The week that brought the NHS to the brink, told by medics on the frontline

It was the nightmare scenario feared by every doctor, nurse, hospital manager and health worker. 

Ambulances queuing for hours outside hospitals to unload patients, wards being converted into ad-hoc intensive care and high dependency units, operations for potentially life threatening conditions being cancelled to make way for emergency cases.

But that is precisely the scene being played out at hospitals around the country as Britain’s Covid infections hurtle ever upwards towards a third peak and the number of daily fatalities reaches more than 1,300.

Worse still there are now very real fears that the NHS is on the brink of being overwhelmed, leaving it unable to cope either with the demand for beds for sufferers of the virus or provide proper care for its non-Covid patients.

It was this prospect that led the British Medical Journal and Health Service Journal to publish an unprecedented joint editorial on December 15, calling for the Government to impose tougher restrictions over Christmas and adopt a greater sense of urgency over the worsening crisis.

A few days later SAGE, the Government’s independent scientific advisory group for emergencies, told ministers they had to shut schools before Christmas to contain the virus, followed by the Independent Sage group of experts saying on December 30 that unless the whole country was immediately put under lockdown there could be ‘tens of thousands’ of avoidable deaths. 

Healthcare professionals say those fears have already come to pass and can only get worse in the coming weeks, as infection rates rise across the entire country – despite the eventual  imposition of Tier 4 restrictions across much of Britain, followed by the national lockdown finally ordered by the Prime Minister on Monday.

Siva Anandaciva, chief analyst of the King’s Fund health think tank said: “It’s not hyperbole to say that the (National Health Service) is going through probably the toughest time in living memory.”

The last three weeks have seen repeated alarm bells sounded, serving as a warning that the NHS was on a knife edge.

To take just one, on December 27 the Queen Elizabeth Hospital, in Woolwich, southeast London declared a major incident over fears about a shortage in oxygen caused by the demand from coronavirus patients on its wards.

The hospital was forced to ask London Ambulance Service to take emergency patients to other units amid concerns about the flow of oxygen to patients, with the numbers of coronavirus patients needing more oxygen than it could deliver to the wards.

On New Year’s Day it emerged that The Royal London Hospital, in Whitechapel, was operating in "disaster medicine mode" and unable to provide "high standard critical care", with only one nurse for every three Covid patients being treated in intensive care.

A leaked email message revealed the dire state of the situation, with staff told: "We are now in disaster medicine mode. We are no longer providing high standard critical care, because we cannot.

"While this is far from ideal, it’s the way things are, and the way they have to be for now."

Video footage began to emerge of large numbers of ambulances queuing outside hospitals, including the Queen Elizabeth Hospital, in Birmingham, with reports of some patients waiting for as long as 12 hours and having to be treated in the back of emergency vehicles because beds were full. 

Ambulances and a police car are seen outside the Queen Elizabeth Hospital Birmingham 

Credit:  REUTERS

It soon got worse.

On Wednesday an official briefing for some of London’s most senior doctors warned that the capital’s hospitals are less than two weeks from being overwhelmed – even under the ‘best’ case scenario.

In a Zoom call to the medical directors of London’s hospital trusts Vin Diwakar, NHS England London medical director, displayed a series of slides showing that showed that even if the number of Covid patients grew at the lowest rate considered likely, and measures to increase capacity, such as opening the Nightingale hospitals, were successful, the NHS would be short of nearly 2,000 general and acute and intensive care beds in London by 19 January.

Dr Diwakar later issued a statement saying: “Hospitals in London are coming under significant pressure from high covid-19 infection rates which is why they have opened hundreds of surge critical care beds and are planning to open more, including opening the London Nightingale.

“While staff are going the extra mile to care for patients it is crucial that people do everything they can to reduce transmission of the virus.”

Reports from inside a growing number of beleaguered units around the country suggest front line healthcare staff now feel as if they are trying to stem an unending tide.

Monday (January 4) was the busiest day in the 15-year history of the West Midlands Ambulance Service, with 5,383 calls in 24 hours. The previous record was 5,001 calls in March 2018.

How occupancy compares to the spring peak

One paramedic currently working across the region told The Telegraph: “I spent three and a half hours with an elderly patient on the back of my ambulance waiting for a bed to come free.”

He added: “For me and my colleagues it’s been incredibly busy with very, very long delays sitting outside hospitals.

“Nurses tell us that we can’t move people upstairs because there’s nowhere to move them to. There’s simply nowhere to put our patients inside A&E.”

The division of hospitals into ‘red zones’ and ‘green zones’ with a view to isolating virus patients has only made the situation more complicated in the face of “severe” delays, the paramedic said.

“For all types of patients there are severe delays outside many hospitals. A&E at the moment is essentially cut in half and the delays are for both types of patients,” said the paramedic.

Capacity problems on the wards have been worsened by staff shortages. Around 46,000 NHS staff are now off sick with coronavirus after catching it in the community or while working, according to the Doctor’s Association. 

This amounts to one in ten of Britain’s doctors and nurses, only adding to existing problems around staffing.

An NHS intensive care nurse in south Wales told this newspaper his hospital currently runs every shift “at least a couple of people short” as some colleagues self-isolate while bed occupancy continues to increase.

“We are doubling up critical care patients for every critical care nurse, which is not normally the case,” he said. “There are lots of gaps and some we just can’t fill, which creates more pressure. It’s disheartening from that point of view.

“We’re seeing sicker, younger patients than we did the first time round. In the last few weeks we’ve had people in their twenties, thirties, and forties unfortunately succumb to Covid.

