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NHS crisis: Adult patients put on children's wards as trusts struggle for space over winter

Exclusive: Whole floors of children's hospitals given over to adults while paediatric consultants decry pressures forcing hospitals to consider drastic measure

Alex Matthews-King

Health Correspondent

Friday 05 January 2018 22:20 GMT

NHS staff are being stretched to their limit as trusts implement 'black alert' action plans to protect urgent care (File photo) (Getty)

NHS trusts are turning over space on children’s wards to care for adult patients, as the health service faces it’s most serious winter crisis to date.

The Independent has identified three hospitals which are so full that they are turning over paediatric beds to older patients or have put in plans to do so.

One paediatric consultant said staff were “incredulous” when managers came on to a children’s ward to risk assess it for use with adult patients if pressures continued to worsen, as predicted by health economists yesterday.

Professor John Appleby, chief economist of the Nuffield Trust, said: “The sobering reality is that winter for the NHS has hardly started.”

NHS England also warned that a cold snap expected in the coming days will heap more pressure on services.

Everyone the Government blames for the NHS crisis – except themselves

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1/6Everyone the Government blames for the NHS crisis – except themselves

Everyone the Government blames for the NHS crisis – except themselves

The elderly

“We acknowledge that there are pressures on the health service, there are always extra pressures on the NHS in the winter, but we have the added pressures of the ageing population and the growing complex needs of the population,” Theresa May has said. Waits of over 12 hours in A&E among elderly people have more than doubled in two years, according to figures from NHS Digital.

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Everyone the Government blames for the NHS crisis – except themselves

Patients going to A&E instead of seeing their GPs

Jeremy Hunt has called for a “honest discussion with the public about the purpose of A&E departments”, saying that around a third of A&E patients were in hospital unnecessarily. Mr Hunt told Radio 4’s Today programme the NHS now had more doctors, nurses and funding than ever, but explained what he called “very serious problems at some hospitals” by suggesting pressures were increasing in part because people are going to A&Es when they should not. He urged patients to visit their GP for non-emergency illnesses, outlined plans to release time for family doctors to support urgent care work, and said the NHS will soon be able to deliver seven-day access to a GP from 8am to 8pm. But doctors struggling amid a GP recruitment crisis said Mr Hunt’s plans were unrealistic and demanded the Government commit to investing in all areas of the overstretched health service.

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Everyone the Government blames for the NHS crisis – except themselves

Simon Stevens, head of NHS England

Reports that “key members” of Ms May’s team used internal meetings to accuse Simon Stevens, head of NHS England, of being unenthusiastic and unresponsive have been rejected by Downing Street. Mr Stevens had allegedly rejected claims made by Ms May that the NHS had been given more funding than required.

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Everyone the Government blames for the NHS crisis – except themselves

Previous health policy, not funding

In an interview with Sky News’s Sophy Ridge, Ms May acknowledged the NHS faced pressures but said it was a problem that had been “ducked by government over the years”. She refuted the claim that hospitals were tackling a “humanitarian crisis” and said health funding was at record levels. “We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need,” said the Prime Minister. “They did that, we gave them that funding, in fact we gave them more funding than they required… Funding is now at record levels for the NHS, more money has been going in.” But doctors accused Ms May of being “in denial” about how the lack of additional funding provided for health and social care were behind a spiralling crisis in NHS hospitals.

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Everyone the Government blames for the NHS crisis – except themselves

Target to treat all A&E patients within four hours

Mr Hunt was accused of watering down the flagship target to treat all A&E patients within four hours. The Health Secretary told MPs the promise – introduced by Tony Blair’s government in 2000 – should only be for “those who actually need it”. Amid jeers in the Commons, Mr Hunt said only four other countries pledged to treat all patients within a similar timeframe and all had “less stringent” rules. But Ms May has now said the Government will stand by the four-hour target for A&E, which says 95 per cent of patients must be dealt with within that time frame.

