Exclusive: Emails seen by the Guardian reveal inexperienced undergraduates are being asked to help in A&E units and wards

Medical students are being urged to help relieve the NHS winter crisis because hospitals are so short-staffed they are struggling to cope with the surge in patients, the Guardian can reveal.

Despite their lack of experience, undergraduates are being asked to volunteer in A&E units and on wards reeling under the weight of extra demand caused by the cold weather, an outbreak of flu and people suffering serious breathing problems.

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They have been told to expect to fit cannulas – the tubes inserted so patients can receive medication – and take blood, work usually done by nurses or qualified doctors.

The British Medical Association said that asking students who had not qualified in medicine to assist with, in some cases, severely ill patients was “a desperate measure” that could put patients at risk and exploit undergraduates who agreed to help.

The disclosure led to warnings that hospitals could face legal difficulties if students made mistakes and concern that their presence on wards could disguise the depth of NHS understaffing.

Medical schools are asking fourth- and fifth-year students for urgent assistance at “hard-pressed” nearby hospitals and GP surgeries, according to emails obtained by the Guardian.



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Dr Andrew Hassell, the head of Keele University’s medical school, wrote to students recently to enlist support in tackling the NHS’s “national crisis”.

“We’re sure you don’t need us to tell you about the extraordinary -situation the whole of the NHS is facing this winter,” wrote Hassell, who is also a senior figure at the NHS trust that runs hospitals in Stoke and Stafford.

Q&A Why is the NHS winter crisis so bad in 2017-18? Show Hide A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. Read a full Q&A on the NHS winter crisis

“As the medical school for this area we think we should be doing whatever we can to support local services while maintaining student learning. We are sure you will want to be part of our collective effort at this time of national crisis,” he said in the email, sent last week. He added that he had already contacted the medical director at his own trust and at the Shrewsbury and Telford Hospital NHS Trust “to ask them to let us know if there’s anything we can do to help”.

Hassell told students: “Do volunteer to help in any way possible, providing it’s within your competence. This applies to students in hospitals and in GP [general practice]”.

On 4 January, two days after the seriousness of the winter crisis led NHS bosses to cancel tens of thousands of operations, medical undergraduates at Liverpool University received a similar email. It told them “the NHS is currently facing unprecedented pressures, particularly in the emergency departments and acute wards”, adding: “During this difficult time it is likely placements may ask student doctors to assist in the acute areas where there is most pressure.”

The BMA said the use of students this way was extremely worrying. “Not only would this be exploitation of students who may be reluctant to say no, but it raises concerns over patient safety if those working on the frontline are asked to work beyond clinical competence”, said Harrison Carter, the co-chair of its medical students committee.

“While the government insists the NHS was better prepared than ever before for winter, this shows hospitals resorting to desperate measures to cope with a system struggling with increased demand and lack of staff and resources.”

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Dr Nick Scriven, the president of the Society for Acute Medicine, said the deployment of medical students raised major concerns. “These students would need close supervision from already pushed and stressed acute ward doctors so there might not be a massive benefit in savings. Of course in the ‘war zones’ some of our units are at present there could be no guarantee they get the supervision they require to practise safely, which is a safety concern,” he said.

“I have other concerns. For example, who covers them if they make an error – the NHS, their university or no one? What pressure is being applied by desperate trusts and how are universities protecting them? How are they being introduced to patients?” he asked. “It definitely hides issues with staffing gaps in wards.”

The NHS has come under the most intense pressure for years this winter, with many hospitals descending into chaos, and doctors describing them as like warzones, as they have struggled to care properly for the increased numbers of patients that the cold weather brings.

Last week, doctors running 68 A&E wards said patients were dying prematurely in corridors, as NHS figures showed the percentage of patients treated within four hours at hospital-based A&E units in England fell last month to its lowest-ever level.

Q&A What are your experiences of the NHS this winter? Show Hide We will be monitoring the situation in hospitals over the next few months and want to hear your experiences of the NHS this winter. We are keen to hear from healthcare professionals as well as patients about the situation. Have operations been cancelled? Has pressure led to certain wards being closed? How are staff coping? Help us document what is going on across the UK.



More than 90,000 patients have been stuck in ambulances outside A&E units during the past six weeks in England, NHS bosses have cancelled tens of thousands of operations to free up beds and staff, while ambulances’ inability to reach patients quickly enough has been blamed for patients dying and suffering prolonged pain. Theresa May has been forced to apologise, but she has been criticised for downplaying the extent of the crisis.

Dr John Oxtoby, medical director at the UHNM trust – which is under some of the most intense pressure in the NHS – said it would be glad to receive help from Keele undergraduates.

“Given the current severe and sustained pressures within our hospitals, we welcome the fact that the university has now written to all clinical students asking them to consider volunteering,” he said. “It is important to be clear that … medical students will not be asked to do anything beyond their competence,” Oxtoby added.

Q&A Does the UK have enough doctors and nurses? Show Hide The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors per capita. Greece, Austria and Norway have the most; the three countries with the fewest are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals. NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem. Read a full Q&A on the NHS winter crisis

A spokesperson for NHS England said: “There have been no -instructions for medical students to act in any clinical professional roles and they do not work as doctors. Senior medical students have always worked alongside doctors and in clinical teams as part of their apprenticeship experience in all parts of the NHS.”

The Guardian can also reveal that specialist nurses are being diverted from looking after patients with dementia to help on general wards, in another sign of how workforce gaps are compounding the NHS’s efforts to give patients proper care this winter.

Evidence collected by the Royal College of Nursing shows nurses skilled in caring for patients suffering acute pain or who have a major wound are also plugging gaps elsewhere.