“It’s a vicious, indiscriminate disease and people are just so badly affected. They’re sicker for longer and need much more support. People are dying with their eyes wide open, looking at you in fear as they’re holding your hand.”

As the surge in admissions is inevitably followed by a rise in the number of people who have died, some on the frontline are exhibiting symptoms of post-traumatic stress disorder, the mental toll of the pandemic too much to bear.

“I regularly see members of nursing staff and medical staff crying before, during and after shifts," the nurse said. With his hospital "really struggling", he fears that few  lessons have been learned from the first wave of the virus last spring.

“You can have as many intensive care beds as you want, but if you haven’t got the staff to look after those beds they’re next to useless anyway. It’s a really worrying time for all of us and there are just more and more patients coming.”

In parts of northern England Covid patients in need of urgent medical treatment are being sent to Scotland as an increasing number of hospitals now face being overwhelmed.

Hospital occupancy

Patients in Cumbria, who would normally be taken to the Cumberland Infirmary in Carlisle have instead been dispatched across the border to Dumfries after the hospital triggered the highest Opel (operational pressures escalation level) alert, signalling it was “unable to deliver comprehensive care”.

Several patients being treated in the centre’s intensive care wards have also had to be transferred 60 miles to Newcastle in a bid to relieve the growing pressure.

The situation grew rapidly worse, with the United Lincolnshire Hospitals NHS Trust declaring a critical incident on Tuesday and hospital chiefs in Birmingham issuing warnings over the pressure on nurses in critical care departments.

On Thursday St Helier Hospital in south London became the latest to divert emergency patients to other hospitals after demand for oxygen reached unsustainable levels. – a problem being faced by several hospitals around the country.

Professor David Oliver, a consultant with 31 years experience who works in another hospital in the south east, said: “I’ve never seen so many patients needing oxygen for so long. More and more wards are being occupied by Covid patients and these people can’t go home quickly so more and more beds are being turned into Covid beds.”

Another doctor, working at a hospital in London, painted a grim picture of the pressures being faced by staff.

"We’re having to convert all our beds into high-dependency areas where you can ventilate patients," said the doctor. "The problem with Covid is it’s brought the NHS to the brink because of the acuity of the patients. They’re harder to look after because they’re so sick. We’ve got the Nightingale empty and the reason for that is a shortage of critical care nurses, otherwise they could fill it."

"So many lives have been saved but it’s the sheer number of patients. We’ve got a new variant that is much more transmissible and they’re still being given PPE that isn’t good enough.

"It just means that if you’re a hospital worker you could be transmitting to patients as well."

At University College Hospital in central London staff warned quality of care would begin to suffer significantly within days if the number of admissions from Covid did not begin to slow down.

Staff at the hospital spoke of being placed in the position of having to choose who receives care first. 

Deputy sister Ashleigh Shillingford, who alongside one other junior member of staff looks after three or four ventilated patients at a time, told a BBC camera crew last week: "We are so stretched we have to prioritise and prioritising care is not the NHS that I grew up in – we shouldn’t have to choose which patient gets what care first. You just don’t know who to help first."

An Air Ambulance car outside the Royal London hospital on January 8, 2021 in London

Credit:  Getty Images 

The picture worsened still further on Thursday, when it emerged that the south west, the English region least touched by coronavirus, was now showing the sharpest growth in the number of beds filled with Covid patients.

In the seven days to 6 January, the south west saw a 29 per cent increase in Covid inpatients. This compared to the English average over that period of 22 per cent growth, and the 27 per cent growth seen in London, the second fastest rising region.

The south west, which has a relatively low population density and the lowest hospital capacity in the country, now has 142 per cent of the Covid inpatients seen at the peak of the first wave.

The figures showed that London is under the greatest pressure, with the seven day total up by 257, or 65 per cent, in the period to 31 December. The south east’s performance is also grim. The number of deaths there has risen 45 per cent.

Even the least affected region, the north east and Yorkshire and the north west saw rises of six and four per cent respectively over the same period.

Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, said ambulances left queuing outside hospitals meant crews were not available to respond to other emergencies and the service was facing a "crisis" unlike any other he has seen.

Dr Boyle said: “People may feel they have a winter crisis every year but this is a different order of magnitude. This is the worst winter crisis I’ve been through in my 25 years of practising as a doctor."

Then, on Friday, the Mayor of London, Sadiq Khan, declared a ‘major incident’ in the capital, as the coronavirus infection rate in London exceeded 1,000 per 100,000 people, a 27 per cent increase in hospital patients between December 30 and January 6.

There are now more than 7,000 people in hospital with Covid-19, a 35 per cent increase compared to the previous peak of the pandemic.

Mr Khan also announced plans to open London’s NHS Nightingale hospital in the “coming weeks” to treat recuperating patients in the hope of freeing up beds elsewhere.

But Dr Tom Dolphin, a British Medical Association (BMA) council member and consultant anaesthetist in London, warned the worst was yet to come: “We are seeing unrelenting waves of patients coming into hospitals every day with Covid as well as with other winter issues and we haven’t seen the peak yet after the mingling of households over Christmas.”

Like so many other front line healthcare workers he urged the public to continue taking social distancing measures seriously, to help slow and eventually stem the spread of Covid.

“Staff are struggling to cope,” he said. “It’s coming to the point that, despite reducing elective work, converting beds into Covid intensive care wards and taking other mitigating measures, hospitals are close to being overwhelmed.”

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