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More hospitals declare critical incidents as demand surges More hospitals declare critical incidents as demand surges
(35 minutes later)
Four more hospitals have joined the list of those declaring major or significant incidents, amid mounting evidence that A&E departments are struggling to cope with unprecedented demand on their services.Four more hospitals have joined the list of those declaring major or significant incidents, amid mounting evidence that A&E departments are struggling to cope with unprecedented demand on their services.
Hospital A&E units recorded their worst ever performance in the week before Christmas as NHS emergency care services struggled to deal with an unprecedented number of patients, figures released on Tuesday show. The figures vary widely by hospital with some departments now teetering on the edge of crisis. Hospital A&E units recorded their worst ever performance in the week before Christmas as NHS emergency care services struggled to deal with an unprecedented number of patients, figures released on Tuesday showed. The figures vary widely between hospitals, with some now on the verge of a crisis.
The Guardian has established that there are four more hospitals declaring a major or significant incident, meaning they are struggling so much with demand that they are being forced to cancel planned operations or asking people to come to A&E only in an extreme emergency. They take the total number of hospitals that currently have the status to at least 11. The Guardian has established that there are four more hospitals declaring a major or significant incident, meaning they are struggling so much with demand that they are being forced to cancel planned operations or asking people to come to A&E only in an extreme emergency. They take the current number of hospitals with that status to at least 11.
Peterborough City hospital trust said it had cancelled eight operations on Tuesday, after cancelling nine on Monday, in order to prioritise emergency care. Brighton and Sussex University Hospitals trust, which termed its incident “significant”, said that the Princess Royal Brighton and the Royal Sussex had also cancelled some appointments, clinics and operations but did not provide further details. Norwich and Norfolk hospital revealed that it had reinstated an “internal major incident” and was discharging patients able to go home immediately to increase capacity to meet demand. Peterborough City Hospital Trust said it had cancelled eight operations on Tuesday, after cancelling nine on Monday, in order to prioritise emergency care. Brighton and Sussex University Hospitals Trust, which termed its incident “significant”, said the Princess Royal Brighton and the Royal Sussex had cancelled some appointments, clinics and operations but did not provide further details. Norwich and Norfolk hospital revealed it had reinstated an “internal major incident” and was discharging patients able to go home immediately to increase capacity to meet demand.
The others known to be affected are the Royal Stoke University Hospital, Stafford Hospital, Gloucestershire Royal Hospital, Cheltenham General Hospital, Scarborough Hospital, Ashford and St Peter’s hospitals. The others known to be affected are the Royal Stoke University hospital, Stafford hospital, Gloucestershire Royal hospital, Cheltenham General hospital, Scarborough hospital, Ashford and St Peter’s hospitals.
The Queen Elizabeth Hospital in King’s Lynn, has been on “black alert”, the step below a “major incident”, since the weekend. The Queen Elizabeth hospital in King’s Lynn has been on “black alert”, the step below a major incident, since the weekend.
A 12th hospital, Croydon University, briefly declared “an internal major incident” on Tuesday morning but downgraded it in the afternoon.A 12th hospital, Croydon University, briefly declared “an internal major incident” on Tuesday morning but downgraded it in the afternoon.
Other hospitals appeared to be taking similar action to those that had declared major incidents, while avoiding using the actual term.Other hospitals appeared to be taking similar action to those that had declared major incidents, while avoiding using the actual term.
Epsom and St Helier University Hospitals NHS Trust declared a “business continuity incident” on Monday and said consultants were asked to review patients to see if they could be discharged to free up beds. Epsom and St Helier University Hospitals NHS Trust declared a “business continuity incident” on Monday and said consultants were asked to review patients’ conditions to see if they could be discharged to free up beds.
The Isle of Wight NHS Trust cancelled some planned operations on Monday and said ambulances were queuing because of a lack of beds but did not formally declare a major incident. Hereford hospital said it has cancelled routine operations. Non-essential surgery has also been cancelled this week at the Great Western Hospitals NHS Foundation Trust, which has had two significant incidents since 1 December 2014. In Scotland NHS Grampian, which is responsible for five hospitals, said that it was postponing some elective services. The Isle of Wight NHS Trust cancelled some planned operations on Monday and said ambulances were queuing because of a lack of beds, but it did not formally declare a major incident. Hereford hospital said it has cancelled routine operations, while non-essential surgery had been cancelled this week at the Great Western Hospitals NHS Foundation Trust, which has had two significant incidents since 1 December 2014.
The A&E waiting times data triggered a furious political argument over the causes of the problems. “Type 1” A&Es, emergency departments based at hospitals in England, treated and either admitted or discharged just 83.1% of arrivals within the politically important four-hour target in the week ending Sunday, 21 December. In Scotland, NHS Grampian, which is responsible for five hospitals, said it was postponing some elective services.
The NHS also recorded its worst ever A&E performance using the preferred measure of NHS England and the Department of Health: this includes patients receiving urgent and emergency care in settings such as walk-in and urgent care centres, which are based at GP surgeries, on high streets or at some hospitals. The A&E waiting times data triggered a furious political argument over the causes of the problems. “Type 1” A&Es, emergency departments based at hospitals in England, treated and either admitted or discharged just 83.1% of arrivals within the politically important four-hour target in the week ending Sunday 21 December.
The NHS also recorded its worst A&E performance using the preferred measure of NHS England and the Department of Health, which includes patients receiving urgent and emergency care in settings such as walk-in and urgent care centres, which are based at GP surgeries, on high streets or at some hospitals.
