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| Hospitals cancelling urgent surgery despite NHS bosses' orders | Hospitals cancelling urgent surgery despite NHS bosses' orders |
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| Exclusive: shortage of intensive care beds in England leading to operations being postponed | Exclusive: shortage of intensive care beds in England leading to operations being postponed |
| Denis Campbell Health policy editor | Denis Campbell Health policy editor |
| Sun 4 Feb 2018 19.00 GMT | Sun 4 Feb 2018 19.00 GMT |
| Last modified on Sun 4 Feb 2018 22.01 GMT | |
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| Hospitals have been cancelling urgent surgery for patients with cancer, heart disease and other life-threatening illnesses, despite NHS bosses’ orders not to delay such operations. | Hospitals have been cancelling urgent surgery for patients with cancer, heart disease and other life-threatening illnesses, despite NHS bosses’ orders not to delay such operations. |
| Some patients have had their procedure cancelled several times, even though their poor health means the surgery is urgent. Others have had operations cancelled on the day they were scheduled to take place. | Some patients have had their procedure cancelled several times, even though their poor health means the surgery is urgent. Others have had operations cancelled on the day they were scheduled to take place. |
| Doctors’ leaders and the Patients Association have expressed alarm at the cancellations. They warned that very ill patients could die as a result and questioned whether the NHS can still offer timely acute care all year round. | Doctors’ leaders and the Patients Association have expressed alarm at the cancellations. They warned that very ill patients could die as a result and questioned whether the NHS can still offer timely acute care all year round. |
| Hospitals say that the NHS’s limited supply of intensive care beds has forced them to prioritise flu patients at risk of dying before surgery over other very sick people, including those with cancer and heart problems. | Hospitals say that the NHS’s limited supply of intensive care beds has forced them to prioritise flu patients at risk of dying before surgery over other very sick people, including those with cancer and heart problems. |
| More than 190 people in the UK have died so far in this year’s flu outbreak, the worst since 2009-10, with thousands of others being admitted to hospital, often to an intensive care or high dependency unit. | More than 190 people in the UK have died so far in this year’s flu outbreak, the worst since 2009-10, with thousands of others being admitted to hospital, often to an intensive care or high dependency unit. |
| NHS England took the unprecedented step of allowing hospitals to cancel tens of thousands of planned operations this winter in order to free up beds, given the extra demand for treatment. It was made clear to them on both 21 December and 2 January that “cancer operations and time-critical procedures should go ahead as planned”. | NHS England took the unprecedented step of allowing hospitals to cancel tens of thousands of planned operations this winter in order to free up beds, given the extra demand for treatment. It was made clear to them on both 21 December and 2 January that “cancer operations and time-critical procedures should go ahead as planned”. |
| However, since the start of December, acute trusts in England have cancelled up to 91 operations each for patients with cancer, heart problems or an aortic aneurysm – a bulge in one of the body’s major vessels that, unless repaired quickly, can burst and kill. | However, since the start of December, acute trusts in England have cancelled up to 91 operations each for patients with cancer, heart problems or an aortic aneurysm – a bulge in one of the body’s major vessels that, unless repaired quickly, can burst and kill. |
| 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. | 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”. | 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. | 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. | 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 | Read a full Q&A on the NHS winter crisis |
| Rachel Power, chief executive of the Patients Association, said: “This apparent spread of cancellations from elective surgery to surgery for life-threatening conditions suggests the NHS may be in worse trouble than we’d thought. | Rachel Power, chief executive of the Patients Association, said: “This apparent spread of cancellations from elective surgery to surgery for life-threatening conditions suggests the NHS may be in worse trouble than we’d thought. |
| “If the winter pressures are putting such enormous pressure on intensive care beds that seriously ill patients are facing delays to their treatment that could result in wholly preventable deaths, one has to question whether we have an NHS that is capable of functioning all year round in any meaningful sense.” | “If the winter pressures are putting such enormous pressure on intensive care beds that seriously ill patients are facing delays to their treatment that could result in wholly preventable deaths, one has to question whether we have an NHS that is capable of functioning all year round in any meaningful sense.” |
| A spokesperson for NHS England said: “The national emergency pressures panel asked hospitals to defer non-urgent operations to free up capacity to deal with winter pressures. However, decisions on whether or not to go ahead with a procedure are rightly always made locally by clinicians with the best interests of the patient in mind.” | A spokesperson for NHS England said: “The national emergency pressures panel asked hospitals to defer non-urgent operations to free up capacity to deal with winter pressures. However, decisions on whether or not to go ahead with a procedure are rightly always made locally by clinicians with the best interests of the patient in mind.” |
| Rev William Morrey, a retired vicar in Nantwich in Cheshire, has had his heart surgery cancelled three times by the Royal Stoke hospital: on 12 December and on 18 and 26 January. The 64-year-old needs to have his aortic aneurysm repaired and a new aortic valve fitted. | Rev William Morrey, a retired vicar in Nantwich in Cheshire, has had his heart surgery cancelled three times by the Royal Stoke hospital: on 12 December and on 18 and 26 January. The 64-year-old needs to have his aortic aneurysm repaired and a new aortic valve fitted. |
| In a letter to the hospital’s chief executive, Paula Clark, Morrey wrote that its cardiothoracic surgeon who was to perform the surgery had categorised it as urgent, given the risk to his life. “This surgery is considered urgent, as the size of the aneurysm is beyond the threshold where surgery becomes essential and the consequences of a ruptured aortic aneurysm are catastrophic and usually fatal.” | In a letter to the hospital’s chief executive, Paula Clark, Morrey wrote that its cardiothoracic surgeon who was to perform the surgery had categorised it as urgent, given the risk to his life. “This surgery is considered urgent, as the size of the aneurysm is beyond the threshold where surgery becomes essential and the consequences of a ruptured aortic aneurysm are catastrophic and usually fatal.” |
