Stress, emotion and drama: Behind the scenes at the NHS

Liz Miller and Alastair Bailey

Every day, staff across the NHS are in contact with over 1.5 million patients and their families. Here, two medical professionals working within emergency departments give an insight into the decisions and pressures they face.

Matron Liz Miller searches outside the main entrance to Queen Elizabeth Hospital in Birmingham for a patient who has gone missing. She explains it is a regular occurrence.

"I don't suppose anybody thinks when they come into nursing that's what they will spend a proportion of their day doing," says Miller, "but that's the reality."

She is in charge of the Clinical Decision Unit (CDU) - an emergency assessment unit that monitors patients and then takes the decision either to discharge or treat them. The unit also acts as a gateway to the hospital wards.

On a typical day the unit can see 130 patients or more.

"It's almost like a big filter for the hospital. You come in here, we will decide whether you actually need a hospital bed, or we'll filter you off home again to make sure that the only people that are in hospital are the people that really need to be here," says Miller.

With a growing demand on NHS staff time and resources, Miller does not appreciate time-wasters.

On her way into work on the same day, she encountered a patient who had discharged himself and was walking away from the hospital in his gown complaining he had been waiting too long.

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Media captionAt Leeds General Infirmary, NHS staff treat Graham who had a stroke

"It's interesting that he dialled an ambulance and it's interesting that he came to Accident and Emergency (A&E). He's waited an hour and he's left. That's completely unreasonable," says Miller. "That is a waste of public resources and an unacceptable way to behave."

Miller and her team help save lives on a day-to-day basis, but she says the NHS is not a bottomless resource.

"I don't think as a society we are very stoical anymore. The minute you feel slightly unwell you don't go and see your GP, you don't go and see your pharmacist, you come straight to the emergency department... but you can't have an NHS that picks up everything, otherwise it will cease to function."

The NHS is facing widespread structural reforms, said to be the most radical overhaul since the creation of the service in 1948.

On 1 April 2013, GPs and other clinicians will be given much more responsibility for spending the budget in England.

Booming birth rates, lifestyle issues (such as smoking, drinking and obesity) and an ageing population, are all putting a greater strain on services.

Advancements in medical technology have also led to rising prices and we are often not aware of what hospital treatments really cost.

Behind the headlines about NHS cuts however, it is people like Alastair Bailey, a brain attack nurse specialist, who must deal with big decisions much of the time. Bailey works at Leeds General Infirmary and says that it is impossible to detach yourself from the job when you finish your shift.

"Being in the caring profession you can't switch off, you do take things home," says Bailey. "Luckily my wife is a nurse as well, so she understands me, but you do get emotionally attached to patients, you can't help yourself. We're human also."

Bailey treats stroke victims and when dealing with an emergency on the front line, is charged with assessing a patient, taking blood tests, collating their medical history, organising a CT scan (computerised tomography) and assessing the risk factors of using thrombolysis (a clot reducing drug)... all within 30 minutes.

"Everything has got to happen really quickly and I suppose the message to anybody is timing, that's our adage - 1.9 million neurons are lost every minute if a stroke is left untreated," says Bailey.

It is a highly stressful environment, but Bailey says that following a routine - or set "care pathway" - helps in the heat of the moment.

"I suppose I've been nursing a long time now and I think remaining calm and knowing the process, inside and out, is probably the most important part of the role. I know my pathway, I know how my pathway works, so everything becomes almost hard-wired into you."

As well as performing life-saving treatments, there are also the incredibly hard moments, for instance, when a patient dies. As a nurse, Bailey has come to terms with the inevitability of death, but it is not something that he can quickly forget.

"Obviously it fades… like a scar, it's something that you carry with you, just for a little while, and you often dissect what happened."

Bailey says that he has cried with patients and their relatives before because he can feel their pain. Even when patients are dying, there are decisions to be made about how long they might have left and whether to move them to a hospital bed and out of the A&E department.

He says he also finds it helpful to talk about events with his co-workers.

"We are all in it together and assisting and helping your colleagues and recognising if your colleagues are stressed or having difficulty coping is also another really important part of working in the NHS," says Bailey, "…because some days A&E can be so busy. You can have a child die in the morning and then save an 80-year-old man's life in the afternoon, the emotions are up and down."

For Bailey however, dealing with patients is also the most enjoyable part of his job.

"I used to describe my nursing job a bit like acting - you go on to the stage each day with the ward or the emergency department and you play out your role to the binman who turns up… and it may be a professor you meet next," says Bailey. "You change your manner, you change your personality to suit the situation."

"I'm very lucky on a day-to-day basis. I get to be involved in people's lives, potentially save them, but also be there at the end if that is the case. It's a very privileged position in which to work and I wouldn't change my job."

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