I went undercover in one of Britain’s worst emergency departments – I’ll never forget what I saw

No one could have prepared me for the reality of working there (Picture: Matt McQuillan / Channel 4)

Hospital alarms pierced through the chilly June morning as I rushed to help on my first resuscitation. The consultant leading the CPR handed me the patient’s bloods to test, my hands shaking from adrenaline and Red Bull as I approached the twelfth hour of my night shift.

Just eight weeks prior, my experience of A&E had been largely confined to a bad bout of COVID and a broken nose aged four. However, now aged 23, I was working in one of Britain’s poorest performing emergency departments.

When Channel 4 asked me to go undercover in the Royal Shrewsbury Hospital for a Dispatches documentary, I was still a journalism student in London. My lecturer had recommended me on account of my interest in healthcare and part-time job in nurse training. I would be working as a healthcare assistant, feeding, washing, and providing a much-needed friendly face to A&E patients, as well as monitoring any signs of deterioration. 

I was unsurprisingly nervous. Less about wearing a covert camera than the prospect of working in such a high-intensity environment for long hours, away from my friends and family. I’d taken some solace in the fact I’d be starting in April, when the so-called “winter pressures” on the service start to ease. 

Even so, on the two-week NHS training course in Telford, I was warned that understaffing, long waiting times and infection control issues now faced the hospital year round.

Often it felt like we’d lost any oversight of where our patients were or what they were waiting for. (Picture: Getty Images)

No one could have prepared me for the reality of working there. Elderly patients waited in chairs for 30 hours, ambulances queued through the night, and often it felt like we’d lost any oversight of where our patients were or what they were waiting for.

Unlike the overcrowded city hospitals I’d witnessed at home in South London, Shrewsbury wasn’t inundated with hundreds of patients on a Friday night. Instead, it felt chronically understaffed and underequipped, resulting in a paralysing sense of chaos that regularly seemed to grip the department. 

Patients and their notes often went missing. I watched a woman with a suspected stroke wait a day in a chair to be seen by the medical team, only to realise A&E had never referred her. Requests for food, medication, and the toilet were often forgotten for hours, and on multiple occasions, patients told me they would be safer at home.  

Patients and their notes often went missing (Picture: Getty Images)

There were aspects of the job I enjoyed, calming dementia patients or supporting distressed family members, helping to make the worst day of many people’s lives a little more bearable. At other points though, I felt completely helpless and overwhelmed.  

Despite being assured that I would shadow another healthcare assistant for the first six weeks of the job, I often found myself alone. On my fifth day, I was sent to a makeshift corridor ward, helping a nurse who was even newer than me.

We muddled together to provide some semblance of adequate care, but there was no sink to wash our hands and with beds lined up along the wall had little space to manoeuvre wheelchairs and clunky medical equipment.

We muddled together to provide some semblance of adequate care (Picture: Getty Images)

At one point the nurse went to find pain medication, leaving me alone trying to care for all five patients, while one woman screamed over and over in agony that she “couldn’t go on”. I called out to a doctor and the Nurse in Charge that I was way out of my depth and needed help, but they never came.   

I cried as I relayed the events of that shift in my daily video diary. It wasn’t the last time. To my surprise, the traumatic injuries or heart attacks didn’t upset me as much as the erosion of our patient’s dignity. Despite working as hard as I could, I felt like I should do more. My colleagues told me I’d have to grow a thicker skin, and I sensed they’d long battled these demons.

One particular gripe of both patients and staff was “Fit2Sit” (dubbed by staff as Fit2S***), a limbo waiting room for those who were ill enough to be admitted to hospital but “well enough” to be in a chair.

The area was introduced as just a few chairs a couple of years ago to tackle hospital capacity issues, mimicking similar concepts used across the country. Now it had room for 20 patients, although it regularly exceeded that capacity.

Fit2Sit lacked side rooms for vital tests and treatments to be conducted, further slowing down patient’s care. There were shortages of equipment and staff to appropriately monitor patients – mandatory observations often falling hours behind.

Perhaps most alarmingly, many of the patients in Fit2Sit were anything but. I saw people suffering with ailments from suspected strokes to cancer patients on active chemo needing isolation to keep them safe. 

My colleagues told me I’d have to grow a thicker skin (Picture: Matt McQuillan / Channel 4)

The staff I worked alongside in A&E were well aware of the poor quality of care our patients were receiving. My colleagues regularly bemoaned the use of the corridor “ward”, the inability to isolate immunocompromised patients, and ambulances being forced to offload patients without proper handovers or bed spaces.

In our morning meetings we received a litany of complaints from management on the department’s “falling care standards”, “lack of communication” and “negligence”.

Still, many begrudged the idea that staff on the ground could combat the enormous pressure the service was facing, without major changes from the Trust and NHS more widely. Those who worked in other hospitals around the Midlands said the issues they faced there were similar. 

My seasoned colleagues were less visibly shocked or upset than me by the chaos in the department, instead, they felt weary. Sometimes they moaned about poor pay, or lack of support, or how sorry they felt for a patient, but most of the time they had their head down and pushed on with the million urgent tasks being demanded of them.

From health care assistants to doctors, there was resounding agreement from everyone I spoke with that our department was underfunded, understaffed and overrun. They also cited bed blocking in the rest of the hospital as having a knock-on impact on A&E.

One senior consultant explained how the lack of community and social care in Shropshire meant that vulnerable patients couldn’t be discharged from the wards, creating a backlog, preventing flow through A&E. Others felt that difficulty accessing GP services meant more people were coming to emergency care unnecessarily, creating additional pressures for the department.  

On more than one occasion I found blood, urine and feaces on equipment (Picture: Getty Images)

Still, not everything I saw can be blamed on external forces. Despite the hospital having struggled to control superbugs like C-Difficile, I noticed that very few staff members washed their hands properly, if at all; and on more than one occasion I found blood, urine and feaces on equipment. The immense stress staff are under undoubtedly contributes to corners being cut, but attitudes around hygiene also need reforming.

When I left the job I felt overwhelmingly guilty. The vast majority of staff I’d worked with were hardworking, resilient and kind, trying to plug holes in an ever more sinking ship. I hold the utmost respect for everyone who still works in the department. The endless pressure and lack of support has left them burnt out and in some cases emotionally blunted.

It is important to show people the real state of A&E in Britain today (Picture: Getty Images)

I only worked in A&E for 8 weeks, but struggled to imagine how I would manage if the role was permanent. Worse than the exhaustion or stress was the embarrassment of being the face of a failing care system. I can’t count how many times I had to apologise to a patient on behalf of an organisation that was setting us up to fail. As one senior nurse told me, “this isn’t why you come into nursing.” 

As we gear up for the general election and the NHS becomes an increasingly focal issue of political debate, it is important to show people the real state of A&E in Britain today.

For me, I hope that’s the last interaction I’ll have with a hospital for a little while. But unexpected accidents and emergencies happen, and my experience has not filled me with confidence if me or a family member needed urgent care. 

Undercover A&E: NHS in Crisis – Dispatches will air Monday 24 June at 9pm on Channel 4