It wasn't yet seven in the morning... already A&E was stacked, 9 deep.
The night staff were at the ragged end of the shift. Dark eyes sinking into their sockets. Tired... obvious. There was still the meticulous handover to do and then step out into the cold morning air. Home, collapse. Come back and do it all again in 720 minutes... back to back shifts.
It's easy to talk, or even write, about the pressures the NHS is under... until you see it, up close. Then you realise what it means to work in an A&E designed for 300 people a day, that is caring for 700.
It is at that point the fatuousness of politicians and their press officers strikes home. Whatever they say, dissemble or disavow, there is not enough money. There are not enough qualified, regular staff. Care homes and unsupported frail elderly are the most likely contributors to the problems... and no, this can't continue.
No matter how much the remnants of NHSI huff-n-puff and call chief executives to another 'emergency', three-line-whip meeting (as far as I can see, to cover the backsides of NHSI) they are merely making the hotels and rail companies richer.
No matter how much top-down bullying goes on, in the name of planning and assurance. No matter any of that.... the truth is the NHS is running on money-vapour and the high octane goodwill of the professionals who turn-up every day and struggle from one shift to the next.
I've spent the week on the road seeing for myself. Between us the Academy of Fabulous Stuff have visited thirty health and care locations and the story is always the same: an unhealthy fear of the CQC; a resigned acceptance that politicians have abandoned the NHS and an amazing, gargantuan determination to continue to do the heavy lifting of healthcare with rota-gaps you can drive an ambulance through and an incessant, tide of demand that no one seems to have the first idea how to stem.
I have met some glorious people this Change Week. Super-heroes of health care, working quietly to improve services, develop ideas and innovate. Where the enthusiasm comes from... I have no idea but it does and thank your god that it does.
The NHS does much more than it is paid to do, delivers more than the politicians deserve and so much more than the public will ever know.
Thank you to everyone who took the time and made the effort in busy days, to meet our team, showcased their Change Week Pledges, highlighted their outcomes and showed us their good stuff.
I can't thank everyone in the 700 words I have and to single-out anyone wouldn't be right... but I will.
In the 9-deep hospital, beds are the problem. There are not enough and to harp on about sending people home and punishments for delayed discharge is to reveal a criminal ignorance of what's involved.
One person I met, understood it. That's why this discharge co-ordinator came into work an hour early because... they knew it was going to be busy and they wanted to help.
The whole panoply of care, the edifice, the weigh of the system depends on this one person... getting people out, so that we can get more in. Making the flow work, avoiding the fines, the bottlenecks, the angst, the aggro.
One person on an admissions ward, removing the bottlenecks, making the relationships with social care, the voluntary sector, the families and the allied health professionals. Understanding the labyrinth.
The one person, the least senior person I met in a whole week. One person at the bottom of the pay-bands. The one person we depend on and don't know it. The one person who can keep the NHS out of the headlines and the system keep moving.
An NHS hero, unsung, invisible and indispensable. One person in a plum-red tunic, with a smile that brightened the dawning day and who did the job, 'because it matters'.
... it does matter and so do you all and thank you.
Have a good weekend.
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