Moment that mattered: NHS hospitals declare “black alerts”
Cold weather and a bad strain of flu pushed UK hospitals to breaking point over winter. In the first week of January, the bed occupancy rate hovered at around 95 per cent, and over the course of the month more than 1,000 patients in England waited over 12 hours to be seen – the highest number of patients ever to exceed this waiting time. The lack of beds meant doctors were forced to move patients into corridors.
By 2nd January at least 24 hospital trusts across England had issued a “black alert”, the most severe emergency warning, indicating that patient safety could not be guaranteed. Thousands of operations were cancelled, leaving patients in discomfort, as well as inflicting huge financial costs on the trusts, which receive funding for completed operations.
For Dr Sanjana Majumdar, junior clinical fellow at the Queen’s Medical Centre in Nottingham, which went on black alert on 3rd January, the crisis was exhausting and demoralising. “The gap between supply and demand was really obvious. Every day you were just getting through the shift,” says Dr Majumdar. “People in A&E would go the entire shift without having proper breaks. Your lunch break becomes your walk across the hospital while you shove a sandwich in your mouth. I had days starting at 8am where I didn’t get a break until 5pm. I was knackered.”
“Jeremy Hunt admitted the winter was the ‘worst ever’ for the NHS”
Dr Majumdar recalls moving one patient out of a ward to make way for an incoming patient in need of intensive care. “We took her bed and wheeled it outside. She was parked in the corridor so there was no privacy,” she says. “She was so understanding, which made us feel worse. But what are you going to do? You can’t let somebody die in A&E.”
On 8th February, Britain’s minister for health and social care, Jeremy Hunt, admitted that the winter was the “worst ever” for the NHS. Dr Majumdar is unconvinced by the government’s approach to healthcare. “It’s contradictory to say it’s the worst winter and then cut funding,” she says. “It is the worst winter, but what have you done about it? You’ve made the rotas worse, you’ve made the social care worse.”
Dr Majumdar believes that a lack of social care provision lies at the heart of the crisis in hospitals, as many elderly patients were forced to come into A&E with minor conditions such as diarrhoea or vomiting. “They just needed some care at home,” she says. “You shouldn’t need to come to A&E for things like that, you should have enough support in the community. A&E is meant to be for emergencies.” With no space for patients in care homes and insufficient support available at home, hospitals were unable to discharge some patients after their treatment had ended. This limbo increased their risk of picking up an infection in hospital as well blocking beds for new patients.
In this context, NHS England’s decision on 2nd January to cancel all non-urgent (‘elective’) operations seemed like a necessary evil to Dr Majumdar. “It was damage control,” she says. “We were so full and resources were so stretched that it would have been unsafe to take on electives, as we wouldn’t have been able to provide adequate post-operative care. It probably stopped untoward incidents that might have led to serious complications or worse.”
The cancellations have not solved the problem, only delayed it. “I don’t know when they will happen,” says Dr Majumdar of the cancelled procedures at her hospital. “These patients are in significant discomfort and it’s interfering with their lives. Imagine waiting six months only to be told it’s another six months, and even that’s not guaranteed. It’s so upsetting, I try not to think about it too much.”
Dr Majumdar is adamant about the need for reform and additional resources. “The system needs changing,” she says. “Unless something transforms the NHS in the next few months I’m pretty sure it’s going to be exactly the same crisis next winter.”
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