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NHS patients dying in hospital corridors, A&E doctors tell Theresa May NHS patients dying in hospital corridors, A&E doctors tell Theresa May
(about 9 hours later)
Patients are dying in hospital corridors this winter because the NHS is so “chronically underfunded” and dangerously short-staffed, doctors who run 68 A&E units have told Theresa May. Patients are dying in hospital corridors during the ongoing winter crisis because the NHS is so underfunded and short-staffed that it cannot cope, senior doctors have warned Theresa May.
In their unprecedented warning the doctors told the prime minister that more than 120 patients a day were being managed in corridors in some hospitals, with “some dying prematurely” because staff were so busy due to the sheer number of people needing care. A&E units are under such intense strain that patients are at “intolerable” risk of being harmed by receiving poor care, specialists in emergency medicine from 68 hospitals have told the prime minister in a letter of unprecedented alarm.
In the letter, sent on Tuesday and obtained by the Health Service Journal, they also warn her that the routine overcrowding of hospitals, and the fact that as few as 45% of A&E arrivals are being seen within four hours at some hospitals, are putting patients’ safety at risk. In recent weeks some hospitals have become so overloaded that they have been looking after as many as 120 patients a day in corridors, with “some dying prematurely” as a result, the letter says.
The doctors, who work at hospitals in England and Wales, draw on their own experiences this winter to paint a stark picture of how hospitals are struggling amid extra demand that is at odds with May’s repeated assurances that the NHS is better prepared than ever for winter. The doctors, consultants who work in or run A&E units in England and Wales, have written to May to highlight “the very serious concerns we have for the safety of our patients. This current level of safety compromise is at times intolerable, despite the best efforts of staff.”
“Some of our own personal experiences range from over 120 patients a day managed in corridors, some dying prematurely,” say the doctors, who have all written in a personal capacity as NHS frontline health professionals, and not on behalf of the NHS bodies that employ them. Conditions in many A&E units are so appalling that they could kill patients, claim the signatories, who work at both major teaching hospitals and smaller district general hospitals. They include Frimley health trust in Surrey, which May visited last week in an attempt to reassure the public that the NHS was coping well this winter.
The signatories are from hospitals including major London teaching hospitals such as the Royal Free, King’s College and Guy’s and St Thomas’s, as well as regional trauma centres such as the University Hospitals of North Midlands NHS trust, which runs the Royal Stoke hospital, as well as several of the seven health boards in Wales. “As you will know a number of scientific publications have shown that crowded emergency departments are dangerous for patients. The longer that the patients stay in [the] emergency department after their treatment has been completed, the greater is their morbidity and associated morbidity,” they write.
They explicitly reject May’s attempts to portray the NHS as coping generally well with the expected spike in demand for care caused by the recent cold, people suffering serious breathing problems and rising incidence of flu. Their intervention came as new NHS figures showed that the percentage of patients being treated within four hours at hospital-based A&E units in England fell last month to its lowest-ever level – 77.3%. The performance of all types of settings offering A&E-type care taken together, including walk-in centres and urgent care centres, was better but still the joint worst ever at 85.1% – far below the politically important target of 95%.
“It has been stated that the NHS was better prepared for this winter than ever before. Only three of the NHS’s 137 acute trusts hit the 95% target, while 32 were at or below 70%. Blackpool teaching hospitals trust had by far the lowest performance, at 40.1%. The figures reinforced the warning to ministers on Thursday from NHS Providers that it would be impossible to deliver on their pledge that all hospitals would be achieving 95% by March.
“There is no question that a huge amount of effort and energy has been spent both locally and nationally on drawing up plans for coping with NHS winter pressures. Our experience at the front line is that these plans have failed to deliver anywhere near what was needed,” they write. “Our emergency departments are not just under pressure, but in a state of emergency,” said Dr Taj Hassan, the president of the Royal College of Emergency Medicine, which represents A&E doctors.
