Major NHS trust turns away A&E patients 13 times in a week

Denis Campbell and Pamela Duncan
NHS data shows that the Worcestershire trust treated just 70.1% of patients within the required four hours of their arrival at A&E in November. Photograph: Rui Vieira/PA

A major NHS hospital trust had to turn patients away from its A&E units 13 times last week – including four times in one day – as the snow left it facing “extremely challenging” conditions.

Worcestershire Acute Hospitals NHS Trust was forced to divert emergency patients away from the A&Es at two of the hospitals it runs, the Worcestershire Royal in Worcester and Alexandra in Redditch.

The increased number of patients seeking care as the first cold snap of winter hit meant it had to declare an “A&E divert” four times on both 4 and 5 December, and a further five times last week.

NHS England’s latest performance figures

Two patients died at the trust last winter, one reportedly after spending 35 hours on a trolley, days before the British Red Cross said the chaos in many hospitals constituted “a humanitarian crisis”.

Snow put the trust under such pressure that it issued a plea last Sunday for nurses, doctors and healthcare assistants who could safely get to either hospital to come in and help out. Some staff slept in the hospitals and others stayed well past the end of their shifts as part of a major operation to keep the hospitals open.

The unusually high number of diverts illustrates how the cold weather has added to the already heavy pressure on hospitals, especially A&E units.

The trust’s 13 diverts – more than three times more than any other trust – were disclosed in NHS England’s latest performance figures. They emerged as a senior doctor warned that some hospitals were already experiencing “carnage” as a result of winter’s arrival.

“All we can say and see is pressure, pressure and more pressure – the system is on a knife-edge,” said Dr Nick Scriven, president of the Society for Acute Medicine.

“This week alone frontline staff from across the UK are reporting their hospitals are ‘imploding’, there is ‘carnage on the ground’ and they are run off their feet. Some hospitals are already cancelling planned surgery and that is something patients will face increasingly over the winter months,” Scriven added.

The Midlands trust said the 13 diverts were between its two A&E departments and none involved patients being sent to another trust. “If one unit is significantly busier than the other we work with West Midlands ambulance service to divert to the less busy one if it is safe to do so – meaning that the patient gets seen more quickly and the ambulance crew are able to transfer their patient to us in a more timely way and go on to their next call. This proved particularly useful during the recent spell of bad weather,” it said in a statement.

NHS data also showed that the Worcestershire trust treated just 70.1% of patients within the required four hours of their arrival in A&E during November – the ninth worst record among 137 acute trusts in England. The target is 95%. A total of 2,983 of the 9,984 patients had to wait longer than four hours.

Blackpool Teaching Hospitals trust performed by far the worst against the four-hour target; it managed to treat just 57.8% of patients within that time period.

The Worcestershire trust is also the ninth worst in England at treating cancer patients urgently within 62 days and the 29th poorest at giving patients non-urgent operations within the NHS-wide 18-week target. Its bed occupancy has been running at 98.4% – well over the 85% limit that the NHS accepts is the right level to ensure patients receive safe care.

“It’s tough. We are certainly feeling increased pressure,” Michelle McKay, its chief executive, told the Health Service Journal this week.

The trust suffers more than most from the understaffing causing problems at almost every hospital in the NHS. Its most recent staffing figures show that in September 40% of its wards had so few nurses they were below the “safe staffing” fill rates used by the NHS.

NHS England’s figures also showed that the flu jab had so far been administered to fewer than half of eligible adults, less than 20% of young children, and just 46% of NHS staff, despite repeated recent warnings of a potentially major outbreak.

“It’s deeply concerning that rates for flu vaccinations are currently so low. Prevention is vital in protecting the most vulnerable in our society, those with an existing lung condition, children, pregnant women and the elderly, to ensure they don’t get flu,” said Dr Penny Woods, chief executive of the British Lung Foundation.

In addition, one in eight (11,852) of all patients who arrived at hospital by ambulance last week had to wait in the vehicle for at least 30 minutes, despite NHS rules that say no one should be forced to do so for more than 15 minutes.

Norovirus, the winter vomiting bug, led to the closure of 1,123 hospital beds a day on average last week, 70% more than the 64 closures a day seen the previous week.