Crying Derby A&E staff asked to hide tears from patients

Drastic issues with staff shortages, low morale, sickness and burnout at Royal Derby Hospital’s emergency department are posing risks to patient safety, a leaked report claims. And it says that exhausted and desperate staff, driven to tears by the pressures, have been told to “cry privately” rather than in front of patients.

The study commissioned by the University Hospitals of Derby and Burton NHS Foundation Trust involved 45 members of staff in the emergency department, along with 14 consultants and doctors. The December 2021 Empowering Voices report, seen by the Local Democracy Reporting Service, found a number of recurring themes about how low morale and overall physical and mental exhaustion were widespread in the department.

Comments given by staff as part of the report, aimed at investigating the impact of sustained pressure brought by the pandemic and other areas of concern in the department, show a pattern of widespread dismay and burnout with workers past breaking point. The report, paid for by the trust, was aimed at giving staff a confidential way to air their concerns and let out their emotions and opinions with guaranteed anonymity.

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During these talks, staff claimed they were frequently driven to tears due to the stress and exhaustion of their roles and the pressure they face from leadership, including the trust’s board itself. They claim they have been told to cry privately, not within the view of patients and visitors, and several staff are said to have cried while talking to the report team.

Out of a score from one to 10, with one being the lowest, the emergency department team scored the level of morale among staff at two overall. One member of the Royal Derby emergency department team said to the report lead, Ashley Brooks, an independent staff and patient advocate: “So many staff cry now, every day I have them queuing at my doors, all suffering anxiety, stress, insomnia. I worry constantly if we will push some too far.”

Another member of staff said: “I fear for us, I really do, I feel scared, sad, and ashamed of what we are doing here.”

A more blunt summary was provided by one member of staff, saying: “It is a colossal s***-show.” A further member of staff said: “We are in the worst of negative ruts.”

One member of staff said the issues were not simply attributable to the pandemic, saying: “We can’t keep blaming Covid 19, all this rubbish was here long before. If anything, Covid helped us identify the state we are in.”

Staff said the “thank you for your hard work brigade” – involving repeated social media posts heaping praise on NHS staff – was also not welcome. A comment was made that the praise had become “throw-away language”.

A member of staff is reported to have cried as they told the review team: “I am not happy, I have always loved being a nurse and working for the NHS, but I can’t keep this up, this pace, this speed, this total lack of care over me, us, and our patients.”

A further member of Royal Derby staff said: “I love my job, my role, but this has defeated me, I want to leave and never come back. I was happy, but this is all just too difficult, it is chaos every moment. I feel like I am drowning, and everyone can see I am, but no one offers to save me or pull me out.”

Employees in the department claimed the level of underqualified and inexperienced staff was “unsafe” and potentially “negligent and criminal”, with the department in urgent need of both more staff and more experienced staff to provide sufficient support and expertise.

A concerned member of the Royal Derby team said: “The inexperience in the team is dangerous. We are all just expected to get on with it. [It is] sink or swim training.”

One employee said: “Staffing is shocking, sickness is shocking, at an all-time high, there is simply too much pressure on the existing staff.

“Please listen when I say that if the trust does not do something to help the pressure, recruit extra staff or stop the number of patients we see, there will be devastating consequences to our emergency department’s staff’s physical, emotional, and mental health. We are seeing this already, but the cavalry is not coming.”

One example given by a member of emergency department staff is that on one Saturday shift in September there were supposed to be 23 doctors on duty, but instead there were eight, they claim. A key concern reiterated throughout the report is the apparent pressure from leaders, right the way up to the trust’s own executive trust board, through an array of targets.

This, staff said, made them feel like they had lost their humanity and was causing them to “suffocate”, with alleged repeated accusations from leadership that employees are not working hard or fast enough and were the cause of “flow” issues throughout the entire hospital.

