One December evening in 2019 I was walking home along a main road in east London when I had to call 999 for the first time. I heard a thump and saw – with an eerie delay, like seeing a firework before you hear it – a woman hit by a double-decker bus. People rushed towards her (she was pinned beneath the bus) and I stammered answers to the voice at the end of the line. After two minutes a rapid-response car arrived and veered on to the pavement. The woman’s condition was critical but, as I was reassured in an unexpected call from the emergency services a few days later, she had been reached on time.
Reporting on the story of ambulance delays and A&E failings across Britain for the past year and more, I’ve often thought about that night in London. Paramedics would class it as a “cat one”: the most life-threatening incident, which they must reach within seven minutes. Today, people in many areas of Britain wait longer than 15 minutes in such cases – if they are reached at all. The headline “NHS crisis”, dismissed over consecutive winters as a media cliché, now encapsulates a flatlining emergency service. Ill children sleep on waiting-room chairs; a 92-year-old woman “asked to die” during 33 hours spent in a corridor; an A&E patient waited for four days on a gurney. One doctor in the north-west of England told me she is assigned corridors as she is ward rounds.
While flu and Covid are intensifying the chaos this winter, ambulance waiting times have been rising since early 2021. During lockdown, people without Covid-19 avoided hospital; diseases were missed, conditions grew worse. In the New Statesman, we called them the “missing patients”. Now, they are turning up: the number of 999 calls is rocketing, and people are sicker than they might have been had they presented earlier. “The patients are quite different,” observed an emergency doctor at a London hospital, noting that some are being diagnosed with stage-four cancer for the first time in A&E.
By November 2021 I was already hearing alarming stories. Sarah-Jane, a parent in rural Cornwall, called 999 when her epileptic two-year-old began having a fit. Fifteen minutes passed as she stood in the road, listening for a siren – only to be told no ambulance was free. When her daughter last suffered seizures, she was “blue-lighted” to hospital and resuscitated. This time, Sarah-Jane had to drive her daughter to the hospital herself: a 35-minute journey when at any moment she might have to attempt roadside CPR. “When they said ‘No one’s coming’ my heart was thumping in my chest,” she told me at the time. “It’s every parent’s worst nightmare.”
Sarah-Jane’s daughter survived. Others have not been so lucky. A 71-year-old man in Devon – otherwise healthy – who had an aneurysm was advised not to bother with hospital. “The paramedics said there would be no beds and he’d be stuck in the car park for hours,” his wife told me. Instead, he suffered an avoidable death at home. A paramedic in the south-west of England I spoke to spent 14 and a half hours with just one patient in the back of an ambulance. From 6.30pm to 9am, calls to “life-or-limb” incidents came in on her radio. She couldn’t go. Some paramedics label themselves “glorified nurses”, so often are they in this scenario. They cushion stretchers with blankets to try to make them more comfortable. Handover to hospital should take 15 minutes; in a quarter of cases, it’s now taking over an hour.
Beds are full, many with people who should be discharged to a care home or with visiting carers. Social care provision, funded by councils and exorbitant private fees, is stretched. The head of a major hospital trust described this market as “volatile, fragile and not well-funded… that means patients end up staying in our hospitals. It backs up.”
Jeremy Hunt, now the Chancellor, conceded to me last year that social care cuts while he was health secretary were a “silent killer”, and a reason behind “people waiting an hour to get an ambulance for a stroke”. This is not only dangerous but inefficient: waiting for help – or, indeed, being in a hospital bed when you should be at home – makes you worse. “We had an elderly woman who had fallen over – she was fine and hadn’t broken anything – but had been waiting 12 hours on the floor for an ambulance,” an A&E doctor in the south-west said. “That can break down their muscles, affect their kidneys: we had to admit her.”
Nurses and paramedics are striking. Doctors are likely to follow suit in March, said a union source. Inflation is eroding real wages, which were frozen under austerity. Record numbers of staff are quitting the NHS. One in ten nursing jobs in England is vacant. “Outside the hours of 8am to 5pm, we have enough staff for one and a half emergencies,” the south-west A&E doctor revealed. “Essentially, the doors are still open and the lights are still on.”
Many NHS workers are burned out from the pandemic, and troubled by working conditions. “Patients are not safe and that’s on our heads,” said a nurse with 22 years’ experience whom I interviewed while she was picketing outside a London hospital.
Behind every 999 call is an understanding that someone will help when we are helpless. That contract is breaking down, and so is trust in the NHS. Satisfaction levels with the institution characterised as a “national religion” have reached a 25-year low. Once there for people in a crisis, the NHS is locked in one of its own – and with a prime minister fatally slow to respond to its call.
This article appears in the 11 Jan 2023 issue of the New Statesman, Burning down the House of Windsor