By Emily Craig Deputy Health Editor For Mailonline
17:35 13 Dec 2023, updated 18:16 13 Dec 2023
- Seasonal pressures are already overwhelming wards, A&E and ambulances
- MailOnline can reveal a dozen hospital trusts have declared critical incidents
NHS hospitals are braced for what could be their worst winter in history amid the looming threats of flu, Covid and strikes.
Seasonal bugs like norovirus are already piling pressure on stretched wards, A&E units and ambulance crews, weeks before demand typically peaks.
MailOnline can today also reveal that a dozen hospital trusts have declared critical incidents over the past two months, in a clear sign of escalating tension within the beleaguered service.
Health leaders fear that junior doctor strikes over Christmas and the New Year will only exacerbate the crisis.
Experts also predict cases of flu will soar in the coming weeks, and have speculated that Covid cases could explode with the emergence of a troubling new variant.
Miriam Deakin, director of policy and strategy at NHS Providers, which represents acute, ambulance and community services, told MailOnline: ‘Winter is always difficult for the NHS and this year will be no different.
‘Our recent survey of leaders across the NHS showed that 80 per cent are expecting this winter to be tougher than last year.
‘Nasty bugs including norovirus, flu, Covid and RSV are already ramping up the pressure on stretched services and NHS staff.
‘Hospitals, mental health, community and ambulance services are doing everything they can to treat patients as quickly and as safely as possible as we head into winter.
‘But faced with staff sickness, winter bugs and handover delays and now more industrial action by junior doctors in the coming weeks, this is looking increasingly difficult. It’s vital the government and unions get back around the table and do everything they can to resolve these strikes.’
Last year’s winter NHS crisis was considered the worst in a generation.
Terrifying scenes saw military personnel drafted in to drive ambulances during strikes and waits of up to 30 hours in A&E, with patients treated in corridors and sleeping on the floor due to Dickensian overcrowding.
MailOnline’s audit found 12 NHS trusts have, since mid-October, publicly declared critical incidents — formally signalling that patient care may be under threat.
These include the Isle of Wight NHS Trust, which yesterday warned that demand for emergency care is ‘far outstripping the capacity the hospital has’.
As a result, patients are waiting a ‘long time’ for a bed in the emergency department.
Trust chiefs pleaded with the local community to take their relatives or friends home from hospital ‘as soon as they are declared ready to’.
Bed blocking — when a patient medically fit to be discharged remains in hospital — is a major problem across the health service.
Around 12,000 hospital beds across the country — one in seven — are occupied by patients declared well enough to go home.
Patients should be moved to a care home or offered home support. However, social care staff shortages mean many are left to languish on wards for weeks. Some have spent up to nine months in hospital.
It has a knock-on effect on A&E wards and ambulance response times, as 999 crews are stuck in queues waiting to hand over patients instead of being ready to respond to incoming calls.
At the same time, hospitals have fewer beds than a decade ago, giving them less space for patients during periods of high demand. It means medics are forced to ‘warehouse’ patients in emergency departments, where there can be the equivalent of a full ward of patients in need of care.
Portsmouth Hospitals University NHS Trust also declared a critical incident yesterday, warning that its emergency department and hospital were ‘full’.
Both ambulance patients and A&E attendees have been left waiting ‘much longer’ than expected, which the trust admitted was ‘not acceptable’.
Other trusts that have raised the alarm in recent weeks include Hampshire Hospitals NHS Foundation Trust, where a crash in its carpark interrupted power supply to the hospital, and West Hertfordshire Teaching Hospitals NHS Trust, where a burst water pipe led to a flood in its emergency department.
However, the number of critical incidents publicly announced by NHS trusts is a huge underestimate of the true figure and may be three-times higher than disclosed, hospital bosses have warned.
Some trusts choose not to declare one, as it often does lead to any support with delivering care and triggers paperwork and inspections, according to insiders.
Latest NHS data for A&E performance shows that 44,655 people, or more than 1,400 a day, were forced to wait at least 12 hours in A&E in October before being admitted, transferred or discharged.
Just seven in 10 were seen within four hours — the health service’s target.
But these figures, published monthly, only look at trolley waits — the time between doctors deciding a patient needs to be admitted and them getting a bed.
Figures capturing exact arrival times at A&E paint a much bleaker picture, with up to one in 10 forced to wait at least 12 hours.
One of the country’s top doctors labelled the situation ‘chaotic’ and ‘dangerous’. He warned the NHS is in a ‘spiral of decline’ which will see patients treated in corridors, endure long waits and suffer ‘inevitable harm’ over the winter.
Separate data on ambulance performance revealed response times have slowed.
Heart attack and stroke patients in England, known as category two callers, had to wait an average of 41 minutes and 40 seconds for paramedics to arrive on the scene in October
This is more than twice as long as the 18 minute target.
The average category one response time — calls from people with life-threatening illnesses or injuries, such as cardiac arrests — was 8 minutes and 40 seconds. The target time is seven minutes.
Although nowhere near the terrifying delays seen last December, the responses are slowing ahead of the peak of winter pressures.
Separately, around a third of ambulances were forced to wait more than half an hour before handing patients over to hospitals in the week to December 3. NHS rules set out that the process should be completed within 15 minutes and that none should last more than one hour.
Recent victims of NHS waits include Pauline Dee, who sat in A&E for 15 hours.
She went to the emergency unit at the Royal Shrewsbury Hospital on November 21, as she was suffering from chest pain.
The former Shropshire councillor arrived at 1pm but was not offered a trolley-bed until 5am the next morning. After seeing a consultant, she was then forced to wait in the hospital until nearly 3pm that afternoon to collect her medication.
