The struggling NHS has been in the news again as winter takes its toll on Accident and Emergency departments across the country. 15 hospitals have declared ‘major incidents’ this week including Addenbrooke’s Hospital in Cambridge and Croydon University Hospital in South London.

The term ‘major incident’ essentially means that the hospital is struggling to cope with the demands placed upon it. This can happen after a very serious road traffic accident for example but as has happened this week, it can also occur in winter when illness outbreaks such as influenza mean that more people attend their local Accident and Emergency Department. When a major incident is declared at a hospital, additional staff can be called in to cope with the demand and existing staff can be asked to work overtime.

In addition to those hospitals declaring major incidents this week, several more have declared ‘internal incidents’ which is one step down from a major incident and again means that extra staff are called in to treat those most in need.

What is the impact when a hospital declares a major incident? When excessive demand is placed on Accident and Emergency departments, the ramifications for patient care can be wide ranging. Firstly and most seriously, if the demand is extremely high, the A&E department may be forced to close its doors to new patients. One paramedic for West Midlands Ambulance Service reported that Royal Stoke University Hospital had locked its doors to patients and ambulance staff alike. This of course means that patients, some of whom may be quite seriously ill or injured, will have to be taken to other hospitals for treatment. 

High demand inevitably also means that waiting times to be seen in A&E increase. The target for hospitals in England is that 95% of patients should be seen within four hours of arriving at A&E. However, it was reported this week that three NHS Trusts, including Cambridge University Hospitals NHS Foundation Trust, were achieving in less than 80% of cases and seven more, including Barking, Havering and Redbridge University Hospitals NHS Trust, were achieving below 84%. On average, only 92.6% of patients were being seen within 4 hours, which is the lowest figure recorded since records were started a decade ago.

Considerable strain is also placed on ambulance services which struggle with the number of emergency callouts and whose ambulances may then end up queuing outside Accident & Emergency because there is no space for the patients to be admitted to the hospital. It was reported last week that a woman aged 81 had to wait 11 hours overnight for an ambulance after suffering a fall at home. A rapid response vehicle attended at her home after the initial 999 call but it was decided that she could not be transported to hospital without an ambulance and one did not become available for 11 hours. When she was finally admitted to hospital, she was left on a trolley for over an hour. Her son stated that staff at the hospital involved, the Queen Alexandra Hospital in Portsmouth, were having to treat patients in the ambulances queuing outside

Lastly, routine operations and outpatient appointments are often cancelled when a major incident is declared so that resources can be diverted to those who most need treatment. This of course means that patients are waiting longer for operations which may then become urgent and are not being followed up properly after previous treatment. 

A large part of the problem is that many people are attending at A&E with coughs and colds and minor injuries which could be more appropriately treated in a non-emergency setting at their local pharmacy, GP or walk in centre. Most NHS hospitals are stretched financially in any event and, as these events demonstrate, simply cannot cope when additional demands are placed upon them. 

This inevitably impacts on patient care as waiting times at hospital increase and operations and other appointments are cancelled. The consequences could be dire for those who require urgent care but cannot be admitted to hospital either because ambulances are not available or because there are no beds or resources to treat them in hospital. 

It is not hard to see that standards in care will begin to fall when there is such high demand. This could quite conceivably lead to clinical negligence claims in situations where patients have suffered substandard care as a result.