Hospitals experiencing ‘perfect storm’ as Covid infections and holiday season collide

Hospitals are experiencing a “perfect storm” as Covid hospitalisations, high infection rates and record-breaking demand for A&E collide with the holiday season, NHS executives have warned.

Across England, admissions to hospital for patients with Covid have risen by more than 30 per cent over the past week with hospitals now being told by NHS England to prepare for a difficult period ahead as the summer crisis worsens.

New Covid wards have been opened and operations cancelled across the country as the healthcare system buckles under the crisis. But hospital leaders say the start of the summer holidays – already a peak season for emergencies – could prompt a fresh wave of pressure.

At Newcastle upon Tyne Hospitals, chief executive Dame Jackie Daniel told staff on Friday that severe demands were “affecting every part of the trust”, which was facing “exceptional pressures”.

She said: “We are going through the ‘perfect storm’ of high numbers of Covid patients in hospital, high Covid infections in the community, which is affecting staff and our families, unprecedented levels of urgent and emergency demand and peak holiday season, all of which comes after 18 months of exhausting work.”

Some hospitals are already making plans to redeploy staff again to look after Covid patients.

A message to staff at Barnsley Hospital Trust on Monday said oxygen usage “was still relatively high” and urged clinicians to be vigilant.

During the height of the pandemic last year, several hospitals came close to a collapse in their oxygen supply to wards because the building pipes could not physically deliver the amount of gas needed by patients.

Watford General Hospital closed its A&E in April 2020 after an oxygen failure, while several trusts in London had to divert patients to other hospitals as they neared their system limits in the January wave.

Despite the rollout of the vaccine programme, the rise in coronavirus infections across the country, made up predominantly of the Delta variant strain, means hundreds of patients with Covid are being admitted to hospitals every day. As of Friday there are 4,390 Covid positive patients in England, a level not seen since March, with more than 715 in intensive care.

The message to staff in Barnsley sent earlier this week said: “The number of positive patients continues to increase, and today [Monday] we have 51 people with Covid-19 in our bed base. ICU remains very pressured with 16 patients in total, of whom 13 are positive. Oxygen use has reduced slightly but remains high so please be vigilant.”

One ICU worker said: “Sixteen in ICU is very tough for us. It was a seven-bed ICU pre-pandemic. Theatre lists are being cancelled due to staffing issues now.

“It feels like the government and most of the media have just thrown us to the wolves and are sticking their fingers in their ears shouting ‘the NHS will cope’.”

A spokesperson for the trust said it had two dedicated Covid wards open now and non-urgent procedures were “being reviewed” to ensure it can continue to meet demand.

In the northeast of England, James Cook University Hospital in Teesside has been forced to cancel routine operations again as the number of Covid patients takes over more beds.

On Wednesday, the trust had 94 patients with Covid-19, 13 of whom were in critical care.

A spokesperson for South Tees Hospital Trust said: “Over the next two weeks, a small number of complex orthopaedic elective surgeries are being rescheduled following an increase in Covid-19 admissions, and we have recently opened a further ward to ensure our clinicians can safely care for all patients.”

Dame Jackie Daniel, the chief executive at Newcastle upon Tyne Hospitals, said some staff had reported the situation feels worse now than at the first Covid peak.

She said: “I know that we are not currently able to offer all of our patients the exceptionally high level of care that we aspire to. It’s a place that none of us want to be. Several people have said to me that it feels more difficult now than it did at the height of the first wave of the pandemic.”

The trust had 80 patients with Covid on Friday and has postponed planned surgery to ensure it can meet the needs of emergency patients.

It has authorised extra overtime rates for staff and redeployed some corporate staff to help out on wards. Dame Jackie warned some staff might be asked to consider changing their holiday times to ensure staffing levels were maintained but she said this would be voluntary.

NHS England bosses in the West Midlands have warned hospitals they need to prepare themselves to open up extra surge areas to cope with Covid admissions.

In a letter to hospital bosses first reported by the Health Service Journal, NHS England said: “These are incredibly difficult times as we collectively try to ensure ongoing safe care for all our patients, recognising just how exhausted you and your staff are and how much the Covid waves have impacted on you all.

“We are seeing a sustained rise in Covid-19 admissions across the Midlands … We are entering, potentially, what will be the most difficult period since wave one of the pandemic and at the moment the most vulnerable capacity is adult critical care.

“There are clear indications that we are heading towards a period where we need to surge capacity.”

The HSJ also reported concerns some hospitals are already stretching their ratios of critical care nurses to patients as more staff are absent and numbers rise.

Nicki Credland, chair of the British Association of Critical Care Nurses, told HSJ: “There are a number of trusts which are now having to reinstigate surge plans.

“This means moving back to surge staffing in some areas. As with surge one and two this means that the nurse staffing ratios are becoming diluted again as we try to cope with increasing numbers of patients requiring ICU.”

This will mean staff being redeployed to care for Covid patients and routine operations being delayed.

One hospital medical director warned Covid cases were rising and the NHS could face one of its worst winters ever.

Deepak Dwarakanath, medical director at North Tees and Hartlepool Trust, said his region was now “top of the league nationally” for infection rates, adding: “This has started to have an impact on hospital admissions.

“Two to three weeks ago we had no Covid patients in the trust. As of Tuesday, we had 35 patients in our care – 12 were admitted in one day on Sunday. We also have six patients in intensive care – four of which are on ventilator support.

“These people aren’t elderly, they are younger or middle-aged. This is still a massive problem and it is still with us.”

He warned things would get worse as the winter approached and flu became more of a problem saying: “We must maintain our core services, in spite of these pressures, with cancer care and appointments. This will be one of the most pressured winters the NHS has ever had.”