Doctors, nurses and senior managers across the country have warned of their fears that rising numbers of patients with Covid-19 are undermining efforts to treat routine patients, with some already having surgery cancelled.
Leaked emails, seen by The Independent, reveal the University Hospitals Birmingham Trust, one of the largest hospital trusts in the country, has told its surgeons to begin cancelling routine operations for some patients because of the pressures it is facing.
The West Midlands trust’s three main hospitals have at least 214 patients with coronavirus on their wards with bosses at the trust taking the unprecedented step last week of warning patients who attended A&E they would be turned away if they were not a true emergency.
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The latest data show there were 5,402 patients with coronavirus in English hospitals on Monday, up 47 per cent on the 3,665 patients in hospital seven days earlier. Across the UK there were 21,331 positive infections reported on Monday with a surge in deaths to 241 on Monday.
They added the situation at the hospital was being reviewed daily, with surgeons told there was a need for them to “wake up and smell the coffee” around the requirement to help. This included seeing more patients referred from A&E quickly and for a true seven-day service of consultant ward rounds reviewing patients in beds and considering who could be discharged.
Last week, Nottingham University Hospitals announced it would have to cancel most of its planned operations while University Hospitals Plymouth has said it would also have to pause some operations.
In Greater Manchester, the numbers of patients in hospital with the virus has jumped by more than two-fifths from 430 on Friday to 620 on Tuesday. The city was placed into the tier 3 alert level by the government today after talks with Manchester mayor Andy Burnham broke down without a deal.
In Birmingham, surgeons have been told to cancel some planned operations and to do more to help ease pressure on the hospital.
In an email to surgeons sent by a division director on Monday, staff were told: “The directive from Dave Rosser [chief executive] is very clear. Stand down elective activity to focus resources on emergency flow.”
The email added: “It is only by enacting a successful proactive response to the urrent wave and perceived crisis that surgery will maintain the crucial elective activity over this winter that we all believe is vitally important. It will be difficult to make the argument if we fail to deliver on the acute model demanded.”
A second email by a senior surgeon revealed tensions over the plans to cancel operations. It said: “I think we all agree that we cannot simply cut elective services. This is what was in spring. It did untold harm to very many patients and this is widely recognised by colleagues, the politicians and the public.”
Across the north of England, similar pressures were reported by doctors, nurses and managers spoken to by The Independent over the past two days.
While in some areas patient admissions with Covid-19 were not yet at a level to threaten services there was concern over how fast the numbers were rising. Some staff also said the second wave would be hard on staff as it would last longer without the support they had in the first wave.
One intensive care doctor said: “The reality is we’re ordered to prepare for the same as the peak, but lasting three months, but keeping theatres running – so we can’t use the theatre staff.
“The Nightingales only reduce NHS staffing. We’re all knackered. It’s completely desperate.”
They added: “We’ve just fought the Battle of Britain and barely survived. Now we’re being asked to fight it again, for longer without half the staff and resources we had before.
“And as a human resource we’re depleted.”
One intensive care nurse said: “We’re at the whim of what’s happening to Covid-19 transmission in the community. We’re getting redeployed staff again, but that doesn’t help the general wards, we’re robbing Peter to pay Paul.
“Things are far worse than people or even the government realise. I think without a national lockdown by mid-November we’ll be in a worse place than April, but with our hospitals full. Many of us are on the edge, and this is just the beginning.”
In Manchester, one doctor said: “ICU beds are heavily occupied with Covid patients. No one really knows what will happen next. Elective surgery will be threatened if numbers continue to increase.”
This time round fewer patients are being put on ventilators, but this is leading to large numbers of patients being cared for on hospital wards where nurse staffing levels can be stretched.
In cases where junior anaesthetists are used to help staffing on critical care wards this means consultant anaesthetists have to fill in the gaps. One surgeon said: “There are not enough anaesthetists left to run all the elective [surgery] lists – so some need to be cancelled.”
In parts of the northeast where infections and admissions have been increasing, but not yet as high as the northwest, NHS managers are watching the daily admissions closely for signs they may soon hit capacity.
One senior NHS manager said: “We are all watching this develop. We are doing all we can to keep the important stuff going but there is a sense that it’s when and not if we have to take some tough decisions.”
NHS England had told trusts they needed to get back to 90 per cent of their pre-pandemic levels of activity for surgeries such as hip operations and other routine services where huge backlogs have built up over the last six months.
There are more than 4.2 million patients on NHS waiting lists with over 111,000 waiting longer than a year for treatment.
University Hospitals Birmingham confirmed the cancellation of routine surgeries but refused to say how many patients would be affected. It is thought the cancellations will affect the lowest priority patients first.
A spokesperson said the trust was delivering 75 per cent of its pre-pandemic activity, but added: “A group of senior doctors, led by a surgeon, continue to prioritise surgery based on clinical need with a view to maintaining time-critical and cancer surgery, and we will continue to maintain access to outpatient appointments and maintain diagnostic activity. We recognise it is distressing for patients whose elective care does need to be rescheduled, however we must always ensure that the care we provide is safe.”
They added the trust’s Solihull Hospital was being kept as a Covid-free zone and the trust would continue sending patients to the private sector.
In a statement, the British Orthopaedic Association said it was concerned about reports of hospital cancellations adding trusts must continue doing planned operations for as long as possible.
It added: “Where surgery is to be cancelled we urge hospitals to ensure that this is for the shortest possible time. At the end of August, there were almost 200,000 people in England awaiting admission for much needed orthopaedic surgery, and average waiting times were at their longest for many years.”
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