One doctor said he was left in charge of 100 patients overnight. Photograph: Robert Ormerod/Robert Ormerod (commissioned)
“Dangerous” medical understaffing in hospitals is so rife that signs of illness are being missed, blood tests delayed and newly qualified doctors left in charge of up to 100 patients.
Chronic shortages of medics are also leading to those with little experience of some types of illness taking responsibility for wards full of medically needy patients, or with complex issues, whose conditions they know little about and do not feel qualified to give proper care to, including in intensive care and stroke and surgical units.
A survey of UK doctors, the results of which have been given to the Observer, reveals widespread concern that gaps in rotas were risking patients’ safety. Doctors said they were left stressed and in tears at being “pressurised” by managers to work more shifts to help hospitals cope with rising demand and said their relationships with patients were suffering.
One trainee surgeon said shortages meant a colleague in his first year of training was the only doctor in charge of more than 100 surgical patients overnight.
An elderly care registrar said: “I was the only medical doctor covering medical emergencies [and] cardiac arrests in the whole hospital, medical admissions, referrals from A&E [and] GPs, and the whole hospital for a medical opinion. It was frankly unsafe.”
Another doctor said: “I feel out of my depth.”
Pete Campbell, a hospital doctor in the north-east who undertook the survey with the assistance of the British Medical Association, said: “This survey is just a snapshot of medical understaffing, which is going on on a significant, worrying and dangerous scale. Doctors believe that these rota gaps pose a direct threat to patient safety because the time-critical work they do is put under pressure.”
Doctors’ leaders said the survey reflected worsening medical understaffing across the NHS. “The findings are yet another stark warning of the fragility of our health service. A demoralised, stressed and struggling workforce is not going to stay in the NHS for long. This situation is unsustainable,” said Professor Neena Modi, president of the Royal College of Paediatrics and Child Health.
Professor Jane Dacre, president of the Royal College of Physicians, said: “Patient care is being compromised by gaps in trainee rotas. This is a major challenge for the NHS and it is having a detrimental effect on the morale of both trainees and consultants. We need more doctors.”
One medic said that hospitals’ growing inability to have a full complement of doctors on duty meant “we don’t have time to review patients properly. [I am] constantly fighting fires as covering three people’s jobs, so never have time to think about a patient properly.”
In the survey, 395 doctors below the level of consultant described how rota gaps were affecting care. It also found that many medics fear the quality of care they could give patients was declining because so many are often so busy. The findings paint a stark picture of doctors having too little time to talk to patients about their conditions, discharge others, do routine checks on babies, or seek patients’ consent for procedures as quickly as they should.
The survey found that many medics feared that the quality of care they could give patients was declining because they were often so busy that they had less time to engage with them.
“Delayed care, sick patients getting unwell due to this, long waits, histories being taken too quickly to compensate and speed up the process, meaning critical pathologies have been missed,” said one. Doctor shortages are now so acute that, in some areas, emergency ear, nose and throat clinics and non-urgent operations have had to be cancelled at short notice, said respondents.
The survey found that 21% of rota gaps were not covered by any doctor, even a locum. Unfilled gaps result in the doctors on duty on wards becoming responsible for far more patients than usual. Another 18% of gaps were filled by staff agreeing to provide cover, often on top of an already heavy schedule.
The findings come soon after Grantham and District hospital in Lincolnshire closed its A&E unit overnight because it had too few doctors. In April, Chorley hospital in Lancashire downgraded its A&E unit to an urgent care centre for the same reason.
Last week the RCP, which represents many hospital doctors, warned that shortages of many specialist medics meant the NHS was “heading into an extremely difficult autumn”.
Anaesthesia and intensive care are facing particular shortages of doctors.
Unfilled slots are also jeopardising hospital finances and have caused the NHS’s bill for agency staff to hit £3.3bn a year in England.
The Department of Health declined to respond directly to the findings. A spokeswoman said: “We expect all parts of the NHS to make sure they have the right staff, in the right place, at the right time to provide the very best care for patients that is both safe and sustainable. That is why we have invested in the frontline and there are already 25,000 extra clinical staff on our wards since May 2010.”