Hospitals in England turned ambulances away on nearly 500 occasions over the winter period.
This figure was approximately double the level of the three previous winters, underlining the level of pressure currently facing the NHS.
Closures are considered a last resort, but hospitals have stated that some times this is necessary in order to main safety within Accident and Emergency departments.
Yet paramedics state that the policy negatively impacts on their ability to treat sick and injured patients.
Consequently, ambulance crews have failed to achieve any of their response time targets since May 2015.
And latest figures indicate that one-third of the most critically ill patients wait longer than eight minutes for a 999 response.
Richard Webber, from the Royal College of Paramedics, expressed sympathy for the problems that hospitals face currently, but also suggested that the current situation is unacceptable.
Webber asserted that the closures were causing major delays in treating vulnerable patients, and explained why this is particularly the case.
“There is a double whammy in that not only do crews have to drive further away once a divert is implemented – [but] once that has happened, an ambulance crew will then also need to travel further to get back to their own area to respond to the next call.”
Figures compiled by the Nuffield Trust think tank, and derived from official NHS data, indicated that diversions took place on 478 occasions over the winter period, compared to 265 in the previous 12 months.
Prof John Appleby, of the Nuffield Trust, suggested that addressing this issue must be made an urgent priority.
“The extra time crews are having to spend on the road is not helping the ambulance service’s ability to meet its response time targets,” Appleby commented.
Five hospital trusts accounted for nearly half of the diverts:
89 – Pennine Acute Hospitals
63 – Worcestershire Acute Hospitals
43 – Northumbria Healthcare
38 – County Durham and Darlington
34 – South Tyneside
Saffron Cordery, of NHS Providers, is of the opinion that this worrying trend must be addressed sooner rather than later.
“Diverting ambulances to other hospitals is disruptive for paramedics and bad for patients. The sharp increase in the number of diversions is very worrying. Further steps will be needed across health and social care to address these pressures.”
Responding to the data, NHS England stated that many diverts involved hospitals in the local area, and thus patients were not being sent away significant distances from their places of residence.
The healthcare organisation also announced its intention to review the existing system in order to identify a more efficient way of running the ambulance service.
NHS hospitals will postpone thousands of operations and appointments in an attempt to ensure that the health service continues to function through the winter months.
Government plans have already been initiated which will see contingency measures put in place to safeguard emergency care.
Details have already been provided to the Commons Health Select Committee, with concerns that the NHS will suffer even more serious bed-blocking in the winter months than previously experienced.
Each hospital trust will be tasked with creating its own specific plans to cope with the winter workload, with the new concept of Accident and Emergency delivery boards to be set up in the next couple of weeks.
Evidence provided by the Royal College of Nursing suggests that hospitals are already buckling under the strain of rising demand, and in the busiest health service period it is obvious that this will worsen still.
The Royal College of Emergency Medicine believes that both numbers of doctors and beds are falling far short of what is required.
Dr Cliff Mann, RCEM president, commented that an extreme set of circumstances could render the NHS impotent this winter.
“What is really worrying is that when you look at last winter, the NHS came under very heavy pressures despite mild weather and little flu. All it would take is a bad flu outbreak this winter and we would be poleaxed.”
David Behan, chief executive of the Care Quality Commission, opined at a recent board meeting that he would rather see waiting times increased as opposed to witnessing an overall slump in care quality.
However he said the public “and politicians in particular” place a high value on the waiting targets.
Mr Behan told colleagues that “it would be silly to deny that care quality could be at risk due to the current financial constraints, with a record £2.45bn deficit declared last year. I see the evidence of waiting times increasing, times in A&E increasing, where people are trying to hold on to quality and doing their best to balance money. If I was trying to run a trust at the minute I think that is the balance I would be trying to strike.”
An NHS England spokesman defended the approach of the health service, indicating that provisions are already in place to deal with an upsurge in demand.
“The NHS again proved resilient this winter despite further increase in demand, with fewer trusts reporting serious operational issues and a significant reduction in trolley waits. We are already preparing for the upcoming winter with hospitals, GPs, social services and other health professionals coming together to work out the best way of responding in every area of the country.”
Accident and Emergency has recently missed requisite NHS targets, as the A&E system struggles under the weight of an increased patient demand.
A report produced by Northampton General Hospital suggests that the NHS is enduring its worst winter in three decades.
The consequence of the worst winter for thirty years has been a spate of underfunding and poor staff morale, according to the Northampton-based institution.
“Maintaining Quality Over Winter” has recently been published by the hospital, with the intention of assessing and outlining the problems that the NHS faces in the winter period.
Commenting on the report, Deborah Needham, chief operating officer at Northampton General Hospital, suggested that there are more than logistical issues for the NHS to contend with.
“There are a number of reasons for low morale in the workplace and it is difficult to show causation. Regardless of the reason, it can affect productivity, increase errors, increase sickness absence and affect joint working between teams and departments.”
