But then, once Towlson was back in the UK, Green Park seemed less willing to offer aftercare support: with disastrous consequences. By 11 May, Towlson was dead, found decomposing in her home. Her tragic story is far from unique. Since 2019, some 28 Britons have died after cosmetic procedures carried out in Turkey. In truth, though, fatalities represent only the most extreme outcomes. For every death, hundreds more patients return to the UK with complications requiring urgent NHS treatment — treatment which the British Association of Aesthetic and Plastic Surgeons (BAAPS) estimates costs the NHS £15,000 per patient.

Combined with a rise in dangerous off-the-books procedures in Britain itself, and the beauty industry is having a profound impact on our health service. Part of the solution involves tightening up regulations, and clamping down on dodgy practitioners. But the problem ultimately stems from deeper societal issues — around beauty standards, mental health, and the immense power of imported US culture. Without addressing these root causes, the NHS will continue to bear the physical, psychological, and financial burden of beauty gone wrong.

Medical tourism is booming, with Turkey especially emerging as a primary destination for dental work and cosmetic procedures. Yet if BAAPS figures show the country is comfortably the most popular destination for Britons opting for cosmetic surgery abroad, everywhere from the Dominican Republic to Tunisia are represented too. All told, the ONS has found that the number of British residents leaving the country for medical treatment increased by over 100,000 from 2021-2.

Yet as the Towlson case so vividly shows, these expeditions can end in disaster. In a sense, this is unsurprising. Investigating Towlson’s death, the coroner expressed concern about the lack of coordination between international medical authorities, and the absence of clear warning systems for British patients considering procedures abroad.

Even when patients don’t die, they can still suffer, with symptoms ranging from post-operative wound infections to full-blown sepsis and pulmonary emboli. I see similar basket cases in A&E, from red raw peeling scalps that have been butchered by backstreet hair replacement clinics to faces so swollen by cheap collagen implants that the patient’s head takes on an eerie alien look.

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Yet far from crowing about the state of foreign cosmetics practitioners, cases like Susan McGowan’s highlight the deadly potential of procedures inside Britain itself. An NHS Scotland nurse, McGowan died on 4 September 2024, after receiving injections of tirzepatide (more commonly known as Mounjaro) from an unqualified practitioner here in the UK. McGowan’s colleagues at University Hospital Monklands in Airdrie fought to save her life, after she presented at A&E with severe stomach pain — but to no avail.

As with Anne Towlson, McGowan’s case is the sharp end of a far wider wedge. Weight loss drugs like Ozempic and Mounjaro may be celebrated on social media as miracle cures, and even trumpeted by Health Secretary Wes Streeting. But the numbers are worrying. Data submitted to the UK drugs regulator show that, as of January this year, dozens of deaths have been linked to these medications.

The side effects of these medications — primarily nausea and suppressed appetite — are often misunderstood or downplayed. As treatments go, indeed, this is Wizard of Oz stuff: pull back the curtain and you’ll lose weight not because of the wonders of modern medicine but simply because you feel sick all the time. I had a patient who thought her persistent stomach issues were simply side effects of Mounjaro. Actually, the drug was masking symptoms of potentially life-threatening bowel cancer.

At the same time, patients seem increasingly unwilling to accept clinical guidance. A dentist friend told me of a patient who wanted a dental bridge. My friend advised against it: the risk of complications and infections was far too high. The patient ignored my friend’s advice, went to Turkey, had the procedure — and the predicted complications duly appeared. My friend refused to fix the problem, advising the patient to return to Turkey for additional treatment. This may seem harsh, but a dentist or clinician who’s advised a patient against a risky procedure isn’t obliged to clean up another practitioner’s mess.

Yet when complications do arise, patients often find themselves in NHS emergency departments, creating a perverse system where private profit is internationalized while the costs of complications are socialized through the NHS. In other words, British taxpayers end up subsidizing both shoddy domestic and foreign cosmetic practices, and patients who haven’t thought carefully about the procedure they’re embarking on — all because they want to save a few bucks and be “Instagram ready”.

