Hospital admits patient care is being compromised as cancer operations delayed

Cancer operations at one of England’s largest hospital trusts are being delayed as bosses admit patient care on wards is being compromised.

Nottingham University Hospitals Trust has been forced to convert one of its few remaining wards for cancer surgery patients into an emergency medical ward to cope with an influx of patients.

The Independent understands the trust’s A&E department is regularly overcrowded with 40 or more patients waiting for a bed at the start of most days.

The trust, which is set to begin filming on a new series of 24 Hours in A&E this week, said staff were going “above and beyond on a daily basis”.

It is one of a number of NHS trusts hit hard by rising demand for NHS services and increasing numbers of coronavirus patients. The East Midlands trust had more than 140 Covid-19 patients on its wards on Monday.

It is also expected to receive criticism from the care watchdog the Care Quality Commission (CQC) following an earlier inspection.

In a leaked message to staff sent on Friday and shared with The Independent, bosses at the hospital said the trust was facing an “exceptionally difficult time” which was “probably the most challenging position we have been in since the pandemic began”.

It added: “There is no doubt that we are having to compromise the quality of care we are providing to some patients to ensure that we are able to maintain a service for the whole population.”

The message, signed by the trust’s chief nurse, medical director and director of operations, added that in some parts of the trust the pressures were “having a critical and unprecedented effect on services…We have been on our highest level of escalation now for 11 days.”

They added: “Our emergency department is over capacity continuously, which means that patients are waiting for extended periods on trolleys with little privacy and dignity because they do not have a bed to go to. We are having to make difficult decisions every day as to whether we can proceed with cancer and urgent operations and we are not able to tell some patients when they will get their operation.

“Staffing pressures in this current wave are leading to some staff having to work in conditions that are not acceptable, but necessary to ensure we can continue to provide treatment for our sickest patients.”

On Friday bosses at the trust converted a ward at the City Hospital site to an emergency medical ward which leaves the trust with just two remaining wards for routine surgeries.

The trust executives warned this would have a “direct impact on cancer patients” adding: “The only way to reverse this is to discharge more patients earlier to free up beds, which may have risks in itself.”

Staff were told they would be supported if discharges led to patients being readmitted or if families complained.

The hospital was thought to have more than 220 patients ready to be discharged on Friday.

In the staff memo bosses said: “We know you are having to make decisions which carry risk – the cancer patient not getting their operation as soon as we would like, the elderly patient lying on a trolley in ED for more than 24 hours or the patient going home a day earlier than we would have planned – some can be mitigated better than others, but it is important that we all understand how they inter-relate and do everything within our own service to manage not just the risk for our own patients, but those patients across our organisation.

“A relatively small increase in discharges across every ward could make the difference as to whether we are able to reduce the crowding in ED or offer timely treatment to our cancer patients.”

They added the Nottingham hospital trust was trying to ensure more patients could be discharged but said community services were also working in challenging situations with “significant staff shortages.”

A spokesperson for Nottingham University Hospitals Trust said: “Despite the exceptional pressure on local health services, we continue to prioritise the most time-critical surgery.

“We would urge people to use make the most of advice available via NHS 111 online so that staff can prioritise emergency care and treat the sickest patients.”