| Morrey will need to recover in an intensive care bed for two or three days after his four-hour operation, which is now scheduled to take place on 14 February. | Morrey will need to recover in an intensive care bed for two or three days after his four-hour operation, which is now scheduled to take place on 14 February. |
| University Hospitals of the North Midlands, the NHS trust which runs the hospital in Stoke, has had to cancel about 50 heart operations and between 20-25 procedures for cancer since December. | University Hospitals of the North Midlands, the NHS trust which runs the hospital in Stoke, has had to cancel about 50 heart operations and between 20-25 procedures for cancer since December. |
| Dr John Oxtoby, its medical director, said: “Due to severe and sustained pressure on our services in the north Midlands this winter we had to prioritise some urgent surgery. There has been a substantial increase in the number of admissions into our intensive care unit and we cannot perform major surgery without a critical care bed being available post-surgery.” The hospital has treated 95 flu victims in its ICU since November. | Dr John Oxtoby, its medical director, said: “Due to severe and sustained pressure on our services in the north Midlands this winter we had to prioritise some urgent surgery. There has been a substantial increase in the number of admissions into our intensive care unit and we cannot perform major surgery without a critical care bed being available post-surgery.” The hospital has treated 95 flu victims in its ICU since November. |
| Small numbers of urgent operations are cancelled every month in hospitals, usually either because the patient is too unwell to undergo surgery or because the hospital is short of beds or staff shortages mean the procedure cannot go ahead. Hospitals which have cancelled unusually high numbers of such cases recently all cited lack of intensive care beds as the key reason. An estimated 55,000 non-urgent operations, such as cataract removals and hernia repairs, were cancelled in December and January as a result of NHS England’s edicts to hospitals. | Small numbers of urgent operations are cancelled every month in hospitals, usually either because the patient is too unwell to undergo surgery or because the hospital is short of beds or staff shortages mean the procedure cannot go ahead. Hospitals which have cancelled unusually high numbers of such cases recently all cited lack of intensive care beds as the key reason. An estimated 55,000 non-urgent operations, such as cataract removals and hernia repairs, were cancelled in December and January as a result of NHS England’s edicts to hospitals. |
| Dr Nick Scriven, president of the Society for Acute Medicine, which represents acute medical specialists in hospitals, said: “The cancellation of life-saving or life-prolonging operations is an extremely serious event that was not sanctioned in advice from NHS England’s national emergency pressures panel regarding winter pressures. This will have major impacts on patients and could be a risk to their lives. | Dr Nick Scriven, president of the Society for Acute Medicine, which represents acute medical specialists in hospitals, said: “The cancellation of life-saving or life-prolonging operations is an extremely serious event that was not sanctioned in advice from NHS England’s national emergency pressures panel regarding winter pressures. This will have major impacts on patients and could be a risk to their lives. |
| “The stress for these patients must be unimaginable. To be told you need major potentially lifesaving operations and then have them cancelled, against what is in national guidance, must be horrendous.” | “The stress for these patients must be unimaginable. To be told you need major potentially lifesaving operations and then have them cancelled, against what is in national guidance, must be horrendous.” |
| Lisa Betteridge, from Oxford, has used her Twitter feed in recent weeks to highlight the impact on her family of surgery of the four cancellations of her brain tumour surgery since 22 December. She has now been given a fifth date for the procedure. | Lisa Betteridge, from Oxford, has used her Twitter feed in recent weeks to highlight the impact on her family of surgery of the four cancellations of her brain tumour surgery since 22 December. She has now been given a fifth date for the procedure. |
| 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 they have relative to their populations. Greece, Austria and Norway have the most; the three countries with proportionately the fewest medics 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. | 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 they have relative to their populations. Greece, Austria and Norway have the most; the three countries with proportionately the fewest medics 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 that 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. | 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 that 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 | Read a full Q&A on the NHS winter crisis |
| Oxford University Hospitals NHS Trust, where Betteridge is to have her surgery, said it had cancelled eight cancer and 16 heart operations before the day of surgery since December because of a shortage of ICU beds. It also postponed 10 more heart operations in January “to ensure our staff could prioritise those patients requiring emergency treatment and care”, in line with NHS England advice. | Oxford University Hospitals NHS Trust, where Betteridge is to have her surgery, said it had cancelled eight cancer and 16 heart operations before the day of surgery since December because of a shortage of ICU beds. It also postponed 10 more heart operations in January “to ensure our staff could prioritise those patients requiring emergency treatment and care”, in line with NHS England advice. |
| University Hospitals Birmingham, one of the NHS’s biggest trusts, has cancelled 34 cancer operations, 53 cardiac procedures and four aortic aneurysm repairs so far this winter. | University Hospitals Birmingham, one of the NHS’s biggest trusts, has cancelled 34 cancer operations, 53 cardiac procedures and four aortic aneurysm repairs so far this winter. |
| Dr Dave Rosser, its medical director, said that when the trust faced any increase in the number of emergency medical patients who needed intensive care, including those with flu, it had to make patients with other serious conditions, including liver cancer, wait for their surgery. | Dr Dave Rosser, its medical director, said that when the trust faced any increase in the number of emergency medical patients who needed intensive care, including those with flu, it had to make patients with other serious conditions, including liver cancer, wait for their surgery. |
| “Unfortunately this too often leads to the patients requiring these complex operations being cancelled due to a lack of intensive care beds,” he said. | “Unfortunately this too often leads to the patients requiring these complex operations being cancelled due to a lack of intensive care beds,” he said. |
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