The latest NHS figures indicate that the health service has recently experienced the busiest week in its history.
And this resulted in record numbers of hospitals being forced to relocate patients and declare major alerts.
Fifty-two hospital trusts had to send ambulances elsewhere between 8th and 15th January.
This is nearly double the same figure from last year, according to NHS England.
Meanwhile, 68 trusts – 45% of the 152 in total in England – declared an alert last week.
NHS England suggested that the escalation can be partially attributed to alterations in the way that data is recorded.
But healthcare professionals have continually emphasised that the situation in the healthcare system is as challenging and relentless as it has ever been.
Additionally, 15 trusts were placed on continuous alert over a 10-day period between 3rd and 13th January.
Bed occupancy rates in acute NHS trusts hit 95.8% last week; well above the safe levels of 85%.
Among acute trusts, 15 were completely occupied, while an additional 24 had five beds free for patients needing to be admitted in an emergency.
Norman Lamb, the Liberal Democrats’ health spokesman, was critical of the overall picture, and placed the blame firmly on the government.
“This NHS winter crisis brings bad news day after day and patients are paying the price. The government is doing nothing to deal with it. I don’t know how bad the figures need to get for them to actually take action.”
Both statistical and anecdotal evidence from within the healthcare system points to serious problems.
This winter has been particularly challenging, despite the fact that it has been rather mild.
The government will face increasing calls to invest more heavily in the NHS, at a time when it is in fact requiring NHS trusts to achieve massive efficiency savings.
Lakeside Healthcare will be pitching in with the treatment of ambulatory patients who arrive at Leicester Royal Infirmary’s accident and emergency department.
This critical issue of primary care has been instigated by University Hospitals of Leicester Trust.
As part of the arrangements, Lakeside Healthcare will treat stream its patients at the unit’s ‘front door’.
The scheme is intended to ease pressure on the Royal infirmary, as numerous institutions across the NHS struggle with capacity problems.
It was reported a couple of weeks ago that capacity in large part of the NHS is already running at winter levels.
This is an alarming statistic considering that the busiest period of time for the NHS has yet to arrive.
The scheme will see specialist GPs and nurses from the Lakeside institution make key decisions about whether patients can be treated within the hospital.
Additionally, assessments will be made about whether it would be possible for patients to utilise alternative services.
As the Leicester trust continues to face pressure, this scheme is essentially a pilot that will be run over the next couple of weeks.
Should it be successful in easing pressure on the health service in the East Midlands region, it is likely that it will continue until November 2016.
While the initiative is funded by Leicestershire clinical commissioning groups – Leicester City, East Leicestershire and Rutland, and West Leicestershire – Lakeside will be contracted directly with the trust.
Lakeside Healthcare is one of the 14 multi-speciality community provider sites under NHS England’s vanguards programme. It is also part of Leicester, Leicestershire and Rutland urgent and emergency care vanguard site.
The ‘front door’ service is operated by Lakeside Plus, the Corby-based provider’s urgent care delivery arm, which also runs the Corby Urgent Care Centre.
Commenting on the new scheme, the trust’s chief operating officer, Richard Mitchell, stated: “The volume of patients that come into Leicester Royal Infirmary on an emergency pathway are greater than anywhere else in the country. Linked into this, the estate is very poor. We have looked for experience and skill sets outside of the local health system. The measures of success will be the use of community streaming [where patients who can use other services are directed to them].”
Mitchell was also positive about the potential of the scheme in the future.
“We hope to see community streaming increase. We hope to see the volume of patients transferred into the major emergency department reduce,” Mitchell commented.
Robert Harris, chief executive of Lakeside Group, believed that the scheme was a successful one, and welcomed its pilot status.
“This is a huge opportunity for Lakeside to demonstrate the difference that general practitioners with deep expertise in managing urgent care patients can make. Simply putting a locum GP in a booth in the emergency department makes little or no difference. You need a full advanced life support trained team of doctors and senior nurses who are coordinated and who understand how to cope with significant volume pressures,” Harris stated.
The health regulator Monitor has criticised ambulance bosses in a move that could greatly influence the future of the emergency service.
It has been suggested that managers of the ambulance service could be forced to resign their positions after systemic failings over the handling of NHS 111 calls.
Monitor specifically criticised the South East Coast Ambulance Service over a project which increased how long some patients were forced to wait for ambulances.
The organisation was guilty of transferring some NHS 111 calls to the 999 emergency system, in order to give the staff a further 10 minutes of time to respond to calls.
This project was implemented as a response to massive pressures that the ambulance service faced during the winter last year.
Extra time was given to calls which were placed in the second most serious category.
Monitor indicated that there had been a clear failure of management processes, and the health regulator has intervened in order to rectify the situation.
The Health regulator added in a statement that there are major concerns about the way that the trust is being run, and particularly the decision-making process related to ambulances.
Monitor also said it has reasonable grounds to suspect the trust is in breach of its license to provide NHS services.
With an investigation into the matter imminent, the health regulator has indicated that it will commission a review into the way that the project was handled, and more widely into the way that the trust makes decisions.
Paul Streat, Monitor’s regional director, commented that the project was fundamentally flawed and is a massive cause of concern for the health regulator.
“Over the winter, there were significant demands on the NHS and it is understandable that trusts want to explore better ways of delivering the best possible care. But this project was poorly managed from the start, done without the proper authorisation and without enough thought given to how it might affect patients. We have asked the trust to review the action it took to make sure there was no harm to patients, and look again at the way decisions are taken to prevent something like this happening again.”
Paul Sutton, chief executive of the South East Coast Ambulance Service, defended the ethos behind the procedure, but also acknowledge that the health regulator’s concerns were reasonable.
“The process was undertaken to ensure that the right response was provided to patients and that we were able to respond promptly to the most seriously ill patients. However we recognise that it was not well implemented and we did not use our own corporate governance processes correctly. These are serious findings,” Sutton stated.
In addition, Sutton indicated that the organisation had already begun to implement new measures in order to ensure that there was no repeat of the incident.
“We have already begun to take steps to address Monitor’s concerns and as part of this process, independent reviews will assess how decisions are made within the Trust, governance processes and our approach to patient safety. As a Trust, we remain extremely proud of the high quality and compassionate clinical services that SECAmb provides to our patients,” Sutton indicated.