Swine flu- NHS hospitals gridlocked

The NHS is in “gridlock”, with hospitals across the country being forced to declare that they have reached the highest level of emergency because of flu and other winter viruses.
Swine flu- NHS hospitals gridlockedBritain’s most senior accident and emergency doctor said that four weeks of intense pressures had left casualty departments “overwhelmed” with patients.

He said desperately sick people had been left for hours waiting on trolleys, with even those requiring intensive care enduring long delays.

Dozens of NHS units have cancelled surgery and clinics for outpatients.

At least 10 major centres issued “black alerts” — the highest emergency warning — meaning they were at breaking point, forcing patients to be sent elsewhere.

Scores of hospital wards closed due to norovirus, the winter vomiting bug, which put more than 1,200 beds out of use in one week as nurses attempted to isolate the disease.

Hospitals in Cambridge and Norfolk were on “black alert” for more than two weeks. In the past 10 days, major hospitals in London, Liverpool, Surrey, Southampton, Peterborough, Derby, King’s Lynn and Great Yarmouth issued the same warning.

While many hospitals did not schedule non-emergency surgery during the Christmas and New Year period, in the past week dozens cancelled thousands of planned operations.

Routine surgery was stopped at hospitals in Leicester, Sheffield, Macclesfield, Middlesbrough, Northallerton, Durham, Darlington, Bassetlaw, Belfast, Portsmouth, south Wales and many parts of London.

Last night it was disclosed that two boys, aged two and 10 months, had died from swine flu in Northern Ireland.

John Heyworth, the president of the College of Emergency Medicine, said: “We have seen A&Es absolutely overwhelmed, with people queuing on trolleys and long delays even for those being admitted to intensive care. The hospitals are gridlocked.”

He expressed anger about the failure of Government and the NHS to develop sufficient contingency plans, given that a flu outbreak was widely anticipated following the swine flu pandemic in 2009. “My frustration is that so much of this is predictable. This did not come out of the blue and yet the planning is inadequate — as though there is a sense of denial about it. The planning this winter has been far less effective than last year.”

Mr Heyworth claimed that casualty units had been hit by a “dramatic surge” in demand not just because of an increase in the number of very sick patients suffering flu complications, but also because less serious cases went to A&E because they could not see a GP at evenings or weekends.

“In many parts of the country out-of-hours services are absolutely inadequate, so what we get is people turning up at A&E simply because they do not know where else to go, or else they delay and only seek help when their condition is serious,” said Mr Heyworth. It is not good enough. We are failing the public.”

Across the country, hospitals were struggling to cope. Southampton General Hospital spent more than three weeks on “black alert”, closing 10 wards as norovirus swept through the centre. It was forced to stop all non-emergency surgery and cancel most appointments for outpatients during the period. The crisis warning was finally lifted on Thursday.

Because of the same bug, four wards were closed at Royal Cornwall Hospital last week and cancer and surgery wards in Poole, Dorset, were closed to new admissions. Three wards were closed at West Suffolk hospital.

On Thursday, it was disclosed that the number of deaths from flu had almost doubled, with 110 deaths this winter.

Hospitals were already struggling to cope with an increased number of elderly patients needing surgery following falls during the big freeze when they were hit by rising influenza admissions and cases of norovirus.

The latest figures for England showed that in the week ending last Sunday, 23 casualty units were filled to capacity, forcing ambulances carrying emergency patients to take desperately sick people miles further for treatment.

The Government was criticised by influenza experts for failing to introduce a national public advertising campaign about the perils of swine flu until Jan 1, by which time the outbreak was on course to hit epidemic levels.

Katherine Murphy, of the Patients Association, said: “It is really worrying that the NHS is not prepared to deal with these sorts of pressures. The system is on a knife-edge, and it does not have enough slack in it to cope once we have an outbreak of flu and cases of norovirus.”

She said the charity was “inundated” with calls from elderly people who had their operations cancelled and had not been given a date for the surgery to go ahead.

“What concerns me even more is that this is happening at a time when the health service is gearing up to make major savings, and massive reforms,” said Ms Murphy.

A spokesman for the Department of Health said there was always more pressure on the NHS at this time of year and insisted that the service had been prepared and was coping well.

“This year’s flu has resulted in greater than usual numbers of patients requiring critical care,” he said.

“Where necessary, local NHS organisations have increased their critical care capacity, in part by delaying routine operations requiring critical care back-up. This is a normal operational process which is initiated by NHS organisations at the local level.”

From: http://www.telegraph.co.uk/Swine-flu-hospitals-gridlocked

Intensive care beds disaster warning by Lancet

Intensive care bed experts believe there will not be more intensive care beds as health budgets shrink.
Intensive care beds disaster warning by LancetThe relatively low number of intensive care beds in UK hospitals means it is poorly prepared for major disasters, a report in the Lancet says.

Critical care experts say there may be as few as 3.5 intensive care beds per 100,000 people in the UK, compared with more than 24 per 100,000 in Germany.

Dr Gordon Rubenfeld, from Sunnybrook Health Sciences Centre in Toronto, said that huge investment would be needed to keep pace with the growing demand for intensive care services.

One figure suggests that by 2030, the incidence of acute lung injury will have risen 50%, driven by pneumonia cases in older people.

Dr Rubenfeld analysed the availability of critical care beds in various countries, and while conceding that the figure of 3.5 per 100,000 might under-represent the true position, he concluded that, at present levels, the UK would not be in a good position to deal with the extra demands of a disaster.

If we have a pandemic of normal winter flu we would be stretched to the limit”

Currently, an intensive care bed costs the NHS about £1,500 a day, and Professor Mervyn Singer, from University College London, said it was unrealistic to expect a significant expansion of intensive care at a time when health budgets were shrinking in real terms.

He said: “We are clearly in a worse position than some other countries because there is no spare capacity in the system, with many units running at 100% capacity, or close to it.

“While it would be nice to have extra wards and staff ready in the event of a disaster, it is not a particularly pragmatic expectation.

“There are things you can do in the event of a disaster, such as cancelling surgery, which frees up beds, but it is very much a ‘make do and mend’ approach in these circumstances.”
Local demands

Dr Kevin Gunning, a consultant in intensive care at Addenbrooke’s Hospital, Cambridge, and a spokesman for the Intensive Care Society, said that in the event of a major pandemic or other disaster, the true determinant of intensive care capacity would be staff such as trained nurses rather than beds or equipment.

While there had been significant improvements since the year 2000, when a severe outbreak of winter flu caused problems across the NHS, he said the UK was still relatively poorly resourced compared with much of western Europe.

He said: “It’s fair to say that we would have struggled with a flu pandemic of the scale some were predicting last year.

“If we have a pandemic of normal winter flu we would be stretched to the limit.”

A Department of Health spokesman said: “The number of beds has increased and continues to increase but more does need to be done in some areas.

From: http://www.bbc.co.uk/news/health-11503873