A doctor who has worked in the NHS for more than 30 years has described how he "lies awake" at night, worried he has made a mistake due to the immense levels of pressure and exhaustion he and his colleagues currently face.
Consultant gastroenterologist Peter Neville, who works under the Cwm Taf Morgannwg Health Board, wrote of a bleak picture of burnt out NHS staff.
In an article for the New Statesman, he said the continuous pressure healthcare workers like him have been under since the end of lockdown is "too much to take".
It is a situation that has even pushed him to take time-off work and consider if he should leave the profession.
In the article, Mr Neville recalled a typical shift and doing the rounds in the A&E department.
He said: "All of the rooms are full and all of the beds occupied – mostly by patients who were admitted the day before."
One of the people in the waiting room in need of care is an elderly woman who is slumped in her chair, confused, dehydrated and septic. She has been given antibiotics but Mr Neville wrote she is likely to be in that chair all night.
"The hospital is full," he said.
"It may take a few hours or several days to find a bed. It depends on who is going home (or dying). She is unlikely to get home within a month, although she will be recovered within a few days.
"There is nowhere to examine her with dignity. I can’t find a nurse to help me – they are too busy."
He added: "My practice is out of control. A mistake with vetting the letters could result in a patient with a cancer being missed. I lie awake at night worrying about this risk my patients are exposed to. If I get one case wrong somebody could die. It is a heavy burden."
What was supposed to be a "winter crisis" has turned into a year-long desperate situation, Mr Neville said. He warns that the lack of respite for staff "is too much to take".
In a previous thread on Twitter, the consultant explained why the pressure on the NHS is so prominent at the moment. He claims he has never seen the healthcare system in as bad a state as it is now.
He said over the last 15 years there has been "a relentless increase in demand" on hospitals and primary care. This has been largely due to an aging population, where elderly people who need more care are living longer.
He argued increases in NHS funding have been outpaced by the rise in demand on the service.
He also highlighted the issues facing social care. Many patients fit enough for discharge from hospital are left waiting because they do not have a care package available in the community to get them safely home and out of the hospital bed.
The Welsh Government recently advised health boards that they may need to consider sending some patients home without a care package in place because of the "unprecedented demand" facing the NHS.
In a letter, the Welsh Government said in order to preserve hospital capacity "for those at greatest risk" hospitals could put discharge arrangements in place that "may not be perfect".
Staff shortages are also greatly impacting NHS workers, Mr Neville wrote. This is caused by a range of things including sickness, staff leaving for more attractively paid agency healthcare roles and vacancies that cannot be filled.
He said: "Those of us left are working in jobs with constant colleague absences. So we must work harder, often covering extra shifts at short notice. Because we have to.
"There is moral pressure to cover on call gaps because the service cannot be allowed to collapse. We are all so tired."
Mr Neville said he has had to take time off work to recover from the mental exhaustion caused by work. He recalls feeling "withdrawn" and "tired all day".
Staff at health boards across the country are feeling the same pressures, with an A&E doctor in north Wales agreeing that the situation has "never been so bad".
Before the new year, Wales' Chief Medical Officer Frank Atherton said Wales' hospitals were under unprecedented pressure and people were being urged to avoid emergency departments unless they were experiencing life threatening illness.