Medical crisis and moral injury – the state of the NHS in Somerset

NHS Somerset headquarters, Yeovil. Photo by Lewis Clarke

Although government seems to be in denial, it is clear that the NHS is in crisis – a consequence, in large part, of a decade of underfunding

The impact on the service nationally has been logged in detail, with the Financial Times offering a series of particularly thorough analyses.  

We wanted to find out what was happening on the ground in Somerset, however, so we asked Dr Stevan Bruijns, a consultant in emergency medicine at Yeovil District Hospital, to describe his experience.  This is his first-hand account.

“The NHS is facing its harshest winter on record. Articles in the press and stories on social media abound concerning the challenges faced by patients accessing care, and NHS staff delivering it. Most recently, the nursing and ambulance strikes have focused the public attention on the crisis in urgent care. This crisis is sadly nothing new. The Royal College of Emergency Medicine has been tracking winter flow delays since 2015.

Although both Somerset NHS Foundation Trust (Taunton) and Yeovil District Hospital NHS Foundation Trust (Yeovil) have performed well against government standards, neither have been able to do so over the last few years. Neither of the two sites were affected by the nursing strike and yet it has been incredibly busy at both for weeks – so much so, that the ambulance strike hardly registered as a separate event.

So what is going on? Everyone is likely to be familiar with the concept of the golden hour in urgent care – the time in which immediate actions have the greatest benefit. Delaying actions outside this timeframe reduces benefit and increases risk. Dr James Gagg, South West chair of the Royal College of Emergency Medicine, and A&E consultant in Taunton, recently highlighted the harm to patients occurring as a result of increasing delay in care. We tend to group these as four harms – harm to patients waiting for a 999 ambulance in the community, waiting in ambulances outside A&Es for a space inside, waiting in corridors in A&E or wards for a bed, and deconditioning in hospital waiting for an appropriate place to be discharged to. 

It is a sad reality that harm is indeed occurring and that patients, their next of kin and NHS staff are exposed to this now on a regular basis. Moral injury is the strong emotional response associated with situations that violate your moral code, such as providing what is perceived to be substandard care in urgent situations. For a group of individuals who have dedicated themselves to saving the lives of strangers, moral injury is particularly severe at present. Leaving the service or going on strike are decisions taken reluctantly to highlight the harm that they see but cannot prevent.

Both Somerset A&Es continue to provide excellent care to those in greatest need. They use a sorting process called triage to identify patients at greatest risk and prioritise their care. This means that patients whose requirements are at the lower end of the spectrum of need will wait longer – sadly, several hours longer than they may expect to. Both trusts are working really hard to minimise the harms as a result of the delays in urgent care. But it is not all up to them.

Although there is always room for local improvement, the case for funding not keeping up with demand over the last twelve years is compelling. The claim that GPs are not seeing enough patients is without evidence. As with other parts of healthcare, there are simply not enough GPs. Quality healthcare is required for a healthy economy.  An ill or injured workforce cannot work. When healthcare suffers, the economy suffers. It is that simple. 

I would recommend that you present any challenges faced in urgent care to your MP. Use 111 if your problem is not life-threatening. And finally, be patient: your paramedic, doctor or nurse may have just attended to a situation that caused severe moral injury.”

We wrote about moral injury and PTSD in some detail in March 2021. The situation has only got worse.