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Everyone the Government blames for the NHS crisis – except themselves

No one

Mr Hunt was accused of “hiding” from the public eye following news of the Red Cross’s comments and didn’t make an official statement for two days. He was also filmed refusing to answer questions from journalists who pursued him down the street yesterday to ask whether he planned to scrap the four-hour A&E waiting time target. Sky News reporter Beth Rigby pressed the Health Secretary on his position on the matter, saying “the public will want to know, Mr Hunt”. “Sorry Beth, I’ve answered questions about this already,” replied Mr Hunt. “But you didn’t answer questions on this. You said it was over-interpreted in the House of Commons and you didn’t want to water it down. Is that what you’re saying?” said Ms Rigby. “It’s very difficult, because how are we going to explain to the public what your intention is, when you change your position and then won’t answer the question, Mr Hunt”. But the Health Secretary maintained his silence until he reached his car and got in.

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Among those converting paediatric wards is Epsom and St Helier University Hospitals NHS Trust, in Surrey, which has closed the day surgery area in Queen Mary’s Hospital for Children to make space for adults while the trust deals with “sustained and unprecedented pressures”.

The hospital has gone to the highest level of operational pressures, Opel 4 – a “black alert” – and has opened all its so-called escalation beds including those in the children’s hospital to adults. The trust said adults and children were on a different floor with a security door separating them.

The adolescents ward in Blackpool Victoria Hospital for 11 to 16 year olds has also been converted into use by adults for the foreseeable future, it emerged yesterday.

A spokesman for Blackpool University Hospitals NHS Foundation Trust said the ward was only declared an adult space on Tuesday, but that this followed a decision in November to better use the space available for a wider range of patients.

“Due to developments in areas such as child and adolescent mental health services (CAMHS) the adolescent ward was an under-used space and the trust made the decision to widen the age range of patients who could be treated on there,” a spokesman said.

Meanwhile, Dr Ravi Jayaram, a paediatric consultant in Countess of Chester Hospital NHs Foundation Trust told The Independent that managers were assessing whether paediatric beds could be safely reallocated to adult patients to cope with the escalating winter crisis.

“Managers came on to the children’s ward, doing an initial risk assessment in case they were really stuck for beds to put adults in. They were seeing if they could put them here.

“We were incredulous. How has it come to this? It’s completely ridiculous that we’ve got to the point, to have adults nursed on a children’s ward.”

Dr Jayaram said he had also heard anecdotally of other hospitals using children’s wards for adult patients, including one London trust where a doctor told him they have had to use the paediatric ward for the past two weeks.

“If an adult ward gets full, an adult can go to another ward,” Dr Jayaram said. “But if our only children’s ward gets filled with adults, there’s nowhere else for children to go.”

The trust’s medical director, Ian Harvey, said it had been looking at all areas where it could find extra bed space after seeing “unprecedented numbers” of patients who are either seriously ill or can’t be safely sent home.

“When faced with these challenges we have to explore every option to maximise the space available to us.

“This has included having extra beds in areas not normally bedded, but contrary to the implication of the story, mixing adults with children has never been considered, nor would it be.”

Dr Mike Linney, Registrar for the Royal College of Paediatrics and Child Health, said: “Although as a college we have not had reports directly of children’s wards being used to treat adult patients, all trusts must remember that if they do look at this as a coping mechanism, safety of their youngest patients must not suffer as a result – they must still have capacity to treat any children who require urgent attention.”

More than 20 trusts in England have had black alerts this week, meaning there is “increased potential for patient care and safety to be compromised” and trusts must take “decisive action” to protect emergency care.

In the same week figures showed bed availability over the Christmas break fell below even last year’s record level – despite Theresa May saying the NHS was better prepared than ever.

It comes as a former Conservative health secretary told The Independent the Government had not adequately prepared the NHS for the winter.

Stephen Dorrell said ministers needed to undertake a major rethink of how all public services are structured and funded – with increased spending at its heart.

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