[0:03]On the eve of the general election, Dispatches investigates the state of the NHS. An issue that repeatedly polls as being one of the key concerns for voters. For the last three months, a Dispatches reporter has been working undercover in the A&E department of the Royal Shrewsbury Hospital. An A&E where in the winter of 2022, deaths hit three times the national average. Can I have some help please?
[0:39]where overcrowding means patients are offloaded in corridors. The nurse will not get a handover. They just leave the notes. It's, it's dangerous. It is, but it happens all the time. where vulnerable patients are left neglected and suffering. I was out there for two days. Two days? The quality of care is massively rated, it's clearly unacceptable. and where falling care standards jeopardized basic human dignity. We've got people having to go to the toilet in public. I am so angry right now.
[1:14]I don't think this is unique to this hospital by any stretch of the imagination. However bad you think it is, it's, it's worse. This film is a stark warning to whichever political party comes into power in just a matter of days.
[1:44]After 10 days of training, This is my uniform. our undercover reporter Robbie Boyd is ready for the first shift as a trainee healthcare assistant, known as an HCA. Definitely feeling nervous.
[2:01]Oh my God. I'm Robbie. How are you guys? The Royal Shrewsbury A&E is one of the most challenged in the NHS. It's overcrowded, there are long delays and the health regulator, the Care Quality Commission, recently demanded action to stop patients being put at risk. Robbie is soon working in one of the busiest areas. Are you happy to sit? It's known as Fit to Sit, where people who are sick and in pain, but for whom there are no beds, are left to spend hours in chairs. I've been here like, I don't know, about 15 hours? Since three o'clock yesterday. I can't sit here much longer. I'm in pain. I've been here five hours and I've not seen a single person. Okay. How long have you been here? Seven hours. Eight in the morning. You're waiting on blood test results?
[3:00]Robbie discovers that the long waiting times can have potentially life-threatening consequences. As they start their shift, Robbie and a colleague discover a woman who says she's waited almost 24 hours. Sorry to disturb you. Can I take your blood pressure? Do they know when the doctor's going to be around? No. She's a suspected stroke patient, who should have urgent care. Robbie rushes to call the doctors and the medical team to find out what's happening. Hi there. This is Fit to Sit. I'm one of the HCAs. I've been asked to call you because we've had a lady with suspected stroke. She's been sat now for 24 hours in Fit to Sit. We're wondering if you could send someone down? She's not?
[3:53]They say they don't know anything about her. She hasn't been referred to them. I've got some bad news. She's not been referred to medics. We have a patient who's been here for 24 hours. She's had a suspected stroke. They were like, she's not on our list.
[4:21]I don't have any words to express it. It looks like chaos to me there. It just looks like chaos. I'm sorry to say it's unacceptable. 24 hours is too long for a stroke patient. The stroke patient should be seen immediately I would say and they should be having a scan within an hour and then referred straight on to the the medical team for either thrombolysis or what you know the treatment they would think which is most appropriate for the stroke patient. Why they don't add them to the bloody lists instead of pissing around? It irritates me immensely, this does. This patient depending on the severity of stroke may suffer a severe disability which will take away his rest of his life. He may be dependent on people, he may be dependent on care or in the worst-case scenario, not leave very long. We've escalated it with the nurse in charge. They will see you shortly.
[5:25]As a trainee HCA, Robbie will be shadowing qualified healthcare assistants, learning to help the nurses, and should not be left alone with patients for extended periods. But the A&E department has more patients than it can deal with, and staff are often overwhelmed. Can you cover what's her name? One of the nurses in the X-ray corridor. A few shifts in, and Robbie is sent to help a nurse caring for five ill patients in a corridor that's become a makeshift ward. Patients regularly spend 12 hours or more on trolleys in this corridor. Just so you know, it's my third week. It's my second week here. So me and you are all in the same boat. We're in the same boat. Robbie immediately discovers that on the corridor, even the most basic care tasks can be compromised, such as blood pressure checks and heart monitoring. There's not enough plug sockets in the corridor, there's not enough equipment, there's no gloves, there's no sink. We can't wash our hands. We had some wipes. Without things to wipe our hands, where is it? You're blocked off from the rest of the department. So it just means that there's no nurses or doctors walking through that area. And it means that the patients kind of get a little bit forgotten about.
[6:49]One of the patients is clearly in distress and in need of urgent pain relief. Oh God. Ah. Oh God. Ah. The nurse leaves to find pain relief. And so I was then left on my own with not only this woman, but also four other patients.
[7:29]I had a patient in agony screaming. I had no idea when pain relief was coming. I didn't know what to do. I can't cope with this. Oh, you're doing really, really well. They're getting you pain relief. I can't cope with this. I'm so sorry. Robbie is concerned about the woman's prolonged agony and goes in search of help.
[7:56]Can you help us? This woman is in agony. Where's the nurse? She went to get the medication. I don't know where she is. Two secs, I've just got to find out where this patient is going to.
[8:10]Okay, I've got the lead nurse coming. But no one comes to help. In all, it's 20 minutes before the nurse returns with pain relief. Give it to me, give it to me. Oh, I told you to stay with the patient because there was a lot of things I was up to. I literally left for one minute.
