I was the consultant on call and had an enthusiastic medical student with me when I first met George in an ambulance that had been parked outside A&E for ten hours. He had mild dementia and had developed severe chest pain at 2 PM the night before. His wife had desperately called for an ambulance. The paramedics arrived at his home three hours later and suspected that he might have had a myocardial infarction.

George had the appropriate initial treatment but he was stuck outside the hospital because there were no beds. Conscious of the medical student who was beginning to look very anxious, I tried to sound positive, despite my overwhelming sense of frustration and anger. George was one of six other patients in a queue of ambulances, all waiting for an elusive bed to transfer their patient. During this long wait, the paramedics could not attend other emergency calls. I tried to reassure George and my medical student that, hopefully, the bed manager would soon be able to help.

The next patient, Elizabeth, had made it out of an ambulance and into A&E but was one of the unfortunate people who spent the night sitting on an uncomfortable plastic chair because all the beds were occupied. While my team and I spent ten minutes searching for a spare room in which to assess her, I received text messages from a hospital manager asking me to try to discharge patients from A&E due to an ‘unprecedented demand for beds’. Eventually, we found an unoccupied nurse’s office where I managed to speak to Elizabeth in privacy. She required not only immediate treatment for heart failure but also warranted an admission to hospital. I deleted further text messages asking for ‘updates on potential discharges’.

I contacted the bed manager to ask if there was any ‘movement’ on the ward: a euphemistic term for whether any free beds had come up. He responded with a wry laugh. With no prospect of discharges in the next few hours, the only way a bed would become available was if a patient died. Eventually the intensive care unit opened up some of its beds. As I explained the situation to Elizabeth, I felt powerless. I was unable to properly assess an exhausted patient or provide them with the appropriate care they desperately needed. I finished the consultation the same way I had started it: with an apology.

Away from the melee of a busy on-call schedule, I have outpatient clinics. The NHS has the noble aim of a ‘referral to treat’ time of eighteen weeks, but there has been a six-fold increase in referrals to my clinic since the pandemic ended. The current waiting time for an urgent outpatient clinic appointment is forty weeks; for follow-up patients it is in excess of fifty- two. If a patient becomes ill while they wait for an appointment, they often go to A&E, adding to the bed crisis.

We hear in the news that the NHS is under immense pressure and at breaking point, but it was not always like this. Thanks to the buoyant economy in the early 2000s, the Labour government invested vast amounts of money in the NHS and heralded the biggest expansion of staff in my lifetime. Conditions were better and, most importantly, they were better for patients. Clearly, demands on the NHS have increased, but not because of migration or the ‘small boats’, as some politicians would like us to believe.

Today, we face a perfect storm of challenges: an ageing population with multiple comorbidities that present later than usual due to the recent Covid-19 pandemic; chronic underfunding due to over ten years of austerity, which has led to cuts in services and pay erosion; poor staff retention and chronic understaffing; a reduction in acute beds in hospitals in England; the collapse of the care sector; and increased pressure on general practice. Some of these are objective factors that affect healthcare systems across the world, but most are specific to the wanton mismanagement that the NHS has experienced in the past decade.

Another difficult part of my job involves recruiting junior doctors. In the latest round of recruitment, not a single UK-trained doctor applied for a post in my department. Only 50 percent of higher specialty trainees in my field choose to work locally as consultants. Some of those who move out of the UK go to countries like Australia and Canada where jobs are openly advertised as being ‘better than the NHS’. Conversely, the NHS has always relied on foreign-trained staff since its inception, but these days even the international medical graduates appear keen to move almost anywhere else.

The low morale, anxiety, and burnout experienced by so many workers in the NHS is reflected by the fact that up to 25 percent of junior doctors in my region have required pastoral support and that the suicide rate among doctors is rising. When I was a junior doctor, things were different. I did not pay a penny in tuition fees, and so I graduated with a minimal amount of debt. Rent was cheaper for student digs. I had free hospital accommodation and I could afford to buy my first home a year after graduating from medical school. Junior doctors now have no realistic chance of getting onto the housing ladder themselves, facing up to £100,000 debt from student loans.

Towards the end of my day on call, George was eventually moved to a bed on the intensive care unit. By then, he was confused and agitated, undoubtedly due to the conditions he had endured since calling for help the night before. I advised the medical student who had accompanied me never to ‘normalise’ the conditions she saw in hospital that day. It is not acceptable for patients to wait for hours for an ambulance to arrive; for paramedics to be stuck, waiting to hand patients over to hospital; for patients to be sat in hospital corridors; or for doctors to work with an understaffed and underpaid team.

I wanted to tell her that things would get better but I couldn’t. She confessed that once she gains full registration as a doctor, she plans to take a year out to work in New Zealand. I have my doubts that she will return to work in the NHS. And, to be honest, I wouldn’t blame her if she didn’t.