Someone will die and we won't notice

NHS in crisis: 'This is Third World medicine - it's soul-destroying' says an overworked nurse. Could private GPs ease the pressure?

THE LAST bed was taken several hours ago and it is only 5.30pm on a routine Friday night at the John Radcliffe Hospital. Accident and Emergency already resembles a refugee camp with trolleys littering the cramped entrance lobby. Tonight many patients will find themselves sleeping in examination cubicles with just curtains for privacy.

Using casualty as a makeshift ward was unheard of four years ago but now is accepted as normal practice at the Oxford hospital. The bed crisis has been heightened by the severe outbreak of flu this winter. On Monday, patients had to be accommodated in the hospital's icy plaster room as nurses and doctors struggled to cope with the 87 admissions, of which 60 were waiting for beds.

However, flu is only part of the problem and the hospital has already been on red alert for several months. The chaotic scenes this week were only too familiar for weary staff.

Jude Mansfield, a sister, just starting a 12-hour shift, sums up the problem. She has worked at the hospital for 10 years and feels the flu outbreak is an excuse for the Government to divert attention away from the fact that the health service is unravelling at the seams.

"It's not just a winter crisis but a spring, summer and autumn one, and I don't know where it's going to end," she says. "We are been squeezed tighter and tighter and are on our knees. It's soul destroying that we are unable to offer some of the basic standards of care. All I know is that I would never go into nursing if I was starting out now."

John Christie, a doctor, is examining an elderly woman patient in public because all the cubicles are full. He kindly helps to alleviate her embarrassment by closing the curtains around the other patients so they cannot stare at her. "These cubicles were never designed for people to sleep in," he sighs.

Many of the staff themselves, such as nurse Charlotte Tickle, have fallen prey to illness. The sickness has exacerbated the existing nurse shortage problem. "Over Christmas a lot of people have been off sick with flu so they've had to use agency nurses," she says. "But we're always having to cope with a staff shortage. It means that you end up feeling relieved if someone has not died in your care."

There are now five people in the waiting room and another seven already being treated. There can be up to 40 patients needing minor treatment on a busy night so the load is comparatively light. However, the situation can rapidly flip from calm to mayhem. Despite their good-natured attitude none of the staff can relax.

Round the other side where the ambulances ferry in more serious cases, the situation is already strained. All the cubicles are full and frail- looking patients wait to be examined on trolleys in the goldfish bowl - the staff nickname for the entrance lobby.

Lillian Gardiner, 81, has been waiting in the end cubicle since 4pm to see a doctor about her chest infection which is the result of a heavy cold. It is now 8pm. Her daughter and son-in-law wait anxiously by her side but they know they have to be patient. They have already driven her up from Swindon to see her doctor who said she should go to hospital. Her face is now covered by an oxygen mask.

"We've got great sympathy for the nurses," said her son-in-law. "The doctors have been brilliant. It's just a shame that there's not the resources available to make their jobs easier."

Gina, a staff nurse who worked more than 15 hours last night, is shining a torch in the eyes of a man who was knocked over by a motorcyclist whom she also must see. She is relieved to be able to dispatch both patients to the minor casualty section especially as she faces a sudden influx of doc-tors' admissions which are mainly flu related.

It is time to play musical beds. There is a swift juggling of spaces and names are crossed off and added to the admissions board as the ambulance crew wheel in more cases.

Guy, a porter, desperately looks around for spare trolleys. "Try sitting on one of these for half an hour," he suggests. "Sometimes people have to sleep on them if we run out of beds. There's nothing else we can do."

Gina explains that the average wait is up to eight hours for a bed and up to four hours for a doctor. The hospital loses seven nurses a month and many of her friends are now working on cruise ships.

"It's rubbish to say flu is the cause of this," she says looking around at the scene in casualty. "It's been bad for a long time and winter just makes the situation worse. We're practising Third World medicine; the staff are at breaking point and I'm always terrified that someone is going to die and we'll be too busy to notice."

As the evening wears on, the Friday night "drinking casualties" start to trickle in. A young boy has drunk himself unconscious on two bottles of vodka. Cases like his add to the impossible burden faced by Julie Stockbridge, another nurse.

"We're too busy to waste beds like that," she remarks briskly to his anxious family. "As soon as he's sober he'll be out." As she tries to revive him she says to his limp form: "You should be buying your mum a box of chocolates."

By 10.30pm Pippa Savory, the night services manager, has faced up to the fact that six people will definitely be spending the night in casualty with possibly another six joining them. For the patients this will probably mean a sleepless night; they will have to cope with the constant flicker of the strip lights which cannot be turned off, as well as being disturbed by the ambulance crews bringing in emergency cases.

By the time the pubs are chucking out, Mrs Gardiner has been found a bed. But other patients are not so lucky. The hospital staff has already had to cope with the death of an elderly man. For them there is little consolation, only the certainty that tomorrow will bring more chaos.

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