Telling, too, is how many people now arrive at A&E expecting comprehensive corrective procedures to their cosmetic nightmares, misunderstanding the fundamental mission of emergency medicine. Essentially, me and my colleagues are there to maximize a patient’s utility, not magically turn them into Scarlett Johansson. But, today, everyone has a bit of Gen Z about them. No one will wait for anything. Everyone thinks it’s their right to look young, attractive and desirable. When I try to give my oozing, bleeding, weeping patients a “teachable moment”, they don’t want the reality lecture. They want the fantasy outcome.

Nor is the problem going away. If anything, it’s getting worse, with untrained practitioners proliferating right across the country. It’s astounding how many and what sort of invasive procedures can be carried out by someone with zero clinical expertise. As researchers at UCL found, 68% of cosmetic practitioners administering injections such as Botox and dermal fillers are not qualified medical doctors. That’s even as the UK injectables market is predicted to reach a value of £11.7 billion by 2026.

NHS departments regularly treat patients suffering from infections after receiving dermal fillers from beauticians who may have only watched a handful of instructional YouTube videos. Many hairdressers branch out into doing cosmetics after doing a perfunctory online course, thinking they can go from hair extensions or pedicures to collagen implants and butt fillers that breach the skin and enter the body. Ironically, 16th-century barbers who combined cutting hair and trimming beards with pseudoscientific leeching are the progenitors of today’s NHS surgeons. To that extent, then, rogue beauticians are simply reclaiming their birthright.

And like in the Renaissance, unregulated procedures today flourish in a regulatory wild west. The legal specifics differ significantly between countries. In the US, for instance, the industry is considerably more controlled. Start pumping patients up with Polyfilla and not only will you wind up with a massive lawsuit, you’re also going to jail.

The UK, however, has developed a reputation for what one friend calls a distinctive “British style” of cosmetic surgery — one characterized by poor technique and overfilling thanks to looser regulations around who can perform procedures. The landscape is further complicated by dubious online marketplaces. Performance-enhancing steroids and supplements that would send the IOC into a spasm can be bought at the click of a button, from the same sources selling bootlegged weight-loss medicines, corrosive teeth whiteners, or self-administered collagen implants.

Given the shocking deaths of Towlson, McGowan and others, renewed and growing calls for stricter regulation of the beauty industry, from both the Royal College of Surgeons and the British Medical Association, represent the concerns of myself and colleagues who find the unabated rise of cosmetic quackery deeply worrying. But if the Government is incapable of legislating against backstreet practices here in the UK, what hope is there for people who find themselves ill-treated abroad? My advice to anyone contemplating cut-price cosmetic surgery, anywhere, is to take a good, hard look at yourself in the mirror — literally — and ask yourself: is it really worth the risk?

Anyway, even in well-regulated environments, financial incentives can distort clinical judgment. Some practitioners provide prescriptions with minimal oversight, driven by profit rather than patient welfare. There are plenty of unethical private doctors happy to leave a private prescription under the plant pot. These people, though highly trained, are not thinking about patient complications. They’re thinking about being able to buy a new tack for their daughter’s pony.

In the end, though, I think tightening up the rules is only half the answer. Behind every botched procedure lies a deeper psychological narrative. Body dysmorphia, unrealistic expectations, and a profound disconnect between self-perception and reality drive many towards the surgeon’s knife. Talking to my own patients, it’s clear there are vast mental health problems washing about in less-regulated corners of the cosmetics industry. The subtext: I don’t like who I am, I want to be someone else.

Unsurprisingly, social media is central here, revolutionizing how beauty standards are created, communicated and commodified. The “Instagram face” — characterized by inflated lips, sculpted cheekbones, and contoured features — has become a globalized aesthetic. That’s even as rapid cycling between extreme body types, from heroin chic (remember that one?) to Kardashian curves and back again, makes it impossible for punters to keep pace either physically or financially.

Perhaps all that’s an inevitable consequence of a culture that’s preoccupied with difference, individuality, identity politics and celebrity. Once upon a time, if you were some random person out of the limelight, you wouldn’t need to care about what you looked like. But today, if you’ve picked up a couple of thousand followers online, you feel like you have to look a certain way to keep up appearances.

