‘A sustained threat to patient safety’: Hospitals across the country swamped by record numbers in A&E

Exclusive: NHS staff reveal hospitals and ambulance services are being overwhelmed by a numbers of patients

Shaun Lintern
Health Correspondent
Monday 21 June 2021 13:37
Hospitals across the country swamped by record numbers in A&E

Hospital emergency departments across the UK are at breaking point with record numbers of patients swamping A&Es, raising fears that lives will be lost, The Independent can reveal.

Some hospitals have been forced to declare major incidents in the last few days because of the swelling numbers of patients.

Hospitals across the country have set new records for patient numbers in recent weeks, surpassing the worst days of the winter of 2019 – the most recent winter crisis in the NHS before the coronavirus pandemic hit the UK.

A&E doctors from across the country have shared details with The Independent, revealing that in some units patients are waiting as long as nine hours to be seen, with overall numbers up by 50 per cent compared with pre-pandemic levels.

The increase is putting extra pressure on hospital beds, which have already been reduced to try and limit the spread of coronavirus within hospitals. Ambulance services have also reported a rise in emergency calls, along with a growing level of violence against staff from frustrated members of the public.

The Royal College of Emergency Medicine warned that the situation was very serious, and that emergency departments were being overwhelmed.

Vice president Dr Adrian Boyle said: “What's been going on for the last six weeks, the levels of activity we are seeing, is creating a significant and sustained threat to patient safety.

“We know research evidence has consistently demonstrated that excessive occupancy in emergency departments is inevitably associated with an increase in short-term mortality.

“The essence of emergency medicine is identifying the needle in the haystack. If the haystack is getting bigger, it becomes progressively harder to find that needle.”

Shadow health secretary Jonathan Ashworth said that record A&E attendance was “the canary in the coalmine that reveals the scale of the NHS crisis”, and that there was “no question our NHS is under intense pressure”.

“Years of healthcare cuts under the Tories and uncertainty about future funding means patients waiting longer for treatment,” he said. “We want a fully-funded NHS rescue plan to deliver the quality care patients deserve.”

At least 30 hospitals across England have seen record levels of patients during June, stretching from Exeter and Plymouth in the south to hospitals in Middlesbrough, Manchester and elsewhere in the north of England.

On Tuesday, the North Middlesex Hospital in north London declared an internal incident after 700 patients attended its A&E department – the highest level since January 2020, when 684 were recorded in a single day.

The University Hospitals of Leicester trust also recorded its busiest day ever on Tuesday, with 925 patients, as did the University Hospitals of North Midlands trust in Stoke, which saw 866 patients.

At the University Hospitals Birmingham trust, which runs three A&E departments in the region, attendances have jumped from an average of around 900 per day in December 2019 to 1,350 this month. One clinician at the trust said patients were waiting at least nine hours to be seen on some occasions.

At Leeds General Infirmary, the average daily attendance was 350 before the pandemic but has now exceeded 400 patients a day. The trust has publicly warned patients on its Facebook page that they face long waits.

At the Royal Liverpool Hospital the A&E department was described as “at full stretch” with the situation labelled “unsustainable” by one consultant.

Other hospitals declaring record demand include the Royal Free in London, Addenbrooke’s Hospital in Cambridge, and the John Radcliffe Hospital in Oxford.

The pressure is also being felt by paramedics. In a leaked briefing to West Midlands Ambulance Service staff, seen by The Independent, the trust said the problem of delays at hospital was now “the biggest risk to patient safety”.

It added that June was set to be its busiest month on record, saying: “Seven of the top 10 busiest days the trust has experienced from a call perspective have come in June 2021! The situation is quite unprecedented and is being repeated across the country.”

For the first two weeks of the month, calls rose 30 per cent compared to the same month in 2019, with 5,314 calls to 999 on Monday – the second busiest day ever after 4 January, at the height of the Covid surge.

The briefing said: “The trust has not seen sustained pressure like it is currently experiencing in a very long time, if ever. Hospital delays are extensive and growing; members of the public are getting angry at delays in ambulances arriving, and are taking it out on staff over the phone and in person.”

Dr Adrian Boyle told The Independent that demand in A&Es had gone up across all patient groups but was “disproportionately” higher among patients who were less seriously ill or injured, whom he said had “not been served by the rest of the system”.

He said A&Es were picking up the pieces from overworked GPs, who were themselves struggling to meet demand, and from the decline in health as a result of the pandemic lockdown. Delays in treatments meant some patients were now experiencing complications from their initial health problems, he explained.

“The activity we had in May was the second highest on record, compared to December 2019. So we're seeing winter levels of activity in summer. We’re very worried about that.”

And he warned that it had implications for the backlog of surgeries.

“This inability to meet the demand is going to derail the elective backlog. We're very sympathetic to the fact that there are patients who have been waiting a long time for important, lifesaving surgery.

“It will be utterly tragic if we find ourselves in a situation where operations are cancelled because there is no bed – because it is full, because we run our hospitals with too few beds.”

Dr Boyle added that A&E staff were seeing “increased violence and aggression from patients who are frustrated with long waits”, creating a “toxic work environment” for staff.

There is no “quick fix”, he warned, adding: “The strategy we had of trying to run our healthcare system on almost the lowest number of beds per 1,000 people in the OECD [Organisation for Economic Cooperation and Development] is really harming us. We need to properly plan, invest, and develop services.”

An NHS spokesperson said: “Staff in emergency departments are having to work differently from how they did pre-pandemic, with extra time needed for applying PPE and performing rapid Covid tests on patients. The NHS has invested £450m in upgrading A&Es as part of its response to coronavirus, while also providing convenient ways to access care that meet patients’ needs, including an enhanced NHS 111 service.

“Thanks to the efforts of staff, the NHS is ahead of ambitions set out in April for operations and routine care, and is now seeing more people coming forward for emergency care.”

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