Christmas in Hospital: What the Elderly Teach Us About Time

While the world celebrates beginnings, the ward teaches us about endings

Christmas is a peculiar season on the wards. Outside the hospital, it promises warmth, celebration, and togetherness, but inside, the Christmas lights often carry a quieter weight. This is felt most acutely by those who work with the elderly (which, given our ageing population, will be most doctors). It is easy to forget the accumulated years held within each patient, lives that have been shaped by wars, joys and losses, and countless ordinary days that, together, have made a life.

For younger patients, medicine is oriented towards possibility. It is about recovery, improvement, and optimisation of each possible metric. With older patients, the focus subtly but profoundly shifts. Care moves away from what can be restored and towards what can be sustained. Dignity, comfort, and meaning often take precedence over cure.

What Christmas Brings

Christmas intensifies this tension. It draws attention to absence: spouses who have died or families who are distant. For some elderly patients, Christmas is less a celebration than a reminder that the world increasingly belongs to others.

Perhaps the most unsettling realisation for doctors who pause long enough to reflect is that elderly patients do not only confront us with their mortality, but with our own too. In them, we do not see an anomaly, but a future, one that awaits us all, and one that gradually narrows independence and resists the power of medicine.

Christmas, with its rituals of memory and reflection, makes this recognition harder to avoid. The philosopher Martin Heidegger insisted that an authentic life arises when we confront ourselves as beings-towards-death. In this sense, our elderly patients make this realisation harder to ignore.

And yet, despite the discomfort of these truths, there is something profoundly meaningful in these encounters. To sit with someone at this stage of life is to witness what truly endures when much else has fallen away. Every culture claims to value a long and happy life. Christmas on the wards, however, suggests a more profound truth: that a good society is measured not only by how it celebrates beginnings, but how well it accompanies endings.

The Eternal Outpatient Wait - Which Speciality Brings The Longest Wait?

The eternal wait for an elective appointment has become something many patients are familiar with. In the NHS constitution, emphasis is placed on patients having their treatment initiated within 18 weeks of referral. But which speciality has the worst elective waiting lists?

Trauma and Orthopaedics has the largest waiting list as per The King’s Fund, with almost 860,000 people waiting for treatment in October 2025. Next to Oral surgery, which has the highest proportion of waits longer than 18 weeks, with nearly half of all its patients (49%) having to wait more than 18 weeks for treatment.

For those not too familiar with the dental world, the General Dental Council officially recognises 13 dental specialities from orthodontics, peridontology, restorative dentistry, oral surgery and many others. Of these specialities, oral surgery has the highest number of annual hospital appointments, with 956,286 appointments.

Oral surgery is unique in that, unlike other specialities, it sits at the junction between the largely private dentistry sector and the public capacity-limited hospitals. It has become a pressure valve for the collapse of NHS primary dental care.

UK Maternity Failings: Systemic Chaos Is Endangering Families

UK maternity care is facing serious questions…

Maternity failings in the NHS continue with a reported £27bn in medical negligence claims and liabilities since 2019, according to the Guardian. This record number of legal claims comes from hundreds of babies and women dying or suffering life-altering conditions. And what’s the total maternity budget today? £18bn.

Last year, 1,286 families in England took legal action against the NHS for obstetric errors, a number that has now doubled since 2007. Birth data shows us that we can’t put this down to growing birth trends either. Anyone following the issue knows we are facing a birth rate crisis. The 591,072 live births in 2023 in England represent the lowest total in decades and are well below 2007 levels.

So how else to explain the numbers? Well, either we are seeing an increase in actual errors or adverse outcomes, or there is a greater awareness of legal options and a culture that encourages one to litigate severe outcomes.

Importantly, not all of the 1,286 claims will result in compensation payouts, meaning actual cash payments are lower than the headline figure. Compensation itself also accounts for only part of the £27bn. Over the past six years, the NHS has spent £24.6m on legal fees for maternity claims that did not result in damages. We also know that nearly two-thirds of the NHS’s total clinical negligence bill relates to maternity care. If there’s a negligence claim in the NHS, chances are it’s in maternity care.

