NHS: BBC goes inside hospital battling winter pressures

“Can that chap sit, do we think?” asks Dr Raj Paw, a senior consultant in the emergency department at Warwick Hospital.

He is speaking about a patient in his 90s who was brought in after collapsing at home, where he was found cold and confused.

Now he is stable. Could that open up a bed?

“If we can get him to sit then he could go into one of the chairs, and that would free up his bed,” Dr Paw says.

This is the sort of conversation doctors and nurses are having in hospitals up and down the country as a severe flu season puts the NHS under pressure.

More than a dozen hospitals have declared critical incidents – including some of those considered among the best in the country.

Earlier this week, the BBC visited Warwick Hospital. It is run by the South Warwickshire trust, which is one of the top rated in the country and has prided itself on the smooth running of its four hospitals.

But the caseload has been overwhelming this week.

Warwick Hospital has 375 beds and at one point the predicted demand was almost 100 more than that. For the first time ever, it’s had to declare a critical incident – the highest alert level in the NHS.

The BBC was there when hospital administrators made the call. Declaring a critical incident is a warning to the local health system that things are getting bad. Often, it frees up hospitals to redeploy doctors and create new temporary ward space.

Over a two-day period, the BBC saw doctors and nurses doing just that: finding stop-gap solutions to treat patients in whatever safe settings could be established.

With emergency departments overflowing, sick people need to be treated in the chairs they’re sitting in.

Others have had to wait in ambulances parked outside emergency units for hours before they could even be taken inside.

One such patient is Percy, who is in his 80s and experiencing liver failure. He came to hospital because he had been feeling sick and had lost weight over recent weeks.

Dr Arun Jeyakumar, a senior registrar on the ward, is one of the doctors sent out to check on patients like Percy.

Hopping into the ambulance, he has a brief consultation with him. He tells Percy that everything is being done to get him into the hospital.

Percy smiles back weakly, resigned to the wait.

The paramedic who brought him to the hospital is also resigned: he’s seen plenty of cases like Percy’s this season.

He turns up the heating in the back of the ambulance and sits down again as Dr Jeyakumar hops out and closes the doors.

Back in the emergency department, doctors, nurses and consultants discuss how to make space for new arrivals.

Beds are at an absolute premium in the hospital. So many patients have arrived that a room near the ambulance entrance has been set up for people considered “fit to sit”.

Every chair is occupied.

“It isn’t ideal,” one doctor says. “But it is safe.”

Porters have to wheel beds through this open space, between patients being treated in chairs and nurses kneeling on the floor to remove cannulas. Drip stands are shuffled back and forth to make room.

We see a nurse taking a patient, who is still attached to a drip, to the loo in a wheelchair.

She leaves the chair in the corridor and helps the patient in. A porter comes and goes to move the vacant wheelchair.

The nurse dashes back out. “That’s my wheelchair,” she cries.

We roll it back to her and she starts to laugh. “You can’t take your eye off them for a second or another patient will be in it,” she says – only half joking.

Elsewhere, Percy makes it from the ambulance to the emergency department, after a three hour wait.

“It’s getting worse,” he says, wincing as he closes his eyes – but it will be another 12 hours before Percy is admitted to a ward.

When we see him finally being moved, he is contorted in his bed from the pain, clutching onto a sick bowl.

Dr Paw’s first job during his rounds is to check the cubicles to see who he can move off beds.

He has a full waiting room just beyond the doors and four ambulances banked up outside.

A woman in the last cubicle he visits is crying. Dr Paw receives an update from a nurse on her condition and orders some morphine.

“You’re in the right place,” he tells the patient. “We’ll sort out your pain.”

Dr Paw tells us: “The people that come in now are sicker than they used to be. And here we are, trying to get them out quicker.”

He then moves on to a man who was admitted for a heart attack two days ago but is no longer receiving active treatment. Can he safely be moved, Dr Paw wonders.

“These are the decisions we’re being forced to make,” he tells the BBC.

“I’m considering moving a heart attack patient to the waiting room so I can have his cubicle.”

Another patient Dr Paw saw the previous day is still waiting for a bed in the ward more than 24 hours later.

“It’s rubbish. It’s not what should happen,” Dr Paw says. “People shouldn’t be spending 27, 28 hours in an emergency department.”

At one point during our time at the hospital we were taken to a bank of screens displaying statistics.

It showed that patients in the emergency department were waiting nearly 30 hours for a bed and there were six ambulances queued up outside. One had been there for four hours.

“It’s the worst I’ve ever seen it,” one doctor says.

South Warwickshire Trust stood down the critical incident on Thursday – it had been in place for 48 hours. Staff told the BBC though that the pressures on the hospital were still intense.