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Huge pressures at hospitals across the NHS over the last month have led to long delays for patients seeking emergency care, figures suggest.
The NHS England December data showed record delays in A&E with one in five patients waiting more than four hours.
A key problem seems to have been a shortage of beds on wards.
The figures show nearly 100,000 of the sickest patients faced hours stuck on trolleys and waiting in corridors while beds were found for them.
Some hospitals were even forced to introduce emergency protocols and turn away walk-in patients deemed not to need immediate help, while many have postponed routine operations to fee up space.
Royal College of Emergency Medicine president Dr Katherine Henderson said: “The NHS is struggling to escape its spiral of decline.
“This will have been a miserable Christmas period for many patients and staff alike.”
‘My father-in-law spent 25 hours waiting for a bed’
George Bufton was kept waiting on a hospital trolley
Mark Newton’s 83-year-old father-in-law, George Bufton, was taken to a hospital in the Midlands in the first week of January.
He had a chest infection and a suspected gall bladder problem – and this came just over a month after he’d had a major bowel cancer operation.
He spent 25 hours waiting for a bed to be found.
Mr Newton said he was “gobsmacked” by what he saw.
At one point around 20 trolleys were stuck waiting in the corridor, with queues of ambulances outside A&E.
He said staff were doing an “admirable” job in the circumstances, but there was just not enough money or staff to cope.
“It was utter mayhem. This can’t continue. Something must be done about it,” Mr Newton said.
How bad has it been?
December was certainly the worst month since the four-hour target was introduced in 2004.
Just 79.8% of patients spent less than four hours in A&E – well below the 95% target.
Three trusts – Norfolk and Norwich, Stockport and Hull – all saw performance drop below 60%, while a group of Midlands trusts – Shrewsbury and Telford, Leicester, Birmingham and United Lincolnshire – were all in the 10 worst performers.
Waiting times have been getting gradually worse over the autumn – October and November saw record worst levels set as well.
But the problems in emergency care has not just been confined to A&E waits.
The number of patients who then needed to be admitted on to the ward and faced long delays also hit a new worst level.
There were 98,500 patients who faced a so-called “trolley wait” of a further four hours.
That is nearly one in four of the patients who needed to be admitted.
These “trolley waits” can be in corridors or temporary waiting areas, either in A&E or just outside.
Patients who are admitted are often the sickest of those who attend A&E.
But it is not just A&E units that are struggling. The waiting time targets for cancer treatment and routine operations, such as knee and hip replacements have also been missed.
What is the cause of the pressures?
Hospital bosses acknowledged it had been one of the most difficult months they had seen – and this comes despite the extra money the government has put in this year, which saw the NHS budget grow by 3.5%.
There are a variety of reasons behind the problems.
Prof Joe Harrison, chief executive of Milton Keynes Hospital, said his staff had been seeing some very sick patients.
He said it had mainly been a combination of older patients and children, who seemed to have been particularly hard hit by flu and respiratory problems.
Although the figures also show that the number of beds that have had to be closed to contain vomiting and diarrhoea outbreaks has risen by more than 60% compared to last year with 760 beds closed on average each day last month – that is closed to 1% of the bed supply lost.
Prof Harrison also said the social care system in the community, which hospitals rely on to discharge patients into, seemed to have been struggling more than it was last year.
“Keeping people safe has been our main priority. There is significant pressure, not just in this hospital, but across the NHS system as a whole,” he said.
Richard Murray, from the King’s Fund think tank, said he believed there were too few beds in the system.
‘Hospital bed numbers have fallen significantly over the past decade. With hospitals running full to capacity and patients waiting an unacceptably long time for the urgent care they need, it is clear that bed reductions have gone too far.”
The extreme measures being taken
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Ambulance crews have been reporting severe pressures, with the number of hours lost queuing outside A&E units waiting to handover patients to hospital staff rising.
One in six crews had to wait longer than 30 minutes – the target is 15.
A number of ambulance trusts have taken paramedics off ambulances and deployed them to manage the queues in attempts to keep delays to a minimum.
There have been reports of some hospitals ordering staff not to talk to journalists about the mounting pressures.
Routine operations have been cancelled in many places in an attempt to relieve the pressure on wards.
In the most under-pressure hospitals, emergency protocols have seen A&E units refusing to treat walk-in patients so they can focus on patients brought in by ambulances.
There were more than 120 cases of this happening last month – with some hospitals instigating the measure, known as an A&E divert, multiple times.
And in the West Midlands, ambulance bosses have ordered crews to avoid taking care home residents in Worcestershire and Shropshire to local hospitals unless it is an absolute emergency because of the “extreme difficulties” being experienced.
The picture across the rest of the UK
The difficulties have not just been confined to England either – none of the three core targets covering A&E, routine operations or cancer are being met in the other three nations.
In recent days, the Hywel Dda health board, which is in charge of services in west Wales, said it had had to cancel planned surgery at a number of local hospitals because of the “challenging” situation.
The British Medical Association said services across the nation had been stretched, with some reports cancer surgery had had to be cancelled too.
The four-hour performance figures for December will not be released by the Welsh government until later in the month.
Scotland’s figures are not available yet for the festive period either although November was one of the worst months on record.
Meanwhile, in Northern Ireland, which has the worst record when it comes to A&E delays, there is concern that on-going strikes by nurses will have exacerbated the winter pressures.
While A&E departments have remained running during the strikes, the second round of which took place this week, there have been reports that hospitals have struggled to discharge patients quickly enough.
This has a knock-on effect of causing delays admitting patients.
According to the latest figures, which date back to September, a third of patients were waiting longer than four hours in A&E, which was twice as bad as the situation in England and Scotland during that month.
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