Patients are still being treated in the corridor of Aintree Hospital "every other day" weeks after the ECHO reported "makeshift wards" were being used to alleviate "overwhelmed" departments.
Behind privacy screens blocking one hallway to through traffic, paramedics stood next to patients while a row of at least eight ambulances waited in parking bays outside Aintree's A&E this Monday, November 28. There has been spillover from wards and the emergency department into the hallways at least "every other day" for several weeks, according to one source who spoke to the ECHO.
There was no indication patient care was directly compromised as a result this week, but elderly and seriously ill patients were understood to have been lying in corridors for up to 30 hours because wards were at full capacity when the ECHO last reported on this issue on November 4. Three weeks later, a pregnant 17-year-old waited in the hospital's A&E for more than 18 hours while being constantly sick.
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In October, a North West Ambulance Service (NWAS) worker described scenes of "carnage" outside the new Royal Liverpool Hospital as a queue of "over 26 ambulances" waited outside. These hours-long waits experienced by paramedics and their patients are the result of delays handing over patients to hospital staff, leaving ambulance workers with the "horrendous" daily dilemma of whether to stay with potentially vulnerable patients at hospital or leave them to respond to urgent 999 calls.
A Merseyside paramedic, who asked not to be named, said: "It's horrendous. It plays heavily on you because, if that was my family who aren't getting ambulances, I'd be furious. On a regular basis, we're going to people who've been on the floor for 10 hours with broken hips, and because they've been inside, it's not a priority call, it's put way down the list of calls we need to respond to.
"It's infuriating for us, and also we're getting a lot of verbal abuse off the families when we get there because they're, absolutely understandably, upset. But once we've explained to them that there's just not enough of us and it's not that we're standing around on the station doing nothing, we're actually with patients in the corridors - and especially when we take them to hospital and they see the long line of paramedics waiting in the corridors - they can't believe it."
One of the main causes of this congestion is the number of people who are well enough to be discharged from hospital but can't leave because of delays in setting up social care arrangements. A patient discharged after a leg amputation might need home help and visits from district nurses for several weeks after leaving hospital, but it can take a week or more after they've sufficiently recovered before capacity is available.
In the meantime, that hospital bed can't be used to treat anyone else, resulting in patients on trolleys in corridors, ambulances queuing up outside, and people in urgent need due to illness or injury waiting hours for paramedics to arrive.
In light of these reports highlighting makeshift wards and hours-long ambulance queues at Aintree and the Royal, a Liverpool University Hospitals spokesperson stressed the problem isn't isolated to the NHS trust's hospitals, which also includes Broadgreen.
Liverpool University Hospitals actually performed better than NHS trusts in England as a whole in one key measurement this October. Nearly 66% of people attending A&E at Liverpool University Hospitals were admitted, transferred or discharged within four hours of their arrival, according to data from NHS England. Across England, the figure was roughly 69%.
The busiest NHS trust in Merseyside, it outperformed both Wirral University Teaching Hospital NHS Trust (62%) and St Helens and Knowsley Teaching Hospitals NHS Trust (60%). At Southport and Ormskirk Hospitals, more than 73% of people attending emergency departments were seen to within four hours.
But there are problems. Heading into the winter period when demands on emergency care rises, the NHS is already gridlocked as a result of a backlog of cases built up during the covid pandemic, and widespread staff shortages, including a shortfall of nearly 47,000 nurses across the country.
The impact these pressures have on the mental health and working conditions of NHS workers is one of the reasons so many groups are voting for strike action over pay disputes. Many have rejected the below-inflation 4% pay rise the government offered to NHS Agenda for Change workers, including nurses, paramedics and midwives.
Nurses at Royal Liverpool Hospital, Alder Hey Children's Hospital, Aintree, Broadgreen, Liverpool Women's Hospital and all other city sites will walk out on December 15 and 20 after members of the Royal College of Nursing (RCN) voted nationwide for strike action for the first time in the union's 106-year history.
One Liverpool nurse, Carmel O'Boyle, feels "physically sick" at the prospect of walking out, but she feels it's the only way to get the government to change the "heartbreaking" situation, which has seen patient care suffer and nurses forced to rely on foodbanks.
She told the ECHO: "This isn't just about pay, it's about patient safety - there is not enough of us, we have patients lying in corridors and every nurse I know is pulling extra shifts. This winter is already horrific and it's going to get more horrific. Hospitals are full to the brim, we as nurses want to be able to properly care for our patients."
To address delays discharging patients from hospital, the Department of Health and Social Care (DHSC) is distributing £500m to increase the social care workforce across the country. From this, the department is giving £19.2m to NHS Cheshire and Merseyside, which will be used over the winter period to improve bed capacity and free up hospital beds.
If this goes to plan, it should allow for a smoother handover of patients from ambulance crews to hospital staff, reducing the time paramedics spend waiting at hospitals instead of responding to new, urgent calls.
For its part, Liverpool University Hospitals has opened a 21-bed hub at Broadgreen Hospital specifically for patients ready to leave acute care but needing assessment and intervention before they go home. The aim is to reduce the length of hospital stays while reducing pressure on the community and social care system.
David Melia, chief nurse at Liverpool University Hospitals NHS Foundation Trust, said: "Like many hospitals across the country, we are caring for high numbers of patients in our emergency departments. Our teams are working incredibly hard to treat people as quickly as possible in what can be very challenging circumstances, and taking the necessary actions needed to maintain safe care and dignity for our patients.
"As a Trust we are doing all we can to alleviate pressures within our hospitals, such as opening dedicated beds at Broadgreen Hospital to support patients who no longer require acute care but who need ongoing assessment and intervention ahead of their discharge home. This is already reducing length of stay and in some cases, the amount of additional support required from social care services.
"We are working closely with our local partners in adult and social care to ensure patients are discharged safely and in timely manner into community and social care when they no longer require hospital treatment. Our communities can help us to care for our sickest patients by only using A&E when it is an emergency, and to contact NHS 111 to find alternative services if they have less urgent concerns."
Dr Fiona Lemmens, deputy medical director for NHS Cheshire and Merseyside, said: "As is the case in many parts of the country, we are currently experiencing significant pressures across all services as we deal with the backlog arising from the Covid-19 pandemic along with the growing impact of seasonal flu and continued Covid-19 infections.
"We are entering a challenging winter period and at times this is resulting in longer handover times for ambulance crews at our hospitals. We apologise for the impact this has on patients and their families and want to assure them that patient safety is our top priority.
"Our staff are working in challenging circumstances and we want to thank them for their continued dedication to their patients and the wider community. As well as the challenges for staff and patients in the ambulance service and emergency departments, there is also significant pressure in other areas including social care and because of this we are working collaboratively with partners in all parts of the health and care system to address the delays people are experiencing.
"We would encourage people who are eligible to get their flu vaccination and Covid-19 booster as soon as possible and to help us by doing what they can to stay well, this not only benefits the NHS but everyone across Cheshire and Merseyside. NHS services remain open and available for everyone who needs them this winter and we would encourage those who require urgent medical help to continue to come forward."
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