Northampton General Hospital has already implemented numerous measures in order to address the issues caused by high winter capacity.
In particular, the hospital has invested in leadership training in an attempt to address winter capacity issues.
And the institution also believes that valuing and welcoming ideas from everyone, whatever their rank, is another measure to ensure job satisfaction.
Needham also suggested that addressing pressure on staff within the NHS involves addressing smaller, everyday ideas as well as more panoramic issues.
In order to address this aspect of NHS operations, Northampton General Hospital has attempted to engender a positive mentality among staff, which has led to what the institution believes to be an above-average morale.
“We aim to reward our staff through the little things that matter, such as informally saying ‘thank you’ when staff go above and beyond the call of duty to provide a great service to patients and keep them safe,” Needham explained.
As NHS organisations face pressure from logistical issues and funding, the high level of winter capacity is a major challenge across the health service.
It was known weeks before winter came that capacity in the NHS was already running at crisis levels.
Thus, it is not surprising that many hospitals and trusts are now facing difficulties.
Yet the NHS cannot afford to drop the ball at what is an absolutely critical time for the health service.
“During what is likely to be a difficult winter for most hospitals, we need to ensure that we continue to provide the quality of care our patients expect,” Needham stated.
A&E units across the UK are not equipped to cope with the rising demands being seen this winter, according to emergency care doctors.
The Royal College of Emergency Medicine made this claim, with the statement likely to cause particular concern considering the imminent Christmas period.
This is just the latest indication that capacity issues are a massive problem in the NHS.
And the statement will offer little comfort to those who believe that the so-called transformation to a seven-day NHS culture being promoted by the government is completely unworkable.
The Royal College of Emergency Medicine suggests that nine in 10 hospitals are increasing bed numbers.
But despite this they have problems seeing patients quickly enough and discharging them.
Increasingly the picture in the NHS is one of major systemic problems, as the creaking health service struggles to cope with multiple issues.
Funding problems are exemplified by the £2 billion deficit expected this year, with this figure expected to extend to £30 billion by the end of the decade.
Elsewhere, the government faces major staffing issues over rebellions from junior doctors and nurses.
Meanwhile, the evidence presented by the Royal College of Emergency Medicine suggests that just over 86% of patients were seen and dealt with in four hours; well below the 95% target set by the state.
Commenting on the issue, Dr Barbara Hakin, of NHS England, said despite the increasing pressures staff continued to “deliver a first-class service”.
“We are working hard to make sure all parts of the NHS are well prepared for the busy winter period,” she added.
The problems with accident and emergency were in fact anticipated a few weeks ago, when it was already reported that trusts across the country were struggling with winter capacity issues.
Now that winter is officially here, it seems that the situation has intensified, as indeed could have been predicted, and the situation could be a perfect storm by the time that Christmas rolls round.
Scotland is also providing weekly figures for its major A&E departments. It showed that up to the start of December just over 95% of patients were being seen in four hours.
The latest data available in Wales covers October and in Northern Ireland, November. Both nations are missing the four-hour A&E target.
This is just the latest indication that the NHS is failing to meet targets in a number of areas, and perhaps illustrates the systemic problems that the NHS faces in the coming years.
Financial issues, staffing problems, organisational difficulties, and a significant political conflict between the views of the government and the opposition will all play a major role in the future of the health service going forward.
Certainly these are interesting and hugely significant, if challenging, times for the health service in the UK.
The Welsh National Health Service has concocted a plan in order to cope with high demand over the winter.
It has already been reported that the NHS faces a crisis over the winter period due to occupancy issues.
So the Welsh NHS has sought emergency measures in order to cope with the situation.
Among these are cutting hospital admissions and discharging patients more quickly.
And NHS Wales chief executive Dr Andrew Goodall urged people to use emergency care only for life-threatening conditions needing immediate attention.
Pressures on accident and emergency departments last year resulted in one senior nurse comparing hospitals in Wales to warzones.
In an attempt to address this situation, Dr Goodall has stated that health bodies and councils have collaborated closely on joint resolutions.
And extra staff have been recruited by some health boards in Wales in order to deal with the extra demand.
The Welsh NHS has also placed an emphasis on identifying how traditional hospital beds can be utilised in order to respond rapidly to surges in demand.
Hospitals in Wales will also be utilising minor injury units to deal with capacity issues, and working closely with GPs at out-of-hours services in order to reduce hospital admissions.
The Welsh NHS has also pledged better support for people at home in order to help them to be discharged from hospital at the first available opportunity.
Commenting on the plans of the health service in Wales, Dr Goodall suggested that workers from every area of the NHS can play their part in dealing with winter pressures.
“The health service maintains and reviews plans constantly throughout the year but we all know winter can bring additional pressures. Our health boards, councils and the ambulance service have developed integrated winter plans to prepare for winter, particularly during peaks in pressure.”