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All the while, platforms like TikTok accelerate these trends through filters that shrink noses and enlarge lips, creating a distorted self-image that patients then seek to make permanent through cosmetic procedures. This phenomenon drives people to show plastic surgeons their filtered face as their desired result — an inherently unattainable standard. And though traditionally associated with women, cosmetic enhancements have increasingly attracted male patients, particularly for hair transplants and dental work.

Some men also pursue more extreme interventions like bicep implants and chest enhancements, reflecting changing expectations around male physique. Class matters here too. We’re often talking about people who can’t afford treatments in the first place, then can’t afford to take time off work when something goes wrong. At the other end of the spectrum are people with too much money and not enough sense, who pursue extreme procedures without thinking them through.

I’d ultimately argue that whoever’s taking Mounjaro or having their teeth done is falling prey to an insidious form of American cultural imperialism, at odds with British self-perception. We like to think of ourselves as European, modern and sophisticated. The truth, though, is that we’ve got an obscene obsession with what’s happening over the Atlantic. This influence extends to the commercialization of procedures, with practitioners styled after American influencers, promoting not just beauty but a luxury lifestyle complete with private jets and pool parties in Dubai.

Rather than obsessing over miracle drugs, then, perhaps Streeting should encourage society to address the underlying factors driving such procedures. This includes media literacy education, particularly for young people, and more nuanced conversations about body image and self-worth. And it’s worth repeating: this is about more than patient safety. Just as eating disorders, self-harm and substance addiction drive the weak and the vulnerable toward A&E, the dark side of the cosmetics industry will invariably do the same, even if it seduces you with a smile on its face.

Last year, 79-year-old Norman Jopling went to the GP about severe pain in his skull after knocking his head, and was diagnosed with tension headaches. He then suffered a subdural haematoma — a bleed on the brain — and ended up spending months in hospital, unable to speak, walk or move his arms.

And then there’s the case of Emily Chesterton, who made an appointment at her GP practice in October 2022 because her leg was hot and swollen, and she was short of breath. She was sent away with “anxiety” and a “calf sprain” on two separate occasions. The evening of her second visit, she died. She was 30.

These three tragic cases have one thing in common: none of these patients ever saw a doctor. Instead, they were seen by a “physician associate” (PA).

Introduced to the NHS in 2003, PAs were meant to make doctors’ lives easier. They are trained to physically examine patients and take medical histories — and are often the first people to see “undifferentiated” patients (those arriving in either hospitals or primary care without a prior diagnosis). They can therefore play a significant role in determining what treatment a patient gets, even though they are not medically qualified. Where a doctor would have to spend at least 10 years of study and practice to call themselves a GP, a PA undergoes just two years of clinical training.

And herein lies the problem. Even a medical student would likely have recognised that Emily Chesterton was experiencing a pulmonary embolism — which can be easily treated with blood thinners. A recent inquest concluded that she would have survived had she been sent to hospital. The inquest that followed Benedict Peters’s death similarly concluded that it was a “concern” that he was never seen by a doctor.

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Worryingly, Emily did not even realise that a doctor had never examined her, as is the case for many patients. A PA could be assisting with your knee replacement, putting you under general anaesthetic, or putting a needle into your spine. They could even be the only “medical professional” that your child sees in A&E. And you may not even realise: six weeks ago, a survey by the British Medical Association (BMA) found that a quarter of respondents mistakenly believed physician associates are doctors.

Even doctors themselves are not immune to this confusion. When I accompanied my father on a hospital appointment recently, what I now know to have been a PA introduced herself as “one of the team”. She was wearing scrubs and a stethoscope with no obvious ID badge explaining her role. It was only when I started asking questions related to my father’s medication, and she seemed unable to answer, that I asked her outright if she was a doctor.

I don’t doubt the rationale for introducing PAs. Doctors are overworking, and a huge chunk of our time is taken up with administrative tasks that you don’t need a medical degree to perform. As a hospital doctor, for instance, you’ll spend at least 30 minutes every morning creating “the list” — a summary of who your patients are, which ward they’re on and which bed they’re in — before hunting down a printer that works so you can distribute it to the entire team. You’ll then have to locate all the notes on your patients — which should be kept around their beds, but tend to be scattered around the ward. Finding them can also take 30 minutes.

