I do not write this piece lightly. One of the main premises of Big Up the NHS is that unjustified negative press is harmful to patients and staff. Stress and anxiety can affect the experience of treatment and even the outcome. I write this because I am deeply worried about the NHS and because I am very angry with government and its actions that have landed us in this mess.

My message will be frightening for patients and their families and for that I apologise sincerely – but it has to be said.

This winter NHS emergency services will be subjected to unprecedented pressure and in some parts of the country the service will fail. Quality will nosedive in many areas and the patients’ experience of treatment will deteriorate. Some patients who would normally survive will die – and there is precious little at this stage that anybody can do to avoid it.

I can say this because I understand how hospitals work and what causes the pressures on emergency services in winter. I have been a consultant physician for 20 years and for 5 of them ran the emergency services in one of the biggest trust in the county. I have written more “winter plans” than I care to remember.

The causes of the problem are well understood – an aging population, the obesity epidemic, increasing public expectations, shrinking budgets, health inflation and inadequate training numbers. I have been banging on about it for ages.

This year is different though for two big reasons – the NHS financial crisis and the impending collapse of staff morale.

This week’s NHS hospital trusts budget statement shows an unprecedented overspend of pushing £1B in the first quarter. The NHS normally finishes the year with an under spend of several billion which is returned to government. Chief executives are required to balance the books. Their survival in post depends on it. So when faced with prospective overspends they normally take Draconian action such as vacancy freezes to regain financial control.

In reality the only way to reduce expenditure by the amount needed is to reduce staffing levels. Over two thirds of the NHS budget is spent on pay. However emergency activity is increasing so to maintain safety you need to cover the vacancies with expensive locums leading to a vicious downward spiral.

At present it looks as though nearly 80% of trusts will fail to hit the financial targets. These trusts will all be in financial turmoil as winter approaches.

Those staff still working in NHS front door services are under greater pressure than I can ever remember. They are doing more work with fewer people. Sickness is increasing and clinicians and managers alike are feeling the strain. The number of doctors applying to work overseas has reached record levels. I see it every day. Many are near breaking point.

This winter could go one of three ways.

The government keep up the pressure on trusts to achieve financial balance. Managers continue to slash staffing levels to try to balance the books. We hit the winter with a skeleton staff of very tired people who will collapse under the strain and the service will fall apart in dramatic fashion.

The government realise that financial balance is impossible when things start to get really bad and back off. This in some ways is worse. We spend a fortune on under-qualified, ill prepared locums, storing up troubles for the future. Waiting times in emergency departments go up and patient experience plummets. The service rumbles on with increasing numbers of patients spending 24 hours on hospital trolleys and it all fails more gradually.

The government realise the scale of the problem and pump in significant amounts of cash straight away. This is by far the best option if somewhat unlikely. Sadly though, however much money is thrown at the problem, it will not be enough. It is now too late to recruit the necessary trained staff and in many cases they do not exist because we have been cutting training budgets recently to save cash. We will still use under-qualified, ill prepared locums. It will help but we still need to be prepared for the carnage.

So that is why I am worried, but why am I so angry?

I am angry because all of this was entirely predictable. I have been writing about if for years. Whatever you think about the present government one thing is certain. They are not stupid people and they understand EXACTLY what is happening.

They have let this situation develop and they must have done so deliberately. There has been no attempt to put in emergency plans to tackle the deepening and completely foreseeable problems. Indeed they seem to want to make things worse by raising public expectation of a 7 day service in the full knowledge of the impending financial collapse which will make it unachievable. They have played politics with the NHS by picking unwinnable fights with doctors which can only lead to unrest and worsening staff morale.

The only rational explanation I can see for the current government approach is that they want to see the NHS collapse. It cannot be accident or incompetence. The governments stated aim is to increase involvement of the private sector in the NHS and they can do this more easily when it is failing. A privatised NHS is attractive to politicians of all colours as it gets them off the “funding” hook and actually generates new tax revenues. The conservatives also have their own ideological agenda and some possibly have personal financial motivations.

So it seems that we have a government that is prepared to see many millions of NHS patients suffer appallingly and even see some die in pursuit of their own political agenda.

That is why I am angry!

What can we do?

To be honest it is now far too late to do much that will fix the problem in time for this coming winter. There are things we should do now to help us come out the other side with half a chance of keeping a viable NHS.

NHS leaders all know and understand what is going on. They are silent because their jobs will be on the line if they speak out. It is about time they said something. There are signs of this starting

all know and understand what is going on. They are silent because their jobs will be on the line if they speak out. It is about time they said something. NHS staff must work hard to make savings and reduce waste but they MUST NOT ALLOW QUALITY TO BE DEGRADED in the name of cost savings. Giving up quality now is the equivalent if using the lifeboats for firewood to keep warm as the ship goes down.

must work hard to make savings and reduce waste but they MUST NOT ALLOW QUALITY TO BE DEGRADED in the name of cost savings. Giving up quality now is the equivalent if using the lifeboats for firewood to keep warm as the ship goes down. NHS staff must look after each other. Things become frenetic when services fail and we can easily start to look for people to blame. We are all on the same side and must fight together.

must look after each other. Things become frenetic when services fail and we can easily start to look for people to blame. We are all on the same side and must fight together. NHS supporters must work together to spread this message. There are a lot of separate groups doing great things but they are disjointed and could be so much more effective.

must work together to spread this message. There are a lot of separate groups doing great things but they are disjointed and could be so much more effective. The press need to realise that this is bigger than their individual political allegiances. They need to inform the public first and put their prejudices on the hold for the moment.

need to realise that this is bigger than their individual political allegiances. They need to inform the public first and put their prejudices on the hold for the moment. The general public must understand the problems facing the NHS and get behind us. Things will be bad this winter and the government will blame the staff as they have always done in the past. It is not our fault and we will need your support and encouragement more than ever.

must understand the problems facing the NHS and get behind us. Things will be bad this winter and the government will blame the staff as they have always done in the past. It is not our fault and we will need your support and encouragement more than ever. Politicians must listen to the public and to their own consciences – and then DO SOMETHING. At the end of the day it is only politicians who have the power to make the necessary changes to get us out of this mess.

Please spread this message, support your hospitals and their staff, lobby your MPs, join Big Up the NHS or any of the other NHS groups and above all pray you don’t get seriously ill this winter!