The Least Worst Decisions

When I started blogging about healthcare issues over a decade ago, my motivation was to shine a light on the failings I had witnessed in over a decade working for an NHS ambulance trust. I managed that and was grateful for the opportunities it gave me to raise the alarm in print, radio and TV.

The mobility and versatility of paramedic work gave access and insight to many aspects of the NHS, from A&E departments and hospital wards, to community services and general practice. Even then, the cracks were beginning to show.

When I stopped wearing the green shirt in 2012, I became free to speak out without fear of consequences from an employer. Any healthcare professional social media activity was feared and discouraged back then, but the freedom my early retirement granted me allowed me to voice concerns shared by many of my former frontline colleagues. Interviewers would ask questions describing the NHS as ‘being on its knees’ and would raise fears that ‘patients could die’.

That was a decade ago.

And patients have died. Avoidably.

Depressingly, that’s not even news any more, is it? Even before the mishandling of the Covid pandemic from the care home tragedies onward, ‘avoidable deaths’ had been normalised in the UK by cruel austerity measures that impacted social care with tragic consequences. That we are now at a point where the healthcare safety net is so threadbare that it cannot be relied upon is something we have been encouraged to accept as unavoidable. It’s just the culture.

The scope of the failures, ranging from near misses to avoidable deaths, is absorbed and obfuscated by the system and accepted with an institutional complacency that comes from a decade of public healthcare being forced onto its knees and crawling just to keep providing any level of service.

That may sound like hyperbole to the layman, but it is the truth.

Across healthcare in the post-pandemic era, healthcare colleagues are routinely having to make decisions they shouldn’t have to make, searching for a way to avoid failure with utter futility. Ambulance dispatch staff must choose which patients are critical enough to receive an ambulance, abandoning others for more hours than might be safe or ethical, hoping they will survive until more resources magically appear. Operational directors have had to make impossible choices about what age of child might make it through the night with a possible strep-A infection without access to a doctor.

UK healthcare is no longer about best practice, optimal patient journeys, and golden hours. Everyone still at their post is just trying to get through the next shift with as little blood as possible on their hands.

Of course every single healthcare colleague is doing their best, even with the knowledge that their best is rarely enough. Frontline staff continue to do all they can for the patients they do encounter, utilising the dwindling resources available, but what of the many patients left to fend for themselves with little more than some advice and best wishes?

It is no wonder that nurses and ambulance staff have resorted to strike action. It is the final, desperate act of a workforce that has been working on its knees for too long, just trying to make the least worst decisions.