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PAs could be hugely helpful in keeping paperwork in order, and there are also plenty of clinical tasks they could be trained to perform. Doctors spend untold hours on clunky Windows XP computers requesting blood tests, for example. Or, if we need to cannulate a patient ourselves, searching for all the necessary equipment, it can take 20 minutes. Again, there are so many ways PAs could make this task easier.

And yet, last week, a survey of 18,000 doctors run by the BMA found that the majority believe PAs are adding to their workload, with only 21% saying they are helpful. Many doctors spoke of having to check their PAs’ work.

Because PAs aren’t really qualified to diagnose patients, let alone treat them. The two-year clinical course to become a PA is very much an overview of medicine. It involves as little as two weeks learning about the entirety of, for example, Obstetrics and Gynaecology. To secure a place, you once needed a “science-based” undergraduate degree, but even that requirement has now been dropped completely. Many of the top PA courses have a 100% pass rate, suggesting either exceptional teaching or poor academic standards. It’s hardly surprising that, when the Government announced in November that it planned to increase the number of PAs from 4,000 to 10,000, doctors expressed concerns about patient safety.

It’s also worth pointing out here that a newly qualified PA in London is paid more per hour than a newly qualified doctor. The former can expect a starting salary of £44,000, for 37.5 hours a week. Junior doctors regularly work around 48, for a starting salary of £32,000. The rationale behind this discrepancy was originally that PAs, unlike doctors, were unlikely to ever have “pay progression”, but that was years ago; nowadays, PAs can see their earnings increase with experience. I’ve seen job ads offering £70,000.

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I say this not out of resentment, but to demonstrate that increasing the number of physician associates is not, on the face of it, a particularly good use of money. It could also hamper attempts to boost the number of experienced doctors in the NHS.

Since the overhaul in their training 10 years ago, junior doctors have had to “rotate” every four-to-six months until they reach consultant level. Rotations usually require recent med-school graduates to move around the country and switch specialty. PAs, on the other hand, theoretically remain on the team permanently. If a consultant trains a PA to perform a lumbar puncture, or chest drain, or even to be their assistant during a hip replacement, then they will personally benefit from the time they put into training that person. Crucially, they probably won’t have to retrain someone else in a couple of months’ time.

As a result, it’s now not uncommon to find junior doctors doing admin on the ward while PAs are in out-patient clinics or surgical theatres with the consultant. The result, perversely, is PAs getting all the experience that junior doctors need.

The government claims that PAs are merely filling rota gaps because we just don’t have enough doctors. But though it is planning to increase the number PAs, it is doing little to address the bottleneck in opportunities for much better-qualified medical professionals. The NHS’s long-term plan is for consultant anaesthetists to each supervise three Anaesthetic Associates — the equivalent of a PA — simultaneously. Meanwhile, there are nearly 3.5 doctors applying for every anaesthetic training post — a necessary path to consultancy. This bottleneck exists across almost every specialty.

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Given these stark facts, how can the NHS — as the chief executive of the General Medical Council has urged it to do — tackle the perception that PAs are replacing doctors? Indeed, how can it deny that replacement was the plan, when official minutes obtained via an FOI state that “there is an ambition to increase PA numbers in the UK and to make sure that maximum value is derived from them as medical role substitutes”?

And how can they explain why some NHS trusts are actually including PAs on senior doctor rotas? I’ve heard reports of PAs being given responsibility for the stroke bleep — the pager that a consultant doctor specialising in strokes is supposed to hold at all times, so that other doctors can contact them urgently when they need advice. This could lead to the absurd scenario of an emergency department consultant being forced to go to a PA for advice.

Then, at the end of last year, the government announced plans for the GMC to regulate PAs. Billed as a “patient safety boost”, this move has criticised for potentially “blurring the lines” between doctors and PAs. Because what patient will be able to tell the difference between Mr John Smith, GMC number 12345 (an orthopaedic surgeon) and Mr John Smith, GMC 23456 (a PA)?

