‘Winter feels like a scary place’: Bolton hospital prepares for zero capacity

‘Winter feels like a scary place’: Bolton hospital prepares for zero capacity

In a cubicle at the Royal Bolton Hospital, Zoe Grech waited to undergo thyroid removal surgery. When her consultant told her in May that she needed the operation, she expected quick treatment. “They told me I was put at the top of the list because it was affecting my breathing,” she said.

The 39-year-old nursery worker has spent the interim period in limbo, waiting for a position that has been six months in the making. She suffers from anxiety, a condition that has not been alleviated by waiting.

As the UK health system faces the triple threat of record delays, a winter wave of Covid and flu and historic strikes, the The NHS’s own vital signs are cause for alarm.

Graph showing that ambulance response times in England are the worst ever recorded.  On average, someone suffering from a stroke or heart attack now waits an hour for a paramedic

Grech is one of at least 5.5 million people in England waiting for hospital treatment, a powerful symbol of a system in crisis. Almost 390,000 people have been waiting for more than a year, a figure that in the eight years prior to the pandemic at no time exceeded 4,000.

Health leaders urged Chancellor Jeremy Hunt to protect health spending when he delivers the Fall Declaration on November 17. Last month, NHS finance director Julian Kelly revealed that the service was facing a funding black hole of around £7bn next year; services including cancer, mental health and general practice could be affected, he said.

Jennifer Dixon, chief executive of the Health Foundation, a research organisation, said the pressures on the NHS were the greatest she had seen in her 40-year career.

The last decade, in which the service has felt the scourge of austerity, has “just been so poor that we have not been able to accumulate, in particular, the labor that is needed, but also the capital that can save labor. work and new technologies that will enable the NHS to be even more productive than it is,” added Dixon.

Tyrone Roberts, chief nurse, said hospital staff are wearing thin: “They’re human beings and they get tired” © Asadour Guzelian/FT

If high inflation persists, without additional funding in the Autumn Statement, “the NHS is likely to face three years of falling purchasing power, unprecedented in its history,” it added.

The UK is already an international laggard, spending around 0.3 per cent of gross domestic product on capital spending on health care, well below peer countries. Britain has two hospital beds for every 1,000 people, fewer than any other wealthy Western nation, and far fewer MRI and CAT scans than its counterparts.

Chart showing the UK has under-invested in healthcare capital, leaving it with fewer beds and diagnostic scanners than comparable countries

The consequences can be seen in Bolton, North West England, where overwhelming demand from a growing and aging population, in the context of aging property, is straining resources.

Late last month, the trust was forced to declare a “critical incident” after being overwhelmed with an “excessive” number of patients waiting in accidents and emergencies, according to Tyrone Roberts, chief nurse. Such steps were generally associated with the harsh winter months, not a balmy October, he said.

Covid cases are at manageable levels, with 54 patients suffering from the disease, down from a peak of 171 in January. But the impact of the pandemic remains profound. Care-seekers are generally sicker, she said, “perhaps because they’ve stayed away and now they’ve come forward. Or are they more fragile, because they have been waiting [so] length.” The workforce is also running out after two and a half years of relentless pressure: “They are human beings and they get tired.”

A story of the past two years has been the lengthening of ambulance response times, in part due to difficulties unloading patients at hospitals due to a lack of beds.

Chart showing just 6% of English hospital beds are available for new admissions, the lowest available capacity since records began and below the level considered safe

The impact can be seen in the increasing waits for A&E. In England, 43,000 people spent more than 12 hours waiting for a bed in October after a doctor decided they required admission. The equivalent figure in October 2019 was 729.

In Bolton Hospital’s accident and emergency department, the scope of the challenge cannot be concealed. Imran Khan, leader of urgent care, said at the start of the recent critical incident “we had 90 patients. Our [major injuries and illnesses] The department is only built to house 21 patients.” At one point there was a 50-hour wait for a bed, she said.

Chart showing that England's A&E departments are in crisis, with tens of thousands of patients waiting more than 12 hours to be admitted

Steps like repurposing other parts of the emergency department to treat less urgent patients allowed him to weather the storm. “We’ve managed to keep everyone safe,” she said.

However, the department has had to adjust the way it works to deal with patients who go directly to the emergency room, who are unable or unwilling to make an appointment with their GP. “I always call it the Amazon Prime type of healthcare model: People want something and they want it now,” Khan said.

Niamh Brockenshaw, Head of Theaters and Nurseries: “We’re working hard on the free goodwill we have with our teams” © Asadour Guzelian/FT

Bolton is working hard to reduce the backlog of non-urgent treatment. More than 20 percent have been on the hospital’s waiting list for a year or more, but the number of 18-month-old waiters has dropped to 136, from 720 a year ago.

However, labor shortages are important. Niamh Brockenshaw, head of theaters and nurseries, said each morning that the big question is whether they have enough staff to carry out the operations scheduled for that day, along with emergencies.

Sometimes cancellations, which staff are desperate to avoid, can only be avoided if employees work beyond contracted hours or take on more menial roles to fill gaps in rotation, he said.

“As an organization, we’re working a lot on the free goodwill we have with our teams,” he said. The hospital has taken a novel step to increase the portfolio of new employees. Bolton NHS Foundation Trust is working with the city’s university, a local college and council to provide a direct route to health and social care by creating up to 20,000 new jobs and apprenticeships.

Chart showing that one in seven beds in English hospitals is now occupied by a patient who no longer needs a bed, but has not yet been discharged

The trust has managed, through targeted investment, to eliminate its endoscopy backlog, with wait times now at pre-Covid levels. But this is a rare bright spot. The impact of a frayed social care system has left Bolton, like so many hospitals across the country, struggling to discharge even medically fit patients. In England, 14 per cent of beds are occupied by patients who no longer needed to be in hospital, a record.

In Bolton, Cheryl Thompson, leader of reactive care, said that normally around 100 beds a day, out of a total of 578, are occupied by patients who could go home, although the composition of this group is constantly changing as she and your team are successful. in seeking community or family support for patients.

Imran Khan, head of emergency care, said at the start of the recent critical incident: “We had 90 patients. Our apartment is only built to accommodate 21′ © Asadour Guzelian/FT

She leads local authority and hospital staff, a sign of how health and social care services are increasingly working together to ease tension.

His fear, however, is reaching a place “where everything stops. . . where we have no capacity anywhere.” Looking ahead to the coming months and the demands that she and her team will face, she added: “I would say winter feels like a scary place.”

Cheryl Thompson, reactive care leader. She fears reaching a place ‘where everything just stops’. . . where we don’t have capacity anywhere’ © Asadour Guzelian/FT

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