Leading doctor warns of winter chaos

Dr Cliff Mann, one of the country’s leading A&E doctors, has warned that this winter could be the worst in his memory for NHS hospitals. He expects many hospitals, particularly those that are already behind NHS targets or in financial difficulty, will be forced to declare a black alert; turning patients away and asking other hospitals to step in to help.

Patients left on trolleys in corridors, ambulances queuing up outside A&E, cancellation of operations and early discharge of patients are scenes expected to become widespread at NHS hospital across the country in the coming months. Dr Mann believes that January and February 2016 will be the most challenging time for A&E departments as they fail to meet the 4 hour waiting times and face bed blocking by a backlog of patients.

Last winter the NHS was on the verge of collapse due to increases in A&E attendees alongside a lack of funding and resources to deal with demand. This year is expected to be no different and Dr Mann, a Senior Consultant at Musgrove Park Hospital in Taunton, Somerset, has warned that “We will have so few available beds that the numbers of people waiting in A&E to be admitted to hospital will reach new records”. 20 our of 160 Trusts declared major incidents last year, but “significant incidents” or “black alerts” are expected to raise their heads this time round. Dr Mann’s concern is greater for hospitals who already find themselves in financial difficulty and working behind NHS targets. The latest NHS figures show that 80% of critical or emergency services are in deficit or already failing to meet their patient target; suggesting that the majority of hospitals in England may end up closing their doors to new patients at some time in the coming months.

Dr Mann said

I’m not going to predict Armageddon, but the most likely thing is that many trusts will declare major incidents. In the past a large minority of hospital have been in this predicament, but the challenged hospital is now really the norm rather than the exception”. He added “Sudden surges in demand will be widespread and difficulty to handle”.

The Department of Health has accused Dr Mann of scaremongering. It has said that preparations for winter have been underway for months and that

Enhanced, clinically led expert support is in place to support the systems under the most pressure”.

But the President of the Royal College of Physicians, Professor Jane Dacre, has echoed the concerns raised by Dr Mann. She says

More physician time is needed for diagnosis, treatment and monitoring. This leads to cancelled outpatient clinics, reduced time for teaching and education sessions, longer working hours, and healthcare staff being asked to do overtime or come in on days off to cover”.

What none of the commentators on this issue address is the cleaning up exercise that the NHS will face once A&E levels drop in the spring. With staff and departments working beyond limits and hospitals facing the prospect of turning away, the chance of mistakes occurring, diagnoses being missed or patients being harmed by premature discharge increase dramatically. Concern should not just be had for those waiting to be treated, but for those who finally make their way onto a ward or treatment room.

Patients are always entitled to safe and adequate treatment from the NHS, no matter how busy the hospital may be, and it is only right that injuries sustained by failures to provide such a level of care be compensated. The number of negligence claims being pursued may therefore increase and once the winter is over those hospitals will likely face the added pressure of dealing with litigation arising out of the failures. It is therefore crucial that as much as possible is done now to limit the effects of the winter surge and for doctors and nurses to be open with patients about what to expect when arriving at hospital and what other services can be utilised to help hospitals deal with patients safely and as quickly as possible.

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