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When challenged, it’s common to hear NHS managers justify PAs as bringing “diversity” and “a different perspective” to medical teams. But patients don’t want a different perspective. They want the right treatment. And diversity is only valuable when everyone has received training that qualifies them to undertake the tasks they’re expected to perform.

The evidence that PAs risk harming patients is mounting. A recent FOI request of Leeds Teaching Hospitals has revealed that PAs have ordered over 1,000 treatments that expose patients to ionising radiation, such as X-rays and CT scans, which can only legally be ordered by doctors. And new data from Scotland implicates PAs in a number of “never events”. These are, as the name implies, “wholly preventable” events that should never happen: performing a procedure on the wrong body part, maternal deaths from haemorrhage, incorrectly placing a nasogastric tube.

A price can’t be put on the lives that could potentially be lost if the PA to doctor ratio continues to tip. But the cost of compensation is measurable. Where doctors must pay for their own medical indemnity insurance, which compensates patients harmed by medical negligence, PAs do not; when they make mistakes, it is the NHS itself that pays. Last year, the service spent £2.6 billion compensating victims of negligence; how much more could it have to pay if it succeeds in adding 6,000 PAs to the workforce?

It’s a sign of how desperate the NHS is that it is allowing itself to increasingly depend on physician associates. Doctors are burning out at record rates: we need help. But instead, less qualified members of NHS staff are taking on more and more of our responsibilities, because hiring them is easier than tackling the root causes of the service’s malady. To give patients the care they need, sweeping reform is necessary: of administrative systems, of junior doctors’ rotations, of career ladders. Instead, what we have are physician associates — at best a sticking plaster, and at worst a danger to the NHS.

The correlation between alcohol and violence is well-known, and something we contend with on a daily basis in A&E. Handling drunk patients, and their often-volatile friends, is one of the job’s less pleasant challenges. Their perceptions of common decency are warped, their ability to communicate impaired, their behaviour unpredictable. Anger can quickly descend into violence. And when you mix the sick and frail with the intoxicated or inebriated, you create a morbid cocktail.

But it’s not for me to judge my patients’ transgressions or “lifestyle choices”. Whether they are drunk or stoned or high, incurred an injury in a car chase, or fell ill from swallowing a handful of drugs before they were arrested — all this is immaterial from a medic’s point of view, and must not pollute any assessment. There’s one A&E department nearby that saved the lives of two separate patients who had been brought in by the police with serious injuries sustained from fighting. Both were later charged with murder.

Even though I’m pretty accustomed to the risks now, there are still times when I genuinely fear for my own safety. On one occasion, a local criminal with a history of mental health problems confronted me. He had a habit of loudly threatening to commit suicide if he didn’t get to skip the queue — a threat which we had no reason to think was genuine, and which therefore got him nowhere with the staff on duty. When he accosted me, I could see that he was on the verge of hitting me, so I called the police and had him removed. He was twice my size and had that crazed look in his eyes; who knew what he would do? After all, if he didn’t take a swing at me, there’s every chance he could attack a member of my team. Or what if he decided to wait for me in the shadows of the staff car park? I wouldn’t be the first, or last, female doctor to be intimidated on her way home.

And then there are the patients who show up in A&E with weapons. Last week, a police pursuit in Rochdale ended when the suspect’s car collided with another vehicle. Officers detained the man and took him to Fairfield Hospital in Bury for treatment, only to find that he was carrying a gun. According to the Manchester Evening News, “police confirmed that there was never any risk to the public, and the weapon was recovered safely” — a statement that strikes me as, at best, nonsense and, at worst, evidence of a potentially sackable offence. If police officers had properly searched him, they would have found the gun, instead of allowing it onto hospital premises and putting countless lives in harm’s way.

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It was not an isolated incident. Last year, a clinician in a nearby hospital stumbled across a concealed weapon on a patient who had been brought in by police. Apparently, all hell broke loose. The officer guarding the suspect hit the panic button on his radio, and a team of armed police descended on the patient’s cubicle — much to the distress, no doubt, of other patients.

