Hospitals and ambulance services are in a deepening crisis caused by the surge in infections as the removal of Covid-19 rules coincides with added pressure from the heatwave and the return of thousands of workers to offices.
More than half of staff at one NHS trust are absent because of Covid-19 isolation rules, forcing operations to be cancelled, while the number of Covid patients in England has leapt by one-third in the past week.
The chief scientific adviser, Sir Patrick Vallance, told a Downing Street press conference that he expected the NHS to see 1,000 patients a day being admitted to hospital soon.
His comments come as hospitals and ambulance services report surging demand from patients with staff being redeployed to new Covid wards and 999 calls going unanswered for vital minutes because of a lack of staff.
A scorching weekend heatwave saw the West Midlands Ambulance Service declaring “extreme pressure” with 999 calls exceeding levels normally seen on New Year’s Day.
Across England there were 3,813 Covid patients in hospital, up 36 per cent on a week ago. This amounts to around 3 per cent of total NHS beds, but the small numbers are having a disproportionate effect on services.
On Thursday, University Hospitals Birmingham cancelled all its elective operations, including liver transplants. Cancer surgeries have also been delayed at Leeds Teaching Hospital, with delays also at hospitals in Manchester and Newcastle.
At Hull Royal Infirmary, more than half of staff absent from work, in excess of 400 staff, are off because they are either infected with the virus or are being forced to isolate as part of the so-called “pingdemic” caused by the NHS Covid App.
The government has announced plans to relax these rules for NHS staff in order to maintain some services for patients.
The Hull trust has also seen high levels of A&E demand, regularly seeing over 400 patients in a unit designed for a maximum of 350. On Wednesday last week, staff said there were just two beds available across the trust with some patients facing long waits of 15 to 20 hours for a bed.
In the West Midlands, ambulance bosses reported unprecedented levels of 999 demand with chief executive Anthony Marsh admitting the service did not have enough call handlers to cope.
In a briefing to staff the trust said: “The last week has seen all records broken as far as demand is concerned with levels that could barely be considered only a few months ago. On Monday [12 July], the trust took no fewer than 6,406 emergency calls, almost 600 more than the previously busiest day, last Thursday, 8 July. During Monday, call handlers took more than 340 calls in a single hour, something you might have expected on New Years Eve, not a Monday morning.”
Over the weekend, it had 16,058 emergency calls, compared to 12,300 calls between 1 and 3 of January this year.
The volume of calls led to significant delays in responding to patients which then led to worried callers ringing back. Trust chief Anthony Marsh told staff: “Even though we are diverting dual trained call handlers from 111 to 999, we simply don’t have enough staff.”
This picture was repeated in Yorkshire where one paramedic said the service wasn’t safe.
The Yorkshire trust put out an appeal to the public not to call back while they were waiting for an ambulance after a surge in demand saw it receive 4,449 calls on Saturday, 40 per cent more than forecast.
Lower priority calls faced waiting several hours for an ambulance to turn up.
One paramedic told The Independent that 999 calls were being put on hold before answering, with at least one waiting 12 minutes for an answer.
They said: “It’s not safe. When I look at the jobs, I know in that stack there are jobs that we are going to miss. No matter how good the triage we are going to miss things just through the sheer volume of what there is. We’ve been at record levels for a month, no one knows why this is happening.”
They added there were long delays at hospitals for ambulance crews to handover patients with at least one patient waiting six hours outside Pinderfields Hospital, in Wakefield.
A spokesperson for Yorkshire Ambulance Service said it had seen some of its highest demand ever in recent weeks adding: “We are continuing to respond to those in need as swiftly as possible, but acknowledge that some patients are having to wait longer than we would like them to. All emergency calls are categorised according to the nature of a patient’s illness or injury and those in a life-threatening condition are always prioritised.”
Across England, 7 out of 10 ambulance service trusts are now reporting “extreme pressures” on their services. Once referred to as “black alert” incidents, this is meant to be in place for only short periods but has been ongoing for weeks in some regions.
Hospitals are also reorganising their wards to cope with the expected rise in coronavirus patients over the coming weeks, which could see between 1,000 to 2,000 patients a day being admitted.
Sheffield Teaching Hospital has opened up a new Covid ward today and reduced some elective surgery. A message to staff seen by The Independent said senior managers had agreed some “non-urgent clinical work will have to stop”.
The trust has seen the numbers of Covid patients increase from three to 54 in the past two weeks in nine in intensive care. Most are under 50 and unvaccinated, the trust said.
A spokesperson said the trust had now opened one 12-bed Covid ward to cope with increasing numbers.
In anticipation of further cases this week and next week, we have opened one 12 bed COVID ward for which we have staffing.
At Nottingham University Hospitals Trust, staff were told an escalation in Covid cases over the weekend meant a ward at the City Hospital site, which is normally used for planned operations, would instead be used as “additional capacity” for sick patients. No operations have yet been delayed.
In Liverpool, staff told The Independent plans were being drawn up to open a surge ward at the Royal Liverpool University Hospital where there were more than 80 Covid patients in hospital, with 19 in intensive care on Friday.
One clinician said: “I don’t think people realise how much pressure hospitals are already under in this fourth wave. Our staff are knackered, morale is rock bottom.”
They said there were so few medical beds the trust was already having to transfer patients between hospitals and other regions solely for capacity reasons.
They added: “Some ICU beds are closed because we don’t have enough staff for them, at least five beds are closed for this reason.”
Matthew Taylor, chief executive of the NHS Confederation, said the government’s plan was essentially a gamble: “The NHS is under intense and increasing pressure where it feels like winter in summer, not just in hospitals but across primary care, mental health, in ambulances and in the community services.
“The government has taken the decision to lift all Covid-19 restrictions, but it is a gamble and with nearly 50,000 cases and rising, and with some predicting that we could reach 200,000 a day later in the summer, caution has to be key.”
Ellen Ryabov, chief operating officer at Hull University Teaching Hospitals NHS Trust, said: “We continue to experience pressures on our bed capacity at Hull Royal Infirmary but last week was no different to other recent weeks.
“We did not see large numbers of patients waiting in our emergency department for the length of time described although we have had some patients waiting far longer than we would like to be admitted onto a ward. We apologise to them for those delays.
“Like other hospitals, some of our staff have had to self-isolate in recent weeks and that has had an impact on our services.
“We have been able to keep the cancellation of planned surgery to a minimum with staff and resources redeployed to other areas to ensure elective activity can continue.
“We do not have plans to cancel future elective activity but we are keeping this under constant review.”