[8:38]I could literally cry. Okay.
[8:55]It's dreadful. It's clearly unacceptable. It's a basic requirement, isn't it? If we go into A&E and we're in pain, it would be really good to, to have our pain managed. That's an example that the quality of care is really, is really massively eroded.
[9:18]That poor man in that pain, it's really upsetting. What we've seen here, there's a whole series of examples which show what happens when you don't have enough capacity in the whole system to look after people properly. You get people in the wrong place, receiving less good care, receiving undignified care. Our system urgently needs to increase the amount of capacity, both in space and staff. Um, so that we can actually begin to look after our patients properly. It's the job of A&E to stabilize patients so they can be treated elsewhere in the hospital or discharged. Any delays in assessing and stabilizing patients puts them at risk.
[10:07]Hello, you can come to area four. Are you able to get your weight on your feet?
[10:17]Even in early summer, A&E is so overcrowded, patients routinely spend hours waiting in ambulances. Did you have to stay in the ambulance for very long? Two hours. How long were you in the ambulance for? From two o'clock until five o'clock. They transferred you between ambulances?
[10:54]We're meant to take handover within 15 minutes, but it's never that. I've had it before now where I've had 10 outside. 10 ambulances waiting to come in. Does that like, put the patients at risk? Yeah, it can do.
[11:16]It's a huge problem. You've got to look at this as a whole system. And fundamentally the problem is that we don't have enough hospital beds and we don't use our hospital beds efficiently. So the end result of that is our hospitals are too full. Most of our hospitals this year been running at occupancies levels of over 94%. And that trickles down and causes problems for the emergency departments and the ambulance service.
[11:41]Once in the receiving area, patients are meant to be quickly moved on. But the A&E department and the hospital itself often don't have any spare beds. So the ambulance receiving area becomes another makeshift ward. The idea is they'll be in here for 20 minutes, have bloods, ECG, obs, straight into A&E. That's how it should work. But unfortunately, it's like, block, patient comes in, block, hours later moves, another patient comes in. The idea is that it's quick. But we've had them for six hours this morning. Some ambulance services limit how long crews will wait with a patient. After that, they drop and go, leaving the patient with the A&E staff, no matter how busy they are. They've just rapid offloaded this one by the sink. By the sink. Yeah, they just put them anywhere. It's really unsafe. Staff are concerned that these rapid handovers can put patients at risk. The nurse will not get a handover. They just leave the notes. Is that dangerous for the patient? Yes it is, but it happens all the time. It's not appropriate. If you were a patient, if you were a prime minister and I put you in there, do you like it? No. You see the point? It's not appropriate. This is now the fifth or sixth staff member that has told me that it's dangerous, that it's undignified. They should stop it. You know why they still keep doing it? Because nothing happened at the moment. They're just only waiting for something to go wrong.
[13:26]I don't know really what to say. I'm really shocked to see you know this footage. It's something I've not heard myself. Patients being just dropped in and just going without a handover, but that's that's true. It's really concerning. It impacts patient safety. If somebody's been dropped off without a proper handover, then it's a real concern.
[15:05]The latest NHS England figures show that 60% of patients at Shrewsbury and Telford Hospitals Trust wait longer than the four-hour target. This is made clear to Robbie and the other trainees at their induction. The first doctor should see them within the first hour of arriving. This doesn't happen, unfortunately. This would be in fantasy hospital of my dreams. All patients in A&E should be either admitted or sent home within three and a half hours of being in the department.
[15:52]How long do you have to wait? I got told seven hours last night. Been here 29 hours in Fit to Sit before anything's happened for her. That's disgusting care.
[16:07]Robbie quizzes a senior member of staff about why waiting times are so excessive across the department. Are we trying to get them through in under four hours? And these people, bloody hell, like 40 hours, 35 hours. Yeah, at the moment it is. Really? Why? There's just no movement in the hospital. There's loads of patients that are bed-blocking, so they all get stuck in A&E. No, it's not really an A&E problem. It's the rest. I was out there for two days, I think. You were out in Fit to Sit for two days? Yeah. In a chair, yeah. So, longest waiting, 46 hours is the longest one. It's meant to be four hours. These people have been in 46. Yeah, so we're not hitting any targets. I'd say we have at least like, 40 breaches a day. Many of the patients waiting in Fit to Sit for hour upon hour can be seriously ill people. Hang on, we've got a lady fitting. Can I have some help please?
[17:20]Get her onto the floor and onto her side. The risk is that the longer patients wait, the more their conditions can deteriorate. Can I have oxygen, please? Oxygen? Can you get a trolley from somewhere, please? I can't. Sorry, I can't whilst holding her head.
[18:40]It's dreadful. It's clearly unacceptable that people should be cared for in corridors. Clearly unacceptable.
[19:18]I'm anxious about seeing that because I think it will discourage somebody who becomes ill from seeking care. Um, people need to know that when they go to the hospital and they are vulnerable to infection, that they will be looked after appropriately. So I'm anxious about that, discouraging people who need to seek care not seeking care.
[20:24]Fit to Sit is just fit to sit. It's on a whole new level, isn't it, to be fair, this place?