And it’s worth remembering that untrained, illicit firearms users are as much a risk to themselves as the public. A colleague once treated a young man who had received a gunshot wound to a rather delicate part of his anatomy after a firearm he’d concealed in the waistband of his jeans accidentally went off. (One of the patient’s testicles was rendered redundant.)

But even if external forces and authorities are responsible for bringing potential violence to A&E, the conditions within hospitals serve as a catalyst. Long waiting times, overcrowding, stressed-out patients and relatives, staff shortages: all these factors mean tempers run high. As one nurse who is preparing to strike over pay and conditions told me earlier this week: “Part of our campaign is about safe staffing on wards. The ratio of nurses to patients is out of kilter. This is often why people become aggressive in A&E: because they can’t get seen as we’re so short-staffed.” Nurses feel that they are expected to put up with abusive behaviour because, according to a recent survey, it ​was seen as “just part of the job”. Some described it as “normal” because of the frequency of incidents.

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Nurses aren’t the only ones who need better pay and treatment in order to keep patients safe. A&E departments in areas that see a lot of crime also need security staff who are capable of quickly deescalating potentially violent situations. Some hospitals already have this: men with special forces beards, who dress in combat trousers and tactical vests; they look like they are about to carry out a dawn raid with the SAS, not direct Mavis to the disabled parking bay. But these guards are the exception. Those who guard the nation’s emergency departments tend to earn disastrously low wages — and, as the NHS well knows, poor pay attracts poorly trained, unmotivated staff.

These failures trickle down. It shouldn’t need spelling out, but it does: when clinical staff are distracted, abused or assaulted, our capacity to deal with patients is limited, and our departments become less effective. According to The Lancet: “Violence costs the NHS £2.9 billion a year. Indirect costs are much greater, including loss of psychological and social function to the individual, diminished community cohesion, and loss of economic productivity.”

Until the public and the Government realise the immediate, future and generational cost of violence, not just to the healthcare system but to society as a whole, I fear Britain will be paying off a debt it can ill-afford. In the meantime, my staff will continue to look over their shoulders, knowing full well that more tragedies are inevitable.

“It has been shown that if those extra 100,000 people had lived to a ripe old age, they would’ve cost us even more in pensions and social security than they did in medical treatment. So financially speaking, it’s unquestionably better that they continue to die at about the present rate!”

Anyone who’s worked in the National Health Service for more than a few months would, depressingly, recognise this kind of equation.

Those episodes were first broadcast in 1986, when the tobacco tax generated £4 billion in revenue for the government and smoking-related diseases did indeed cost the NHS £165 million a year. Last year, the tobacco tax raised £8.7 billion for the government — but smoking-related illnesses cost the UK healthcare system £2.5 billion per annum. Nevertheless, a smoking ban has never been seriously considered. Behind the gallows humour at the heart of Yes, Prime Minister lies a bleak fact: the state is happy to kill off the weak to balance the books, or even make a profit.

This cavalier attitude to death rather defined the Government’s attitude to the pandemic, as it spread through hospitals and was encouraged into care homes, pushing the NHS to breaking point. In hospitals, we’re battling it still. When Omicron started spreading at the end of last year, we were told it wasn’t as dangerous as previous variants — but that might just have been because patients and the public were more vigilant. Now, vigilance has waned. With most Covid mitigation measures nothing but a memory, hospitalisations could spiral out of control again. And it’s now predicted that, because of a lack of exposure during lockdown, flu deaths will be very high this year. This winter, according to The Lancet the return of influenza as a major public health issue appears “inevitable”.

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Then factor in the cost of living crisis. People are not going to be able to heat their homes. People are not going to be able to put food on their tables. People are not going to be able to put fuel in their vehicles to go to work to earn money. People are not able to afford prescriptions. People are going to have to choose whether to feed themselves or their children. Isolated, vulnerable people are going to be more isolated and more vulnerable. Abused people are going to be more abused. 

Emergency departments throughout the country are starting to seem Dickensian. I routinely see patients admitted with combinations of multiple problems: severe respiratory illness, loss of sphincteric function, terrible hygiene and general self-neglect. Paramedics are having to wear specialist kit to cope with lice, scabies and faecal matter — and incinerate patient property in keeping with protocols.