Another is Samantha Deakin, a mother-of-one who died last month after waiting more than two hours for an ambulance.
Her partner John Leyland, a former first aider, called 999 on November 26 after the 50-year-old began suffering from pain and severe bloating, which he was worried was an internal bleed.
Mr Leyland called twice more at 20-minute intervals after Ms Deakin became pale and was struggling to breathe.
Paramedics finally arrived more than two hours after his first call, despite her case being classed as a category two emergency, which should see an ambulance show up within 18 minutes.
Mr Leyland told his partner that he would see her at the hospital. But she vomited blood and suffered a cardiac arrest on her way to the Royal Stoke University Hospital. Ms Deakin was resuscitated but died at the hospital after a second cardiac arrest.
He is now considering legal action over ‘all the negligence on that day’.
NHS bosses have warned that a surge in seasonal viruses are, in part, to blame for rising pressures on hospitals.
With the exception of last year, flu admissions are at their highest level since 2015.
Data shows that an average of 234 flu patients were in hospital per day in the week to December 3, up by 53 per cent in just one week.
Meanwhile, cases of the winter vomiting bug norovirus are also on the rise, with 386 adults in wards per day, up 19 per cent in a week.
On top of this, norovirus cases led to 92 beds being closed each day, on average, in a bid to stop the highly contagious bug, which causes vomiting and diarrhoea, from spreading to other patients.
Cases of respiratory syncytial virus (RSV) are also up 11 per cent in a week among children, with 146 in hospital per day.
Covid, however, is having less impact than ever on the health service for this time of year.
Just 2.9 Covid admissions per 100,000 people in England were logged in the week to December 3. For comparison, during the same period last year, the figure stood at 5.5. It was even higher in 2021 (6.6) and 2020 (13.5).
However, health chiefs have been spooked by a new strain sweeping Britain, which they fear could trigger a fresh wave of infection at a time when the NHS is already bursting at the seams.
JN.1, which has mutations that help it dodge immunity people have built up from vaccinations and previous infections, has been spotted hundreds of times in the UK.
Health chiefs are now actively monitoring the strain.
As well as taking up space in hospitals, Covid spikes can reduce staffing levels if medics are sickened with the virus. The NHS is already logging around 47,000 staff absences per day due to poor health.
On top of that, the health service is already short of more than 120,000 members of staff.
Any additional pressure would be on top of the health service’s work to bring down the record 7.7million waiting list for routine hospital care.
The figure has spiralled from 4.2million at the start of the pandemic, which caused delays to snowball.
Rishi Sunak made cutting waiting lists one of his 2023 priorities, pledging in January that ‘lists will fall and people will get the care they need more quickly’.
However, the Prime Minister has claimed that strikes across the health service have made the task ‘more challenging’. The NHS has blamed industrial action for piling pressure on the health service, reducing hospital capacity and services.
While consultants are now considering the Government’s pay rise offer of up to £20,000 for this financial year, junior doctors, who earn up to £60,000, have rejected the Government’s latest offer and are set to stage nine days of walk-outs over Christmas and the New Year.
Thousands of junior doctors will abandon posts for three days before Xmas, starting at 7am on December 20.
Another six days of action — the longest in the health service’s 75-year history — are pencilled in from 7am on January 2.
Junior doctors were offered a three per cent rise on top of the average 8.8 per cent increase they already pocketed in the summer.
But the British Medical Association (BMA), which is coordinating the action, said the cash was ‘completely insufficient’, would have been split unevenly across different medical grades and would ‘still amount to pay cuts for many doctors’.
This is despite nurses, physios and paramedics having called off strikes after their unions accepted pay deals. However, some are upset by the offer to consultants, who already earn six-figure salaries, on average, raising the prospect of more walk-outs in the coming months.
NHS leaders have said they will prioritise urgent and emergency care to ‘protect patient safety’ during the walkouts.
More than 1million appointments and operations have already been cancelled because of the action, which began last winter. However, health chiefs say the figure is even higher because hospitals often stop scheduling procedures on strike days, after they are announced.
However, Sir Stephen Powis, national medical director for the NHS in England, warned that the service will likely face ‘another very challenging winter’.
Rory Deighton, director of the NHS Confederation’s Acute Network, told MailOnline: ‘The continued rise in winter viruses and staff sickness suggests that the pressure on health services is only going to continue to mount as we get deeper into winter.
‘While it is welcome that flu levels are still lower than last year, there is always the risk that there could be a spike in cases or staff absences as we get deeper into winter.’
He said the NHS has an additional 1,400 beds this winter compared to last year but bed blocking ‘remains a major challenge’.
Mr Deighton added: ‘All these pressures can only be exacerbated by the upcoming junior doctors strikes which are scheduled for some of the most difficult weeks of the year for NHS services.
‘It is not too late for the BMA to change its mind and for the government to commence fresh talks in the interest of patients this winter.’
Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: ‘We are already seeing a repeat of the heart-breaking scenes we saw last year, ambulances queueing outside overcrowded A&Es, patients facing dangerously long waits on trolleys in corridors, and hospitals full of patients.
‘We are extremely concerned about the coming weeks – in October one in nine patients faced a 12-hour wait in A&Es, now in December this number will likely be worse.
‘It is extremely challenging for staff, who are delivering care to the best of their ability in an under-resourced, under-bedded system, mitigating the risks for their patients. And it is distressing for patients and their families, who suffer these undignified and uncomfortable waits.
‘Each year, winter brings predictable pressures, yet the system and staff are not provided with the beds and resources they need to cope. Inadequate funding and poorly evaluated planning mean that we never break this cycle.
‘Staff are tired of it and tired of burning themselves out because the system doesn’t have the beds, staff, resources and social care in place to protect patients during winter.’
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
