. The causes are similar and extend beyond party politics, but the degree of system failure has been varied, with Scotland performing better and Northern Ireland being the worst.

In 2010, Robert Francis concluded his first report into the Mid Staffs scandal, prompted by unusually high deaths at the Stafford hospital. He blamed “a chronic shortage of staff”, with concerns on the ground ignored.

This system is like Mid Staffs writ large across the whole UK. The health and social care sector does not have enough resources to perform safely. Yet for some reason, this state of affairs is permitted. To solve it requires facing difficult questions about resources, and working practices. We need to face them, or we are complicit in avoidable harm.

Dr David Chung is the vice president for Scotland of The Royal College of Emergency Medicine. 

Photo: Getty
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Ann Summers can’t claim to empower women when it is teaming up with Pornhub

This is not about mutual sexual fulfilment, it is about eroticising women’s pain. 

I can’t understand why erotic retailers like Ann Summers have persisted into the twenty-first century. The store claims to be “sexy, daring, provocative and naughty”, and somewhat predictably positions itself as empowering for women. As a feminist of the unfashionable type, I can’t help but be suspicious of any form of sexual liberation that can be bought or sold.

And yet, I’d never really thought of Ann Summers as being particularly threatening to the rights of women, more just a faintly depressing reflection of heteronormativity. This changed when I saw they’d teamed-up with Pornhub. The website is reputedly the largest purveyor of online pornography in the world. Pornhub guidelines state that content flagged as  “illegal, unlawful, harassing, harmful, offensive” will be removed. Nonetheless, the site still contains simulated incest and rape with some of the more easily published film titles including “Exploited Teen Asia” (236 million views) and “How to sexually harass your secretary properly” (10.5 million views.)  With campaigns such as #metoo and #timesup are sweeping social media, it seems bizarre that a high street brand would not consider Pornhub merchandise as toxic.

Society is still bound by taboos: our hyper-sexual society glossy magazines like Teen Vogue offer girls tips on receiving anal sex, while advice on pleasuring women is notably rare. As an unabashed wanker, I find it baffling that in the year that largely female audiences queued to watch Fifty Shades Darker, a survey revealed that 20 per cent of U.S. women have never masturbated. It is an odd truth that in our apparently open society, any criticism of pornography or sexual practices is shut down as illiberal. 

Guardian-reading men who wring their hands about Fair Trade coffee will passionately defend the right to view women being abused on film. Conservative men who make claims about morals and marriage are aroused by images that in any other setting would be considered abuse. Pornography is not only misogynistic, but the tropes and language are often also racist. In what other context would racist slurs and scenarios be acceptable?

I have no doubt that some reading this will be burning to point out that feminist pornography exists. In name of course it does, but then again, Theresa May calls herself a feminist when it suits. Whether you believe feminist pornography is either possible or desirable, it is worth remembering that what is marketed as such comprises a tiny portion of the market. This won’t make me popular, but it is worth remembering feminism is not about celebrating every choice a woman makes – it is about analysing the social context in which choices are made. Furthermore, that some women also watch porn is evidence of how patriarchy shapes our desire, not that pornography is woman-friendly.  

Ann Summers parts the net curtains of nation’s suburban bedrooms and offers a glimpse into our peccadillos and preferences. That a mainstream high street retailer blithely offers guidance on hair-pulling, whipping and clamps, as well as a full range of Pornhub branded products is disturbing. This is not about women’s empowerment or mutual sexual fulfilment, it is about eroticising women’s pain. 

We are living in a world saturated with images of women and girls suffering; to pretend that there is no connection between pornography and the four-in-ten teenage girls who say they have been coerced into sex acts is naive in the extreme. For too long the state claimed that violence in the home was a domestic matter. Women and girls are now facing an epidemic of sexual violence behind bedroom doors and it is not a private matter. We need to ask ourselves which matters more: the sexual rights of men or the human rights of women?