In their view, that is because “the NHS is severely and chronically underfunded. We have insufficient hospital and community beds and staff of all disciplines, especially at the front door, to cope with our ageing population’s health needs.” The NHS undertook unprecedented planning to help services cope with the annual spike in demand in December and January. Despite that, hospitals had a record number of emergency admissions last month – 520,163, a 4.5% rise on the numbers admitted in December 2016.
Answering questions at an event to launch the government’s green strategy, May said an increase in flu cases was partly to blame for long waits at hospitals. The prime minister added: “We have put more funding into the NHS for these winter pressures. We’re putting more funding into the NHS overall.” A drive to free up 2,000-3,000 beds by 1 September, to avoid hospitals becoming dangerously full, appears to have failed. Separate NHS figures for last week show that 19 trusts were on 99% or 100% bed occupancy between 1 and 7 January. Three were completely full.
Average bed occupancy shot up last week to 95%, far higher than the 85% that experts say, and the NHS accepts, hospitals need to maintain in order to stop patients getting hospital-acquired infections such as MRSA or Clostridium difficile, or experiencing poor care.
Bed occupancy as high as 95% is “a danger to patient safety, with around 7,000 fewer beds open than in the same period last year”, said Hassan.
Drawing on their own experiences in recent weeks ,the doctors who signed the letter painted a stark picture of conditions inside A&E units. Common situations include “over 50 patients at a time waiting beds in the emergency department [and] patients sleeping in clinics as makeshift wards”.
A Department of Health and Social Care spokeswoman said in response to the letter: “There has been a 68.7% increase in the number of A&E consultants since 2010, and the NHS was given top priority in the recent budget with an extra £2.8bn allocated over the next two years.A Department of Health and Social Care spokeswoman said in response to the letter: “There has been a 68.7% increase in the number of A&E consultants since 2010, and the NHS was given top priority in the recent budget with an extra £2.8bn allocated over the next two years.
“But we know there is a great deal of pressure in A&E departments, and we are grateful to all NHS staff for their incredible work in challenging circumstances. That’s why we recently announced the largest single increase in doctor training places in the history of the NHS – a 25% expansion.”“But we know there is a great deal of pressure in A&E departments, and we are grateful to all NHS staff for their incredible work in challenging circumstances. That’s why we recently announced the largest single increase in doctor training places in the history of the NHS – a 25% expansion.”
The letter’s signatories are consultants in emergency medicine, fellows of the Royal College of Emergency Medicine and clinical leads – the consultants in charge – at A&E units at 68 hospitals. May stressed on Thursday that flu was a key factor in the intense strain that NHS services were facing. “We have seen the extra pressures that the NHS has come under this year. One of the issues that determines the extent of that pressure is flu and we have seen in recent days an increase in the number of people presenting at A&E from flu,” she said.
In their letter they tell May of the “very serious concerns we have for the safety of our patients. This current level of safety compromise is at times intolerable, despite the best efforts of staff.” 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.
They note the media’s focus on “how appalling the situation in an increasing number of our emergency departments has become [in recent weeks].” Media outlets have carried pictures of patients lying on the floor of Pinderfields hospital in Wakefield, Yorkshire, and one-year-old Evelyn Johnston-Smith, whose operation to repair a hole in her heart has been cancelled five times, for example. 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”.
But, the medics add: “These departments are not outliers. Many of the trusts we work in are in similar positions.” 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.
But not all senior medics endorsed the letter’s contents. Dr Nick Scriven, the president of the Society for Acute Medicine, said it was unprecedented for a group of senior doctors to write directly to the prime minister like this, and that the facts as laid out in the letter were correct. However, the plea to May was “unnecessarily alarmist” and the whole NHS was overloaded, not just emergency departments, he stressed. 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
Hours after she spoke, new figures from Public Health England confirmed that flu was putting a sharply increased burden on GP surgeries as well as hospitals.
Last week 758 peple around the UK were hospialised because of flu, up from 421 the week before. Of those, 240 were so sick they had to be admitted to an intensive care or a high dependency unit, up from 114. The number of people consulting a GP with flu-like symptoms almost doubled.
A further 27 people died of flu-related symptoms last week, three more than the week before, taking the toll of deaths this winter to 85.