‘Winter feels like a scary place’: Bolton hospital has adjusted to no capacity

In a stall at the Royal Bolton Hospital, Zoe Grech waited to undergo surgery to remove her thyroid. When her doctor told her in May that she needed surgery, she expected quick treatment. “I’ve been told I was put at the top of the list because it affects my breathing,” she said.

The 39-year-old kindergarten teacher has spent the meantime in limbo, waiting for an appointment that took six months to arrive. She suffers from anxiety, a condition that waiting hasn’t helped.

With the UK healthcare system facing the triple threat of record backlogs, a winter Covid and flu outbreak and historic strikes, the NHS’s own vital signs are a cause for concern.

Chart showing ambulance response times in England are among the worst on record. On average, someone with a stroke or heart attack waits an hour for a paramedic today

Grech is one of them at least 5.5 million People in England awaiting hospital treatment, a powerful symbol of a system in crisis. Nearly 390,000 people have been waiting for more than a year — a number that has not exceeded 4,000 at any point in the eight years leading up to the pandemic.

Health leaders have urged Chancellor Jeremy Hunt to protect health spending when he delivers the autumn statement on November 17. Last month, NHS finance director Julian Kelly announced the service would face a funding gap of around £7billion next year. Services like cancer, mental health and general medicine could suffer, he said.

Jennifer Dixon, chief executive of the Health Foundation, a research organization, said the pressure on the NHS was the greatest she had experienced in her 40-year career.

The last decade, in which the service has suffered from austerity pressures, has been “simply so meager that we have not been able to build up the labor force needed in particular, but also the labour-saving and labor-saving capital and the new technologies that will make the NHS possible yet.” to be more productive than before,” added Dixon.

Tyrone Roberts, Head Nurse, said hospital staff were burning out: ‘They are human and they get tired’ © Asadour Guzelian/FT

If high inflation continues without additional funds in the Autumn Declaration, “the NHS is likely to face three years of declining purchasing power, unprecedented in its history,” she added.

The UK is already an international laggard, investing around 0.3 per cent of GDP in healthcare investments, well below peer countries. The UK has two hospital beds per 1,000 people, fewer than any other affluent Western nation, and far fewer MRI and CAT scanners than its counterparts.

The chart shows that the UK has underinvested in healthcare capital, leaving it with fewer beds and diagnostic scanners than comparable countries

The fallout can be seen in Bolton, North West England, where the overwhelming demands of a growing and aging population against a backdrop of an aging estate are stretching resources to the limit.

Late last month the Trust was forced to declare a “critical incident” after being overwhelmed by an “excessive” number of patients waiting during accidents and emergencies, according to Chief Nurse Tyrone Roberts. Such moves are usually associated with the difficult winter months, not a mild October, he said.

Covid cases are at a manageable level with 54 patients suffering from the disease, down from a peak of 171 in January. But the impact of the pandemic continues to be profound. People seeking care are generally sicker, he said, “perhaps because they stayed away and have now called in. Or they are more frail because they have waited [so] long.” The workforce has also burned out after two and a half years of constant pressure: “You are human and you get tired”.

A history of the past two years has been the increase in ambulance response times, in part due to difficulties unloading patients at hospitals due to a bed shortage.

The chart shows that just 6% of England's hospital beds are available for new admissions, the lowest spare capacity on record and below levels considered safe

The impact can be seen in increasing A&E wait times. In England in October, 43,000 people spent more than 12 hours waiting for a bed after a doctor decided they needed admission. In October 2019 there were still 729.

Inside the Accident and Emergency Department at Bolton Hospital, there is no hiding the scale of the challenge. Imran Khan, head of emergency care, said at the start of the latest critical incident: “We had 90 patients. Our [major injuries and illnesses] The department is only built for 21 patients”. At some point you waited 50 hours for a bed, he said.

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

Steps like repurposing other parts of the emergency room to treat less urgent patients made it possible to weather the storm. “We managed to protect everyone,” he said.

However, the department has had to adjust the way it works to cope with patients who come straight to the ER and 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.

Theater and Daycare Matron Niamh Brockenshaw: ‘We work very hard on the complimentary goodwill we have with our teams’ © Asadour Guzelian/FT

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

However, there is a serious shortage of workers. Theater and day care matron Niamh Brockenshaw said the big question every morning is whether, aside from emergencies, they have enough staff to carry out the operations scheduled for that day.

Sometimes cancellations, which employees are desperate to avoid, can only be avoided by having employees work past contracted hours or taking on more junior roles to fill roster gaps, she said.

“As an organization, we work very hard on the complimentary goodwill that we have with our teams,” she said. The hospital has taken a novel step to increase the pipeline of new employees. The Bolton NHS Foundation Trust is working with the city’s university, a local college and the council to offer a direct route into 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

Through targeted investment, the Trust has managed to reduce its backlog of endoscopies, with waiting times now at pre-Covid levels. But that’s a rare bright spot. The effects of a worn-out welfare system have meant that, like so many hospitals across the country, Bolton has struggled to discharge even medically healthy patients. In England, 14 per cent of beds are occupied by outpatients, a record high.

In Bolton, director of reactive care Cheryl Thompson said about 100 beds per day out of a total of 578 are typically occupied by patients who could go home, although the makeup of that group is constantly changing as she and her team thrive at the Seek community or family support for patients.

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

She leads community and hospital staff, a sign that health and social services are working ever more closely together to ease the burden.

Her fear, however, is getting to a point “where it all just stops . . . where we have no capacity anywhere”. Considering the months ahead and the demands she and her team face, she added, “I would say winter feels scary.”

Cheryl Thompson, reactive care manager. She’s afraid of getting to a point “where it all just stops.” . . where we have no capacity anywhere” © Asadour Guzelian/FT

https://www.ft.com/content/9d4eb83f-0466-4f34-a4d4-157bb0fd534a ‘Winter feels like a scary place’: Bolton hospital has adjusted to no capacity

Adam Bradshaw

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