All of this will put immense pressure on the NHS — which is in a terrible position to deal with any of it. After a recent bout of Covid (yes, even doctors get it) left me utterly drained, I dragged myself into my department because — like the rest of the NHS — it is suffering from unprecedented staff shortages. A staggering 40,000 nurses have quit in the past year, many due to stress and poor pay. (Those remaining are deciding whether to strike.) Resignation rates far outstrip recruitment. Sick leave, meanwhile, is running at an all-time high, with some 60,000 healthcare and social care staff suffering from Long Covid. Working conditions for those working are verging on untenable.

The A&E department where I work is representative, in that it is falling apart. Ambulances get stuck outside for hours. There is no patient flow, and therefore no capacity; there are not enough GP appointments, so problems aren’t treated early and people show up on our doorstep far more seriously ill; and there is a dearth of community services. In the past two years — since before the second lockdown — I have seen more severe cases than in the rest of my career. Recently, I had a patient who had telephoned his GP complaining of a sore arm, which was thought to be a muscular or skeletal problem. In fact, the man had been suffering from angina, and the sore arm was referred pain. The situation soon escalated: he had a massive heart attack. We worked on him in A&E, but to no avail. Had the patient had a face-to-face consultation with his GP, things may well have been different.

This summer, we experienced “excess” non-Covid deaths in the region of 1,000 a week in England and Wales — in other words, far more deaths than would usually be expected for the period. Many of them, it seems, were related to lung, heart and circulatory diseases. Research by The Kings Fund healthcare charity revealed that the pandemic era has seen life expectancy in the UK fall by a magnitude that “has not been seen since World War II”. Second only to the US, the UK’s pre-pandemic life expectancy was lower than in many comparative countries for males, lowest for females. In the first 12 months of the pandemic, it fell by over a year for the former, and just under a year for the latter.

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If deaths this summer were way beyond the average, the prognosis for this winter is bleak, given this lethal cocktail of health and socio-economic issues. According to the Government’s own research, for yet another week, “statistically significant excess all-cause mortality by week of death was observed overall in England” — and autumn has only just begun. The nation is about to be plunged into a winter during which people can’t protect themselves, comfort themselves, warm themselves or feed themselves.

Our hopes rest on a new Health and Social Care Minister, Thérèse Coffey. She is, it’s said, in “listening mode”. She has already made remarks that sound great. Everyone is going to be able to see a GP within two weeks, she says, without explaining exactly how she’ll achieve this. (Currently, some people are unable to see a GP at all.) Coffey has also said that nurses won’t get a pay rise. In fact, she’s advocated working for no money at all, unabashedly calling for a “national endeavour” to support the NHS, which “includes encouraging more volunteering across the health service”.

Coffey has proposed tweaks to the NHS pension rules to “allow” retired staff (who are probably well shot of the health service) to return to work if they want to (why would they?). But why the focus on clinicians at the end of their careers? The General Medical Council (GMC) is reporting that two-thirds of junior doctors are “worn out” at the end of a working day and morale among trainee nurses is at an all-time low. Coffey’s plan should throw them a lifeline; instead, it doesn’t mention them. Our healthcare system is dreadful and dilapidated because of this government’s failure to invest — not only financially but also in terms of the time and brainpower needed to sort out the situation — and the same Government is still failing to do anything meaningful about it.

The cherry on top is the fact that Coffey seems poised to bin its plan to tackle smoking. It is no coincidence, perhaps, that she herself smokes. We live in a world in which “optics” matter — particularly in the socio-political sphere — and Coffey, like Jim Hacker’s chain-smoking, tobacco-lobbying health minister, aren’t good. She’s obese. She drinks. She’s known to be cosy with the tobacco industry. And she’s anti-abortion.

