aaccording to May 2023 opinion polls, the NHS remains the main source of national pride in Britain. Of course, there are elements of our healthcare system that are exemplary. But as Dispatches’ damning new report proves, the system’s successes cannot – and should not – overshadow its failures. After watching Undercover A&E: NHS in Crisis you may wonder whether it is more appropriate to describe the NHS as a source of national shame.
Our guide is reporter Robbie Boyd, who after just ten days of training starts working as a trainee healthcare assistant in the emergency department at Royal Shrewsbury Hospital. Boyd often seems to be the only one trying to maintain standards. Through a hidden camera, we see him repeatedly intervene to protect patients, flagging issues around hygiene, best practice and basic safety to senior members of his team. Yet, for all his compassion and common sense, his contribution feels like the equivalent of trying to put out a forest fire with a tea towel. At one point he is left alone in a makeshift hallway ward with a woman screaming and convulsing as she waits twenty minutes for a nurse to return with pain relief. Boyd is the only provider of comfort and reassurance during that time. All he can say is, “I’m so sorry.”
However, this film is not an indictment of employee culture; it is abundantly clear that behind such inhumane conditions lie larger structural problems. Overwhelming bed occupancy on wards leads to overcrowded emergency departments, resulting in frighteningly unsafe corridor wards without hand washing facilities, plus a ward called “Fit 2 Sit”. The cheerfulness of the text-speak title is the insulting icing on the cake of this truly diabolical cake, with patients deemed capable of sitting – often barely – waiting up to 40 hours to be seen. Even if you went in in reasonable health, Fit 2 Sit could technically kill you, leaving you sitting in an uncomfortable chair in bright light, missing medication and deprived of food, cheek by jowl with people with infectious diseases . If you are seriously ill, you may consider it an active threat to your life (we learn that one in 72 people who wait too long in the emergency room will die as a result).
Of course this is just one hospital. The Royal Shrewsbury was chosen because of its known failures. The documentary doesn’t do much to make clear how representative it is of the wider problem – a response from NHS England describes the events as ‘not commonplace’ – but interspersed with Boyd’s footage are responses from senior healthcare officials, who assure us that these situation is serious. not unique. In a statement, a spokesperson for the trust that runs the Royal Shrewsbury said: “We are deeply sorry that our patients have experienced anything less than the quality care we strive for, and we are committed to working with partners to improve care and experience for everyone.”
We are also confronted with two cases from other areas that have led to avoidable deaths: Tony Bundy, who was not examined by a doctor for five hours after presenting to an emergency room in Glasgow with what his family suspected was a stroke ; and the 56-year-old Tracey Farndon, who died of sepsis in a Birmingham hospital. Unable to identify staff to help, her desperate partner resorted to Googling the numbers on her monitor to save her.
These stories are devastating. But while the worst-case scenarios remain viscerally disturbing, everything else – the humiliation, the dystopian waits – is normalized in the public imagination. You will probably be shocked by what you see in this documentary, but really shocked? Probably not. As Prof. Alf Collins of the Patient Association puts it, it is “almost becoming the standard of care that people expect”.
The stereotypical British response to crumbling infrastructure is a blinding, somber acceptance or – worse – a personal apology. Boyd’s low point is how a man has to pee naked into a bottle in a hallway, in front of staff, other patients and visitors due to a lack of facilities. In a video diary after the service, Boyd says that patients generally “don’t want to be a burden. Everyone says: I’m so annoying!” The sheer wrongness of it all drives him to tears.
Undercover A&E: NHS in Crisis explicitly bills itself as a “strong warning” to whoever wins next week’s election. As a political incentive it feels unfair – this situation is well known to politicians – but as an attempt to stoke public panic about how things might escalate, it is chillingly effective. At one point, a man with immunosuppression due to chemotherapy waits next to potentially infectious patients because there is no side room available. Dr. Adrian Boyle, president of the Royal College of Emergency Medicine, looks at the footage and worries it will “discourage someone who becomes ill from seeking care”. A healthcare system so dysfunctional that it deters vulnerable patients? That’s nothing to be proud of.
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