Patients needing emergency treatment are becoming sicker in A&E as hospitals struggle to free up enough beds, top doctors have warned.
Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), told The Independent that elderly patients are waiting so long for treatment in A&E that they’re developing bed sores and delirium.
Another senior NHS doctor, Dr Vicky Price, who is president-elect of the Society for Acute Medicine, warned that corridor care is now “routine practice” with the situation only set to worsen as A&E departments come under increasing pressure.
Their comments highlight the ongoing chaos in emergency medicine, as strikes take place during the most difficult time of the year. The chief executive of the NHS, Amanda Pritchard, said on Thursday that last winter was the worst she’d ever seen for the health service, warning that strikes by junior doctors will only make the situation harder for hospitals this year
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The warnings come as the latest NHS data shows that the prime minister, Rishi Sunak, could fail in his promise to deliver 5,000 more acute hospital beds to the NHS this month. Current data shows that the NHS is falling short of the target by just under 1,200 beds, with 97,818 against a target of 99,000.
This week, a flurry of NHS hospitals have sent out alerts warning patients that their A&E departments are “extremely busy” as winter has driven an increase in flu and respiratory viruses.
One senior emergency care doctor in the north of England told The Independent that, by November, their hospital was already having to put patients in non-ward areas with “no oxygen ports, no curtains, no privacy”.
They said: “[They’re] often in really poor areas. So imagine you’re at the doctor’s desk writing your notes, and on the other side of the desk is an 84-year-old on a trolley who keeps asking for the toilet, but there are 95 patients in the department and 14 nurses. We’d normally open surge areas for these patients, but due to staffing levels, there are no nurses to staff them.”
Last year, The Independent revealed that 12-hour waits in A&E may have been linked with as many as 15,000 deaths. Subsequent estimates by the RCEM have suggested that the death toll is now likely to be twice that.
Earlier this year, Dr Boyle said that the government’s winter plan would lead to thousands dying avoidably, warning that the NHS needed at least 11,000 more beds.
Now, in an interview with The Independent ahead of Christmas, Dr Boyle has warned: “All A&E staff are really stretched. Because they’re not only looking after the patients who are already in emergency departments but are also responsible for the new arrivals, things like pressures sores can get missed.”
He said: “One of the things that we’ve seen, very strongly, is that our emergency department nurses are having to provide care normally carried out on wards rather than in an emergency department, such as giving second doses of antibiotics and making sure somebody gets all of their medication. And it’s not something they trained necessarily to do, but they’re having an extra level of care for a whole new group of patients.”
He added: “The system, which should be designed to help people get better, is making people sicker.”
On long waits, which he said are “particularly harmful” for older people, Dr Boyle said: “That is extremely concerning. I would go as far as to say it is societally unethical that we are subjecting our older people to these long stays.”
He also warned that elderly patients stuck for hours on trolleys in A&E are developing delirium as a result of being left in this “noisy, uncertain and agitating” environment.
Dr Price, of the Society for Acute Medicine, told The Independent: “We have been warning of the dangers of corridor care almost all year, and the fact it has persisted for such a duration reflects that it is now perceived as routine practice – but it is unacceptable. It is not safe, particularly for older patients; it is degrading, and it is demoralising for staff.”
She said that, given the current state of stretched emergency care services, the problem is likely to worsen.
In September, the society found that a coroner in Blackpool had issued a warning over the death of an 80-year-old man who had died while waiting in a chair to be seen by a doctor in an overcrowded emergency department.
Dr Price said: “This was not an isolated case, and many more ... will sadly have similar experiences over the next few months, as there is a tacit acceptance and almost normalisation of poor urgent and emergency care heading into this winter.”
Eighty-one year old patient died after 40 hour A&E wait
George Griffiths, 81, was left waiting for more than 40 hours in A&E at the Wye Valley NHS Trust, a coroner’s report said. He died after developing a pressure sore, which was found to have contributed to his death. During his extended wait, staff within the department failed to notice Mr Griffiths’s toe had turned gangrenous, as they did not remove his shoes.
In its response to the coroner, the trust said that when Mr Griffiths was admitted to A&E, the NHS was “experiencing unprecedented demand and excessive waits in emergency departments”.
A serious incident investigation into Mr Griffiths’s death revealed a failure by staff to assess and treat him for pressure-sore damage, and found that “significant staffing shortages” had played a part in this.
Mr Griffiths’s partner of 20 years, Shirley Corbett, told The Independent about the shock of seeing him in A&E four days later. He still had the same clothes on and his shoes had not been removed.
“I got to see him – he was so confused,” she said. “It was quite hard to watch. He was crying in pain as well, and he’s a big man – he never cried normally, but he was in so much pain. I was so shocked because he still had got his shoes on, and his clothes on, and he was upset because he had a catheter in and it was very sore. I told them [before he went into A&E] to take his shoes off. It was absolutely terrible.”
Before he became ill, Ms Corbett said, her partner was a “comic” and “a lovely man” who would “do anything for anybody”.
In a statement, Wye Valley NHS Trust said: “We are very sorry for the inadequate level of care that Mr Griffiths received during a time of very significant demand in our emergency department. The trust takes this incident very seriously and has put in place a number of measures and changes to improve skin-pressure care in the department, including a refreshed process of senior nurse review as well as providing mattress-toppers and air mattresses for those most at risk.”
Rachel Power, the chief executive of the Patients Association, told The Independent: “We are dreadfully worried about the coming winter and how patients will fare in an NHS that is so stretched. Last year, we witnessed patients treated in hospital corridors, left in pain and distress on the floor at home, and unnecessary deaths as a result.”
An NHS England spokesperson said the latest figures show that NHS hospitals have 1,200 more patients compared with this time last year, alongside a rise in patients with winter viruses and 12,800 beds taken up with those waiting for discharge.
However, they said that the NHS now has more than 3,000 extra beds compared to August, and that work continues to hit the target of 99,000 beds.
The Department of Health and Social Care said it is on track to hit the 5,000 extra beds target.