Pressure on hospitals is particularly high this winter, with more than a dozen declaring critical incidents in recent days.
Hospitals struggle every winter with additional pressures due to the impact of cold weather, but the early arrival of flu this season and high volume of cases meant Christmas and New Year’s weeks were even busier than usual.
There are currently at least 20 hospitals that have declared critical incidents in England, although this is a fast-moving picture, and some trusts will go into critical incident for as little as half an hour.
The latest NHS winter situation reports give a more detailed look at the level of pressure experienced by individual trusts, including those with the worst ambulance handover delays and highest levels of flu patients.
Ambulance handover delays
When a patient arrives at a hospital in an ambulance, clinical guidelines suggest that it should take no longer than 15 minutes to transfer them into emergency care.
It is now common for handovers to regularly exceed this timeframe, however, when emergency departments are overcrowded and lack the capacity to keep up with new patient arrivals.
This is risky for patients because it delays their assessment and treatment by clinicians, and also reduces the availability of ambulances to respond to new incidents.
The trust with the longest delays was University Hospitals Plymouth, with an average handover time of three hours and 33 minutes over the week – two hours and 40 minutes longer than the average for England. It also recorded the longest average handover times for a single day, at five hours and 14 minutes on New Year’s Day.
Use the table below to search for local ambulance handover times:
On 7 January, University Hospitals Plymouth declared a critical incident at Derriford Hospital due to “significant and rising demand for hospital care”, though this has since been stood down.
The Shrewsbury and Telford Hospital Trust had an average ambulance handover time of three hours and 15 minutes, increasing by more than an hour from one hour and 51 minutes the week before.
In Royal Cornwall Hospitals NHS Trust, 83% of handovers took more than 30 minutes, the highest share among areas dealing with more than five ambulance arrivals per day.
This area also recently declared and then stood down a critical incident.
In total across England, 43 trusts out of 127 had average handover times of more than an hour, while nine areas had average handover times of more than two hours.
Flu
This winter’s flu wave arrived earlier than usual and has hit health services hard.
Over New Year’s week, there were 5,407 flu patients in hospitals in England on average each day, more than three times higher than during the same week last year and increasing by 20% from the week before.
The worst impacted trusts were Northumbria Healthcare and University Hospitals Birmingham, with 15% and 13% of all available beds occupied by flu patients respectively in the latest week.
Wirral University Teaching Hospital NHS Foundation Trust had among the biggest increase in flu patients from the previous week, more than doubling from 18 to 42 patients per day on average.
Use the table below to search for local flu hospitalisations:
There are some indications that flu activity may have now peaked, with national flu surveillance showing a decrease in positive flu tests in the latest week, though activity remains at high levels.
Bed occupancy
Current NHS guidance is that a maximum of 92% of hospital beds should be occupied to reduce negative risks associated with overfilled beds.
These risks include the impact on patient flow resulting from it being more difficult to find beds for patients, and negative impacts on performance and waiting times, as well as being linked to increased infection rates.
In the week to 5 January, 92.8% of 102,546 open hospital beds were available each day on average, not far off the recommended level.
However, bed occupancy was very high in some trusts, with more than 95% of beds occupied in 43 trusts on average over the week.
The trust with the highest rate of bed occupancy was Wye Valley NHS Trust, with 99.9% of 332 beds occupied on average throughout the week.
There was only one day when beds weren’t fully occupied, on 3 January, when two beds of 322 were available.
Use the table below to search for local bed occupancy:
Kettering General Hospital NHS Trust recorded bed occupancy of 98.5% over the week. This trust declared a critical incident on 8 January.
Part of the problem for bed availability is prolonged hospital stays – also known as bed-blocking.
This is often linked to pressures in other parts of the health and social care system, for example when patients can’t be discharged to appropriate social care providers even though they are ready to leave hospital.
Just under half of beds occupied by patients in English hospitals last week were occupied by long-stay patients who had been there for seven or more days.
In seven trusts, at least three in five beds were occupied by long-stay patients, while in Barking, Havering and Redbridge University Hospitals NHS Trust the figure was more than four in five beds.
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