YORK HOSPITAL: Exclusive reports from behind the scenes in A&E as the crisis continues

The hospital today gave The Press exclusive access to the emergency department, to see how staff and services were coping.

The hospital today remained "almost completely full" after an extraordinarily busy few weeks, but by this afternoon only a relatively low number of patients had been through A&E - 121 compared to an expected daily average of 250 to 300. 

More on the York & Scarborough Hospitals crisis

• NHS on brink of disaster, warns union
• Cuts in social care to blame for bed-blocking, says York care expert
• FLASHBACK: Fire engine doubles as ambulance as 999 crisis mounts
• TODAY: York falling way short on A&E targets, new figures show

Monday had been much busier with patients being taken from ambulances into an overflow area due to a lack of bays. Last week, the impact on ambulances meant a fire engine even had to double as an ambulance after an elderly woman fell in Woodthorpe. 

The front page of Monday's Press

Today, the 'major incident' at the heavily-inundated Scarborough Hospital was stood down. A spokeswoman the situation had improved but the hospital remained busy. He thanked staff for their work and patients for their understanding. 

Despite the relatively low attendance at York today, ambulances had been parked up and some people were left waiting in bays as there was no space for them to be admitted to the hospital. 

It is what is called an exit block, said Mike Williams, clinical director of the emergency department, and work was under way to discharge patients and create more space after the hospital had been overwhelmed with an unprecedented number of patients. 

Mr Williams said: "This is historically always a busy time of the year. 

"Partly it's a loss of services over four days without a GP surgery and other facilities open." 

Mike Williams, clinical director of the emergency department

Medical director Dr Alastair Turnbull said "delayed transfer of care" - known as bed blocking - was a problem in York with as many as 20 patients at a time having to stay in the hospital due to a lack of social care places or the correct support in place. The hospital is working with the council to resolve this problem, he said.

Among those being treated in the department today were patients being treated for a variety of problems, including a chest infection, motorbike accidents, sepsis infection and end-of-life care. 

The stress on services had caused considerable strain on staff, said Jill Wilford, the lead nurse in the emergency department.

She said: "It has been extremely busy and from a nurse's perspective, while the nurses do everything they can to look after patients and I am proud of the nurses, they have not been able to get round everyone in a timely manner.

"That has affected the morale of the staff  because it's hard to pick them up every day.  There has been no respite.. the nursing staff are tired."

Another member of staff who asked not to be named, said: "There's a lot of staff who are really stressed out at the moment. 

"People have been working short staffed. They are trying to plug large holes where they can. Morale has been low for a while but now it's really bad. People have had enough."

Some patients seemed to head to A&E as a first resort, Mr Williams said, and had an increased expectation of 24 hour care.

He said they had seen one person who had arrived complaining of having had a bad back for the last six months. Their concern was valid but could have been treated elsewhere, and as soon as a patient arrives they are obliged to treat them within the four hour target.

But he added anyone who needed help would always be able to get it at A&E, saying: "We want the people that need us, to use us," he said.

Earlier today, new figures revealed the extent to which York Hospital Trust had struggled to cope with demand in A&E around Christmas.

3,373 people went through the doors of the emergency departments in York and Scarborough in Christmas week, with only 85 per cent of patients treated within four hours, against a 95 per cent target.

The figure places York Teaching Hospital NHS Foundation Trust among the lowest quarter of Trusts in England for the week ending December 28.

Dr Alastair Turnbull, medical director at York Hospital, said: "We are very sorry that's the case. We know by not meeting the 95 per cent target we are letting patients down."

However, he said the problems of with staffing shortages, more seriously ill patients, and difficulty in finding beds were being seen across the country.

In the week ending December 21, 87.2 per cent of patients were dealt with within four hours, just below a national average that week of 88.8 per cent. In the last three months of 2014, York's figure was 89.4 per cent against a national average of 92.6 per cent.

Mike Padgham

Earlier today, health professionals warned that chronic under-funding, staff shortages, and problems with adult social care had pushed the NHS to the brink.

The British Medical Association warned that records showed "unprecedented levels of pressure" on the health service and the Royal College of Nursing said the system was in "crisis", blaming chronic under funding and staffing shortages.

Trade union Unison claimed the NHS is "on the brink of disaster" and The Independent Care Group in York and North Yorkshire said the problems could be eased through greater investment in social care.

Mike Padgham, the group's chair, said: “One of the issues is the number of older and vulnerable adults who are being cared for in hospital rather than at home or in care homes where they would be better off.

“But because local authority commissioners have been cutting and cutting the amount of social care they fund, fewer and fewer people are getting care home or home care support. In many of the current hospital cases, older people are in hospital beds because there is not the right care available for them if they were discharged.

“If the local authorities, and for that matter the Government, put more funding into social care it would actually save money for the NHS by providing care where people want to be cared for and not in hugely expensive hospital beds, which should be available for emergencies.”

Health Secretary Jeremy Hunt this morning said hospital bosses felt they were "running just to keep still" to cope with rising demand. He told the BBC Radio 4 Today programme: "There is a huge amount of pressure, that's absolutely clear."