Additionally, he emphasised that the general public can in fact treat illnesses themselves by utilising “over-the-counter medicines and plenty of rest”.
“When your injury or illness can’t be managed at home, your GP practice, NHS Direct Wales, local pharmacy, optician or dentist can help. A&E is for serious, life-threatening conditions that need immediate medical attention,” Goodall added.
In response to the apparent crisis, Conservative Shadow Health Minister Darren Millar suggested that superior NHS performance would only be possible when ministers from the Labour Party addressed the crippling problems of the health service.
“The reality is that GP out-of-hours services are in crisis in some parts of Wales, waiting times are too long and the four hour A and E target hasn’t been met in six years,” Millar stated.
Reports have indicated that bed occupancy in acute trusts has already raised winter levels.
The unusually high bed occupancy rates have left chief executives in acute trusts concerned with winter provisions.
Typically demand for beds in hospitals rises at this time of the year.
Senior figures in the acute service have already warned that existing occupancy levels are extremely serious.
Based on current reports from the acute trust, at least 50 patients every day have been admitted who are medically fit for discharge and consequently cannot be discharged.
Bosses have admitted that this is a massive problem, yes there is no evidence of the NHS making inroads into the issue.
And chief executives from acute trusts have stated that winter schemes have been running throughout the year without making an impression on the situation.
This is yet another indication that the NHS is struggling to cope with demand, and underlines many of the debates currently occurring with regard to the health service.
Some trusts have already had to open extra beds in order to cope with existing admission levels, indicating that they will potentially be massive problems during the winter period.
Existing levels of admissions are generally considered to be in line with December and January figures from previous years.
James Paget University Hospital Trust recently sent out a ‘black alert’ because all of its beds were full.
The picture across acute trusts in the NHS suggests that the recent plans of the Conservative government to switch to a seven-day culture in the health service could be under serious threat.
Indeed, it seems increasingly facile to assert that the health service is already struggling to deal with capacity simply related to its existing arrangements.
Meanwhile, the closure of care homes follows inspections by the Care Quality Commission, with more than one trust struggling to move patients out of hospital.
The overall picture is one of serious challenges for the NHS in dealing with the critical winter period.
Many acute trusts are already reporting occupancy of 99 per cent, meaning that the normal seasonal service that can be expected in winter will be extremely difficult to cope with.
The closure of services at various trusts, longer lengths of stay for those awaiting nursing homes and social care, combined with increasing complexity of diagnosis and treatment have all contributed to the existing situation.
With NHS services expected to run up deficits in the region of £2 billion by the end of the financial year, the lack of beds combined with serious fiscal difficulties will unquestionably be a massive problem for the health service in the immediate future.
The Conservative government has already conceded that there is a deficit of £30 billion in NHS funding that needs to be met by the end of the decade, but suggest that most of this can be achieved via efficiency savings.
Increasingly, this opinion looks to be ill-founded at best.
According to a report released by Public Health England, the flu jab released last winter was effective in 34 per cent of cases.
This represented a significant improvement on the early trend in the season, but can overall be considered a sub-par result.
At one stage, it was observed that the vaccine was protecting around three out of every 100 immunised people developing symptoms.
However, according to the report, a shift in the dominant circulating strains of flu saw the efficacy of the vaccination improve significantly.
Nonetheless, considering that the flu jab was still ineffective in two out of three cases, there will still be question marks regarding the efficacy of this treatment.
Many campaigners have called into question the need for vaccination against influenza, considering that it is a relatively benign virus in healthy people.
And these latest figures certainly won’t dampen down any such criticism.
Commenting on the figures, Professor Paul Cosford, from Public Health England, conceded that its effectiveness had been “slightly lower” than usual.
In defence of the flu jab, it should be noted that the virus mutates very rapidly, ensuring that manufacturing and distributing an effective vaccine is extremely challenging.
This also explains the reasoning behind a new jab being released every year.
Considering the fact that vaccinations can have side-effects, the relatively disappointing figures could have a negative impact on uptake of the virus in 2015.
Officials are apparently concerned that public opinion could be swayed against the flu jab by the somewhat poor performance of the vaccination in 2014.
Nonetheless, Professor Cosford underlined his particular belief that vaccination remained an effective measure against the flu.
“Whilst it’s not possible to fully predict the strains that will circulate in any given season, flu vaccination remains the best protection we have against an unpredictable virus which can cause severe illness and deaths each year among at-risk groups. These include older people, pregnant women and those with a health condition, even one that is well-managed,” Cosford asserted.
According to the World Health Organisation, flu vaccines can typically be expected to work in roughly 50 per cent of cases.
But the winter past featured one particular strain of flu that mutated so dramatically that the vaccine proffered presented much lower levels of protection than would usually be expected.
An EU report in 2014 suggested that pensioners in Britain are more likely to die of flu or pneumonia than anywhere else in Europe, and that 80 Britons die from the diseases every day.