14
votes
Critical incidents being declared across English hospitals
@Shaun Lintern:
🚨 @UHDBTrust declared a critical incident last night - cancelling all meetings and training to ensure clinical staff "are on wards and patient facing" pic.twitter.com/vLxUHwLZPD
(This is a link to a thread of twitter posts, not just to a single twitter post).
Some notes: In England the NHS is split into different geographic regions which are controlled by ICSs (Integrated Care Systems). NHS England takes money from central government, and distributes it to the ICSs, and the ICSs buy care from local provider organisations. Those are mostly NHS Trusts or NHS Foundations Trusts, but they don't have to be NHS organisations, they can be private providers. (We see that a lot in MH care).
Care is split between:
acute hospitals - this is a what you'd normally think of if you think of a hospital, it often has some kind of emergency department and provides emergent surgical and medical care, and it also provides planned "elective" care (Elective just means planned rather than emergency), and it often provides some kinds of outpatient clinics.
community hospitals - these provide ongoing care to people who don't have severe surgical or medical need, but who are too poorly to be discharged home.
mental health hosptials - these provide care to people who have a diagnosable mental illness.
Some trusts double up, so you may find a trust does acute and community hospitals, or it does mental health and community hospitals. It's a complex mix.
So, anyway, back to the thread: this is catastrophic. This is the worst it's been since forever, there has never been anything like this. People are being harmed by it. People are dying preventable deaths because of it. I'm not using hyperbole, it's a shit show. This is what collapse of the NHS looks like.
Frustratingly, it's the inevitable result of ten years of mismanagement by people who do not believe in public utilities funded by central taxation.
For those of us not in the know, what do critical incidents mean and why is this such a problem for the NHS? I don't quite understand the implication of what's happening.
There's not a huge difference between declaring and not declaring, it's mostly a bureaucratic flag-wave to say "oh boy things are rough".
But it means thing like:
Planned operations are cancelled while they deal with the emergency backlog
Patients are being cared for in corridors, not ward bays
Ward bays are being doubled up, so instead of 6 people to a ward you now have 8 (and those two extra beds don't have a real bed space with access to things like oxygen so it feels like a kludge.
Training and meetings are cancelled to free up staff
There's no room in the hospital so patients wait longer in emergency departments
There's no room in A emergency departments so patients wait longer in ambos
All the ambos are queueing outside ED, so patients needing an ambo are waiting longer at home.
I'll try to find some numbers to illustrate.
Oh wow, that does sound bad! Do you know if the cause of this is a surge from flu/covid or truly administrative mismanagement. Not to give them a pass, I've been baffled by the decisions the UK has made in the last few years (I have citizenship but have never lived there). It's interesting watching from afar.
Hospital flow has many complex causes. The simplistic explanation is that social care has been defunded, and so people who are fit enough to be discharged from hospital but not fit enough to go home will need to wait in hospital until a care package (either in a nursing home, a care home, or their own home with support) is created. And since those packages do not exist it means there's a bunch of people in hospital who'd get better care elsewhere.
That's true, but it's only part of the story.
Some people have complex illness and they need a mutli-disciplinary team to discuss a treatment plan, and those teams only meet once or twice a week, which means someone can be in for a few extra days. That doesn't sound like much, but if you're running the system at 95% capacity rather than 80% capacity those extra days do have knock on effects.