One member of staff, who appears to be responsible for some other employees within the team, is said to have broken down in tears as she told the review: “I have never worked so hard in my career but let me say I never signed up for this. I never signed up for pushing staff into the ground. I don’t want to be a part of a trust who thinks this behaviour towards its staff is acceptable.”

Speaking further on the impact of the strain on staff, one employee said: “We are on very thin ice. I think the good will of staff that has got us this far has disappeared or been used up and it is only the thin ice keeping us afloat.”

Staff reiterate that this pressure on staff is having an impact on patient care. One member of staff said: “I want to say yes, we all put our patients before our own needs, we take shorter or no breaks, we work harder for longer but hand on heart no, we can’t be patient-focused in the true sense because we are all too busy, that is fact and our daily reality.”

A second member of the Royal Derby emergency department, who broke down in tears, said: “No, we are not all patient-focused. No, they put their trust in us and we fail them. We end up treating people twice in twenty-four hours – something has to change.”

A further member of staff said: “We are lambs to the slaughter, staff and patients’ lives put at risk to save face for the trust.”

Staff said trust executives and managers were not listening to concerns and were too target driven. They say leadership has effectively put the voice of the emergency department “on mute”.

They suggested a Care Quality Commission inspection could see services “closed down” if they were to “see the catalogue of F-ups” on display in the emergency department.

Staff also claimed the situation in Derby was heading the way of that being investigated in Nottingham, with a culture of bullying said to be rife. One member of staff said patients were sometimes waiting 17 hours for a bed and staff were seeking to avoid putting them on beds in corridors.

An employee gave a powerful statement: “It makes me sad that one day I could be 90 years old laying for hours and hours on that trolley being ignored, needing the toilet and in pain, how did we get to this?”

A further member of Royal Derby Hospital emergency department staff said: “The sheer exhaustion of it all, we are all just so tired.

“Not the normal run off-off-your feet tired, a night’s sleep or long weekend away will cure it tired, but an inner, deep, emotional feeling of total lack of energy and motivation, it overwhelms me if I am honest.”

Staff allege that the findings and comments in the report have not been acted on or taken seriously since it was published and shared with the department.

A member of the Royal Derby emergency department, whose identity we have kept anonymous, said: “We are so stressed and this ultimately leads to worse care and potentially outcomes for patients. I will say that, currently, I do not know of any harm that has come to patients. But I feel it is only a matter of time.”

The trust says it has appointed a project manager to oversee the work for the next 12 months and that each of the research themes will be sponsored by a medical lead, a nursing lead and a member of the executive team – which will lead to action plans being developed.

Dr James Crampton, interim executive medical director and emergency medicine consultant at UHDB, said: “Our A&E workforce has been under immense pressure during the pandemic and has shown resilience throughout, but they are human too and as an emergency medicine consultant myself I know first-hand how intense it is working in that environment.

“As part of an ongoing programme of support around staff wellbeing, colleagues were encouraged to share raw thoughts and feelings through these series of confidential conversations and group sessions and I’m very grateful they did and I want them to know they can keep talking to us. In doing so they will bring about real change as we build on their experiences to make improvements.

“The wellbeing of those who provide frontline care is our priority and we have a number of staff support initiatives, including listening programmes such as these, on-the-day access to counselling and a wellbeing activity calendar.

“Those attending A&E can be reassured the team continues to provide the highest standard of care possible at this stage of the pandemic.

“The public can support the NHS by using the most appropriate service for their health needs and keep A&E free for life-threatening and serious emergencies.”

Royal Derby Hospital was rated ‘Good’ by the CQC in October 2020 and the trust as a whole was rated ‘Good’ in June 2021. In November, Royal Derby’s A&E was seeing an average of 541 Type 1 (high priority) attendances each day, with attendances across the network 11 per cent higher than before the pandemic – comparing September 2021 to September 2019.

Meanwhile, in January, 295 patients waited more than 12 hours for care at the trust after being found in need of admission – many years worth of breaches, by pre-pandemic standards, in one month. This situation is said to have improved.