NHS under pressure: Hospitals full at 9am as patients wait 12 hours to be seen in A&E

It is 9am and the hospital is already full.  

Patients are waiting an average of 12 hours to be seen in the emergency department - more than three times the NHS target.

It's a similar picture on the surgical ward - that's full too. Some patients are languishing on their beds in the corridors.

"We're in a bit of a surreal position," says Karen Kelly, the chief operating officer at Russells Hall Hospital, part of the Dudley Group NHS Foundations Trust.

She's chairing the morning meeting which is attended by heads of departments, consultants, nurses and paramedics.

They're standing socially distanced in a large room that has big monitors on the wall showing graphs, numbers and a dazzling variety of flashing lights.

"We've had a really difficult few weeks and the pressure is still on," Ms Kelly says.

Lack of space and short of staff

She's not wrong. The numbers are staggering: 220 medically fit patients are ready for discharge but have nowhere to go.

More than 100 ambulances have turned up, 20 out of 21 surgical beds are being used.

"I've got no beds at the moment," says a voice joining the meeting over video call.

"The bedded area in surgery is full and we have no discharges planned," says another voice.

"We're struggling for capacity at the moment simply because of lack of space," says another.

"Are diagnostics on the call," Ms Kelly asks.

"No, they're struggling with staffing," someone says.

The crisis faced by the NHS this winter is laid bare in this meeting. Staff look tired but they encourage each other to press on as the meeting draws to a close.

Not enough resources

The numbers don't add up here. Put simply, there are too many patients and not enough resources to deal with them all. But somehow, they will get through this day.

There is a simple truth in the NHS: the most seriously ill are treated first and whatever happens in one part of this complex system has inevitable knock-on effects elsewhere. This is the anatomy of the NHS - and two long years of a pandemic have taken their toll.

Craig Powell is seriously ill. His bowel has ruptured, and he is in agony. But the 28-year-old has already been waiting in the emergency room for 10 hours and there is no surgery bed or theatre available.

Liz Brooks is a surgical bed manager and right now she has a phone to each ear negotiating a way to find Mr Powell an operating theatre.

"Can we do a deal?" she says like a city trader.

"Is there anything we can do to speed this process up a bit?" she pleads, spinning a biro through her fingers.

"He's only a young guy. He needs to be operated on fairly urgently. We'll have to do a bit of moving around," she says.

At this same moment, a lady from Liverpool is expecting her much anticipated routine operation to go ahead. She doesn't know it, but the operation is about to be cancelled to make way for Mr Powell.

Ms Brooks walks at a million miles an hour through the wards. Suddenly she's in the emergency department and makes a beeline for Mr Powell in cubicle four.

"Hello. Is it Craig?" she says. "I'm Liz, the surgical bed manager. We've got you a bed and you'll be heading down to surgery very soon. All the best darling." And before anyone knows it, she's gone.

And before Mr Powell knows it he's being taken to surgery. Ten minutes later he's under the knife. But the other patient has to wait a bit more for their operation.

There are six million patients waiting for operations on the NHS now and that number is expected to double in the next year.

And while some people want to get into hospital, many thousands are desperate to get out.

Diabetic Paul Nolan was admitted to hospital last month with an infected leg. Surgeons couldn't save the limb and the decision was made to amputate.

The 54-year-old is medically fit for discharge but has declined the offer of a nursing home, instead opting to return to his own home.

But he cannot be discharged without a plan for his care. But his local social services department is under pressure too and no plans have yet been made. So he's stuck in a bed he no longer needs.

This is what the NHS calls a "delayed discharge" it's sometimes knowns as "bed-blocking" and it has huge consequences for the hospital.

"I don't want to be stuck in this bed depriving someone of it. But I cannot go to a nursing home," Mr Nolan said.

"It's not right for me. I have to be in my own home. But I am sitting here waiting and waiting for someone to find the support I need in my own home and it just isn't happening."

Rising patients stuck in hospitals

The number of patients stuck in hospital in England despite being medically fit to leave nearly doubled between February and November 2021. The rise is seen as more evidence that the crisis in the adult care system is creating backlogs in the NHS.

NHS England data shows that the number of times hospital trusts were unable to discharge a patient who no longer met the criteria to stay in hospital increased from 223,593 in February to 402,211 in November - a rise of almost 80%.

Diane Wake, chief executive of Dudley Group NHS Foundation Trust, said: "We can't address this problem as an individual organisation on our own anymore. It has to be worked out as a bigger system. We have to provide more care within a community setting."

'Calls have been coming in thick and fast'

And so as the sun sets on a chilly day, Lisa Bingham prepares to start work.

She's one of 10,000 district nurses whose job it is to treat people in the community - the kind of people Ms Wake thinks are the key to alleviating pressure from hospitals.

But there's a problem here too. District nurses are rushed off their feet.

"Since COVID, the calls have just been coming thick and fast," says Ms Bingham, who has been a district nurse for 12 years.

"As a nurse, you want to help people and if you've got calls coming in from people who are in pain or need assistance, and you've got nobody to send, then that makes you feel guilty.

"But we're out here on our own. We have to make the decisions. And at the moment it's taking an hour and a half to get through to the out-of-hours GP. So we have to try to come up with a solution to help that patient as best you can."