The Turning of The Clock

In the history of medicine, maternity care has been one of our greatest success stories. Only a century ago, in the course of 100,000 births, some 4000 babies and 430 women died. Today, that number is 300 and 8. Yet recent scandals and unsatisfactory care cast a shadow over this success and threaten to turn back the clock.

Baroness Amos will publish her full report investigating national maternity and neonatal services in the spring, but she has recently published some initial reflections, having visited seven trusts over the past three months. Let’s just say the reflections don’t make for comfortable reading. In her words: “Nothing prepared me for the scale of unacceptable care that women and families have received, and continue to receive, the tragic consequences for their babies, and the impact on their mental, physical and emotional wellbeing.”

To put it candidly, we know that giving birth will be one of the most dangerous things that the great majority of women will ever do, and although even the most advanced healthcare services cannot remove risk entirely, the deterioration in outcomes points to far too many errors and missed opportunities to fix them.

What Makes Maternity Stand-Out?

Many departments in healthcare experience staff shortages and a growing workload (Emergency medicine jumps to mind as an example), but we need to single out maternity care for a moment. Labour and birth are inherently unpredictable. A ‘normal’ pregnancy can become an emergency in the blink of an eye, which contrasts with many specialities with elective procedures.

The outcomes also affect two lives (mother and baby), making the margin for error much smaller, and when things do go wrong, things escalate rapidly, requiring immediate, complex interventions.

Because of this, even small delays or staffing gaps can lead to catastrophic outcomes, more so than in other specialities. The data cannot be explained by suggesting that maternity clinicians are “worse” than their peers elsewhere in medicine. Rather, it is the system they work within that is stretched, fragmented, and under-resourced, which places them under greater strain than almost any other part of healthcare.

“Welcome to the time of year where we see the med reg breaking bad news in an elf costume.”

“Few in our profession believe that the restoration of our pay has to be immediate. This is unreasonable given the economic climate, but I want to know what the BMA and resident doctors were doing between 2010 and 2023 as they watched significant real-terms pay erosion to their salaries.”

“Compared to the worst pain he’s ever experienced, Keir Starmer ranked his pain of resident doctors striking as 10/10.”

“This new employment rights bill is going to make strike action much easier for all unions - online voting, longer 12-month mandates for strike action and a reduction in the strike notice period to 10 days.”

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Some things to review when you’re off the ward…

The fight to cut waiting times goes on, with many chasing an improvement in the numbers. There is no straightforward solution to address the pressures faced by the government and the NHS, but speculation continues to simmer regarding the cancellation of long-awaited operations (with some cancelled with less than 24 hours’ notice). Here is a statement by the British Orthopaedic Association on the matter.

The new Employment Rights Bill that has passed through parliament will bring some interesting changes, such as online ballots for strike mandates and longer strike mandate periods. All will serve to make strike mandates much easier to acquire.

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The Student Loan Hamster Wheel For UK Doctors

Many of our resident doctors will be familiar with this feeling… seeing significant chunks of their monthly salary taken away to pay off their student loan, whilst their overall student loan balance rises. This is largely driven by the high interest rates applied to Plan 2 student loans, which are linked to inflation using the Retail Price Index (RPI), with an additional charge of up to three percentage points depending on income. This means that for most graduates, what you are paying off is not the actual loan itself, but the interest that accumulates on it (RPI + 3%).

Thanks to some number crunching from the Institute of Fiscal Studies, we now know that the magic number is £66,000. Graduates need to earn around £66,000 a year before their repayments clear more than the interest they accrue on the loan.

A Graduate earning £66,000 will be roughly sitting within the top 10% of earners in the UK and will pay £3,295 when paying 9% of their earnings above the threshold. But after considering the accrued interest of £3,286, they are clearing a whopping £9 off their student loan balance.

The new Plan 5 system for students beginning undergraduate courses after 2023/24 still applies interest to student loans throughout their lifetime, continuing to rely on the controversial Retail Price Index (RPI) measure of inflation. While it removes the additional three percentage points charged under Plan 2, it extends the repayment period to 40 years.