A top palliative care doctor has revealed how she has to speak to dying patients on trollies without even a curtain for privacy as she lamented the ‘broken’ NHS.
Dr Rachel Clarke admitted said ‘can’t really exaggerate how grim and crisis laden conditions are’ and described conditions in A&E wards in Britain as ‘Dickensian’.
Speaking to Andy Coulson on his Crisis What Crisis? podcast, the doctor from Didcot added that ‘crisis conditions are the norm now and it’s horrendous’.
Dr Clarke is known for writing the book Breathtaking which revealed the realities of working on a Covid ward and was turned into an ITV show starring Joanne Froggatt.
She also spoke about the challenges of palliative care, disinformation especially around Covid and the online abuse that she and many other key workers face.
Discussing the current state of palliative care in the NHS, Dr Clarke said: ‘You can’t really exaggerate how grim and crisis laden conditions are.
‘You know, we all see the news headlines. I walk into the A&E handover in the morning and I see a team who look absolutely broken from the night shift.
‘There are ten ambulances queueing outside each with a patient, some of those patients are dying, they literally can’t even get into the hospital. There are patients in corridors on trollies.
‘I might have to have an end of life conversation with a patient on a trolley in a corridor who doesn’t even have a curtain around them. It’s horrific, it’s sort of Dickensian. This is how broken the NHS is at the moment.’
She said that such ‘crisis conditions’ are the ‘norm now and it’s horrendous’, adding: ‘So you roll up your sleeves and you go into this chaotic situation, and it feels like fire-fighting, often.
‘You really have to be on your best possible game as a doctor, because you have patients who are frightened, who are in extreme suffering, families who are distressed, and you have to go into that crisis situation and try and make a difference, do the best job you can.’
Dr Clarke said it was ‘unspeakable how bad conditions are’.
She continued: ‘I think if people in Britain – if the public knew that there were people suffering at the end of their life in this way, that was wholly avoidable, that we could fix if we changed the way we are managing the NHS and funding the NHS, they would want to do that immediately. You wouldn’t wish that on your worst enemy, let alone someone you loved.’
Dr Clarke also explained how she tries to control her emotions while dealing with tough situations, adding: ‘I allow myself to cry.
‘So at work I will be hard as nails in the sense that my emotions don’t matter, the emotions of my patient and my family are what matters. So I will not indulge my emotions in a way that stops me doing a difficult job. I’ve got to do it as well as possible.’
She said that if she was ‘talking to a six-year-old about mummy dying’, she would not allow her emotions to get in the way of the conversation ‘as well as I possibly can’.
But Dr Clarke continued: ‘Then I’ll go and have a cry with my members of my team. We all do that sometimes, we know that we need to look after each other.
‘And I don’t mind if I’ll sit in the staff car park and cry for a bit before driving home, because that’s human. That’s a natural reaction to the unavoidable suffering that’s a part of being a human being.’
She then spoke about new Health Secretary Wes Streeting and his statement that the ‘NHS is broken’ and needed ‘saving’, which was issued shortly after Labour won the General Election.
Dr Clarke said: ‘I was really delighted that he said that, because it’s just empty pretence pretending otherwise. That doesn’t help anybody. The NHS is in crisis.’
She continued: ‘It has been for a very long time. And you know, there’s a very simple bottom line here which is a country gets the health service it is willing to pay for.
‘And if you want a world-class health service you pay for it one way or another. I favour general taxation, some people favour insurance, but you have to pay for it. And there isn’t really a shortcut.
‘I think at the moment the very fact that we as individuals are good at pretending the bolts from the blue are never going to happen to us. You know, “I know cancer is out there, but I’m never going to get cancer. I know that horrible car crashes are out there, but I’m never going to have a horrible car crash,” and suddenly need hundreds of thousands of pounds worth of NHS care.
‘The very fact that we are good at denying that truth is one of the things that is causing the NHS to fail.’
She also claimed that ‘shaming people because they smoke or they have a bad diet or they don’t exercise’ is not going to bring about healthier lifestyles.
Dr Clarke said: ‘In fact it’s probably likely to make that individual worse because they won’t want to see a doctor or present if they’re only going to come away feeling shamed.
‘If you are wealthy enough to afford your five a day or your thirty different fruit and different vegetables a week, then you are more likely to have a healthy diet.
‘It is much, much cheaper to buy a McDonald’s and fill up yourself and your kids on tasty, delicious and sort of nutrition-free McDonald’s than it is to buy expensive kind of guava and chia seeds, quinoa, whatever it is, your nice middle-class Waitrose supermarket basket, and spend two hours rustling up whatever those ingredients would make.
‘And if you’re time poor, if you’re money poor, if you’re working three jobs to make ends meet, how do you have time to go running, buy nice healthy food?’
She said that improving the health of the nation needs to begin with tackling the root causes of problems, so ‘we need to go for the drinks industry, the food industry’.
Dr Clarke also discussed how the country has been moving on from the pandemic.
She said: ‘I think it’s really important to try to do with the pandemic what a good doctor tries to do with a patient and their family. That is to look at it, don’t flinch away, and try to be honest about the causes.
‘So it’s not helpful to politicise the decision making. Some of the decisions were wrong at the start, of course they were wrong. It was a global pandemic, no one knew what they were doing.
‘We didn’t understand the disease. We thought it was a disease of the lungs, it’s a disease of the whole body. I wouldn’t have wanted to be Boris Johnson, I wouldn’t want to be Prime Minister in a crisis like that. How terrifying, working out what to do.
‘The one thing you can do that’s positive is learn from the mistakes. Don’t use mistakes to browbeat the other side, let’s learn from the mistakes.’
She added that her being ‘pro-vaccine and pro-acknowledging that Covid is a real disease’ has subjected her to years of the ‘most unspeakable abuse on social media including death threats, rape threats, threats against my family and a sort of constant stream of bile’.
Dr Clarke said it was ‘astonishing abuse’ and could not understand why ‘NHS staff were being abused for saying this was a real disease’ during the pandemic.
She continued: ‘I can’t understand that people really believe Covid doesn’t exist and more people died from Covid vaccines than the disease itself.
‘That says something very scary about modern society and the flow of information and what information is believed in modern society.’
Finally, Dr Clarke also spoke about her mantra for life and how this is influenced by the patients she works with.
She said: ‘We get one life. It’s one spark in this immense darkness and then it’s gone. So I just want to savour every moment and make the most of it. And I don’t care about most things; I don’t care about riches and status and a big fancy house. I care about the stuff that I see my patients caring about on their deathbed.
‘And in the end it boils down to one thing. It’s just love. It’s just the people they love, and wanting them to be around them. That’s the only thing that matters. That’s the only legacy that matters. And that’s how I try to live my life.’
Dr Clarke’s latest book The Story of a Heart, which is a true story about two families linked by one heart, comes out in the UK today and the US on September 10.