There is a strange calm in the accident and emergency department at Aberdeen Royal Infirmary.
But that calm is created by the staff, and no one should be fooled about the level of pressure they are under.
They are dedicated and devoted professionals who care deeply for their patients and colleagues and are proud of their profession.
But they are also nurses, consultants and other staff who are exhausted, who can’t see an end to the pressure and who want help.
As A&E waiting times hit the worst on record, we filmed in the department to see for ourselves what is happening behind the figures.
Outside, we witnessed ambulances ‘stacking’ (waiting) outside the doors of A&E. Seven were sitting outside at that point and most, if not all, had patients in them.
Described by one consultant as the “threat behind the door”, the patients are observed by paramedics as they wait for a free bay in the A&E department.
‘Well looked after’
One woman we met, Sandra, waited 90 minutes in the ambulance before she made it through the doors.
There was no complaint from her, she was “well looked after” and “reassured” by paramedics and medical staff.
The alternative is that patients would likely be forced to wait in beds in corridors.
Next to the main 12 beds in A&E, the hospital has created an area with six other beds.
This ‘holding area’ is where patients are taken when they are waiting for a space on a specialist ward.
Getting patients who are well enough to leave, either taken home by relatives or friends, or more likely by getting a care package put in place is a critical issue.
Minor injuries, where possible, will be dealt with by appointments and paramedics are able to call in to a consultant to confirm if a patient really needs to be taken into A&E.
Small tweaks which the staff hope will make a difference.
No one wants ambulances stacking, people waiting hours before being admitted and then waiting hours for a bed and to see the specialist they need.
This is not a criticism of staff. Everything we witnessed showed the passion and dedication that staff have, working in some of the most stressful situations, but driven by giving the very best care.
The public will be grateful, they think. Mostly, they are.
But we were also told of a story where staff have been ‘booed at’ or given a ‘slow clap’ when they inform patients in the waiting area that their wait is longer than anyone, including the staff, would want.
We stood on our doorsteps, we were told to protect the NHS – now some boo those staff.
Messages have gone out that people should only go to A&E if they have an emergency.
But that message, as important as it is, you can see doesn’t always sit comfortably with staff.
They admit that some don’t always know when it is an emergency.
But it is up to all of us to help those who work in our hospitals.
The last few years have been harder professionally on these people than for most of us. They have faced pressures never seen before in our health service.
The big question
There is a wider question which one consultant poses to us. What sort of health service do we want?
Do we need to accept that we don’t have the pinnacle of health services, or at least, in their words, the funding for a pinnacle health service.
It is not just down to consultants and clinicians, but politicians too.
Most of us will know someone working in the NHS and will hear and see the pressure they are under.
We will also see the passion they have for their job and the fear for some of what is to come.
It has almost become cliché to say that this winter will be the worst that the NHS has faced.
We’ve said it a lot recently, but it is true.