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Still, there are signs that somebody, somewhere in Coffey’s department, understands the most pressing challenge facing departments like mine: one of the priorities in what has been titled “Our plan for patients” is the Adult Social Care Discharge Fund, the aim of which is essentially to free up beds. In my region, we can’t seem to get any patients out the hospital and into social care — because there is no social care. If Mrs Smith on ward seven has her pneumonia treated quickly, and she turns the corner beautifully, and she’s off supplemental oxygen and on oral antibiotics, and all the paperwork has been filled out by the junior doctors for the social care assessment — all that happens is she gets into the queue for social care quicker. The queue gets ever-longer. Mrs Smith remains in hospital.

It is hard for hospital managers and clinicians to remain motivated in the face of this absurdity. Making things more efficient within the hospital doesn’t actually speed up the process of getting patients out of hospital. It just gets them onto these waiting lists quicker.

Even the best British satirists might struggle to lampoon it, so dark is our current situation. The other night, while I was on call, the sister in charge let slip that only one or two beds in the emergency department would free up that evening. This is a continual problem where I work: the number of beds available in any given 24-hour period is always far outnumbered by the number of patients requiring clinical admission. Allocation is a simple mathematical equation. On this occasion, the sister followed up her update with another: “We’re expecting a couple of deaths…”

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The tragedy of Matt Hancock

By Will Lloyd

In other words, the only way we can get new patients into our emergency department — and the only way we can get existing patients into the community — is if people die. This health “target” unsurprisingly doesn’t get openly discussed. But it’s there, nonetheless, in the back of management’s collective mind, reminiscent of Sir Humphrey declaring, “it’s unquestionably better that they continue to die!”

If this is the NHS’s new normal, and the Secretary for Health and Social Care is happy to accept it, then that’s a sad indictment of her stewardship. But her party sets the tone. We’ve been here before with this government: in April 2021, Boris Johnson said he would rather see “bodies pile high” than take the UK into a third lockdown. The UK currently has a body count of 205,000 Covid-19 deaths, and the Tories seem all too comfortable with this — which doesn’t bode well for the coming winter.

Without adequate support from the Government, the NHS will be forced to keep relying on a shameful, unofficial “beds for death” policy. Staff shortages will snowball. The new generation of clinicians is already battling with severe financial and mental health issues. And they’re not stupid: they know exactly what their employers are depending on, to free up beds. That these young people are trained, pressurised, and ultimately programmed to operate within an NHS that relies on human misery to create capacity is yet another sign of a healthcare system at breaking point. To make a dent in these systemic problems, the service urgently needs money and personnel — not a spate of excess deaths.

It’s just before 8am on Monday morning, and my A&E department is heaving. I’ve been on-call all weekend — I’m shattered — but I don’t have time to dwell on it. Our traffic light system is a sea of red: red for staffing, meaning we’re low on doctors and nurses; red for capacity, meaning we have far too many patients; and red for acuity, meaning a terrifying number of those patients are severely ill. Some of them are dependent on a ventilator. Some won’t make it to the end of the day, let alone the end of the week.

And I can understand why: we’re on the brink of disaster. As a consultant, I am alerted every day to cases in my hospital and beyond that suggest the service, not just A&E, is at breaking point. Breast cancer sufferers had critical mammograms cancelled due to the pandemic. Nine out of ten NHS dental practices are not accepting new adult patients. GPs are quitting in droves. An unwell father-of-two waits 20 hours in A&E, refusing to leave until he gets a blood test, which ultimately reveals he is suffering from terminal leukaemia. A patient who, during lockdown, had his blood pressure managed remotely finally discovers his problem isn’t high blood pressure: he’s got a brain tumour.

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Why the Tavistock had to fall

By Kathleen Stock

It’s not just the problems within the healthcare system that have caused this crisis. The terrible failures of Britain’s social care system also have knock-on effects. In a medium-sized hospital like mine, there are between 60 and 80 patients who don’t need to be there. But there’s nowhere else for them to go. Just as mental health patients wind up in jail for want of psychiatric care, the elderly wind up languishing on hospital beds in corridors because social care is in an even worse state than the healthcare system. On one recent Saturday night, for instance, a psychiatric patient came in for treatment. When I asked how he was doing the following Tuesday, I was told he was still on the ward, occupying a bed, because there wasn’t a psychiatric bed available in the region.

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Why the Tavistock won't talk to me

By Hadley Freeman