In the week before Christmas, just 88.8% of those arriving at all those places were dealt with within four hours, though that rose to 90.5% the following week. The 88.8% performance is the worst yet against the four-hour target, and was a drop on the 89.6% seen a week before, which was itself a record low.In the week before Christmas, just 88.8% of those arriving at all those places were dealt with within four hours, though that rose to 90.5% the following week. The 88.8% performance is the worst yet against the four-hour target, and was a drop on the 89.6% seen a week before, which was itself a record low.
The British Medical Association (BMA), which represents doctors, said the NHS was “struggling to cope with the sheer number of patients coming through the door”.The British Medical Association (BMA), which represents doctors, said the NHS was “struggling to cope with the sheer number of patients coming through the door”.
The NHS constitution states that 95% of all A&E patients should be dealt with within four hours. David Cameron and other ministers have regularly pledged to meet that and other key NHS targets, but performances gradually worsened during 2014.The NHS constitution states that 95% of all A&E patients should be dealt with within four hours. David Cameron and other ministers have regularly pledged to meet that and other key NHS targets, but performances gradually worsened during 2014.
The 83.1% record is the lowest weekly performance against the target since A&E records began in 2004. It came in the week that a record number of people – 289,530 – attended A&E.The 83.1% record is the lowest weekly performance against the target since A&E records began in 2004. It came in the week that a record number of people – 289,530 – attended A&E.
Type 1 performance recovered slightly in the Christmas week, reaching 85.7% in the week to 28 December, partly because fewer patients attended – 262,879.Type 1 performance recovered slightly in the Christmas week, reaching 85.7% in the week to 28 December, partly because fewer patients attended – 262,879.
While 227,400 patients had to wait more than four hours in the last three months of 2013, many more did so in the final quarter of 2014 – 407,844.While 227,400 patients had to wait more than four hours in the last three months of 2013, many more did so in the final quarter of 2014 – 407,844.
Trolley waits rose across the most recent quarter, from 39,849 in October to 90,338 in December. This sharp rise prompted the NHS England medical director, Prof Bruce Keogh, to write to all hospitals before Christmas, urging them to improve their performance and warning of the risks to patients left waiting for too long on trolleys.Trolley waits rose across the most recent quarter, from 39,849 in October to 90,338 in December. This sharp rise prompted the NHS England medical director, Prof Bruce Keogh, to write to all hospitals before Christmas, urging them to improve their performance and warning of the risks to patients left waiting for too long on trolleys.
Across the three months from October to December 2014, 92.6% of all types of A&E patients were treated within four hours – the worst figure since the NHS began monitoring its performance against the standard.Across the three months from October to December 2014, 92.6% of all types of A&E patients were treated within four hours – the worst figure since the NHS began monitoring its performance against the standard.
Under the Labour government, 98% of all types of patients had to be treated within four hours, but the coalition relaxed that in 2010 to the current 95%.Under the Labour government, 98% of all types of patients had to be treated within four hours, but the coalition relaxed that in 2010 to the current 95%.
Speaking before the publication of the figures, the health secretary, Jeremy Hunt, acknowledged the NHS was under immense pressure, but insisted the four-hour target was being met in 90% of cases. The cautiously upbeat remarks by Hunt, who said that England had the best record for emergency treatment among countries which compile records, contrasted with those of his Liberal Democrat ministerial colleague Norman Lamb, who said the NHS was not meeting its targets. Speaking before the publication of the figures, the health secretary, Jeremy Hunt, acknowledged the NHS was under immense pressure, but insisted the four-hour target was being met in 90% of cases.
Andy Burnham, the shadow health secretary, said the government should take emergency steps to help the NHS cope. But Andy Burnham, the shadow health secretary, said the government should take emergency steps to help the NHS cope.
“These figures are extremely serious … and it shows that our National Health Service today is under extreme pressure all round the country,” he said. “The secretary of state hasn’t put plans in place to ensure the NHS can get safely through the winter. He must urgently do so.” “The secretary of state hasn’t put plans in place to ensure the NHS can get safely through the winter. He must urgently do so.”
The British Medical Association, which represents doctors, demanded urgent improvements to the overall system of NHS care to relieve the mounting pressure on hospitals, such as improving the NHS 111 telephone advice service and providing better social care services to help vulnerable patients stay well at home.
“Staff are working flat out but the system is struggling to cope with the sheer number of patients coming through the door,” said Dr Mark Porter, the BMA’s leader.
“Doctors must be able to treat the patient who’s in front of them based on their individual needs, which is why doctors don’t agree with targets for targets’ sake. Moving away from a system which prioritises targets above all else can help to improve the quality of care doctors are able to give patients by preventing rushed admissions or leaving those most in need waiting longer for treatment. But this will only work in the best interests of patients, if the NHS has the staff and resources it needs to meet rising patient demand,” he said.
The Royal College of Nursing said the A&E figures were evidence that the overall health and social care system was in crisis and demanded proper funding to fix the growing problems.
“Hospital trusts trying to recruit more staff have been hamstrung by the short-sighted cuts to nurse training places, which means there simply aren’t enough nurses in the system,” said Dr Peter Carter, the union’s chief executive and general secretary. “This is made worse by chronic under-resourcing of community services and social care, which means more people end up in A&E who could be better treated elsewhere …
“Nothing short of a long-term strategy and a significant long-term investment in our health service will put an end to this crisis.”