The Welsh NHS is currently facing extraordinary levels of pressure, particularly in emergency care. Rising Covid cases and staff sickness absence rates mean some hospitals have had to reduce bed capacity and limit the number of patients they're able to treat.
At least two of Wales' seven health boards have had to declare 'black alerts' this week where demand is so excessive that services cannot cope. This has led to non-essential care grinding to a halt and people being urged to visit areas like A&E only when their life is in danger.
Each health board has five escalation levels which indicate how pressurised services are, ranging from level one (steady state) to five (business continuity incident/black alert). To find out more about what a black alert means and how it affects patients and staff please go here.
Read more: Health board declares 'black alert' as patients wait more than 14 hours to see a doctor
We have contacted each health board in Wales, as well as the Welsh Ambulance Service, and asked them to provide a snapshot of what demand is like at present and how each of them are dealing with it.
Hywel Dda UHB
Level as of 10am on March 31: Level 4 (red - extreme pressures)
Highest level in last fortnight: Level 5 (black - business continuity incident)
Typical length of wait in A&Es as of 3pm on March 31: Bronglais (up to 4 hours), Glangwili (2 hours 30 mins), Withybush (up to 2 hours)
On Wednesday, Hywel Dda UHB "briefly" issued a black warning for Bronglais Hospital in Aberystwyth at 5.30pm before de-escalating at 10.30pm. Its director of operations Andrew Carruthers said: "As of this morning [Thursday], all of our hospital sites remain under high levels of pressure and we continue to ask for people to support us by following advice on using the range of services available to them, and to only attend an emergency department if you have a life-threatening illness or serious injury."
He added: "I want to commend the extraordinary efforts of every member of our staff who continue to go far beyond what is expected of them to ensure that we provide safe care for our patients in our hospitals and our communities."
Aneurin Bevan UHB
Level as of 10am on March 31: Level 4 (red - extreme pressure)
Highest level in last fortnight: Level 5 (black - business continuity incident)
Typical length of wait in A&Es as of 3pm on March 31: The Grange University Hospital (2 hrs 45 mins)
On Tuesday, Aneurin Bevan UHB declared a black alert due to its services being under "under sustained and unprecedented pressure". A spokesperson said The Grange University Hospital in Cwmbran was seeing record numbers of attendances and that non-life-threatening patients were waiting more than 14 hours to see a doctor.
However, as of 10am on Thursday morning, the health board said it successfully de-escalated to red alert escalation level (level four). A spokesman said: "Our highest level of escalation occurred between Tuesday evening and this morning [Thursday], where, despite actions to try to stabilise our services, we declared a state of business continuity.
"The health board, along with other parts of Wales and the UK, is currently under sustained and unprecedented pressure, with services across our entire healthcare system in higher demand than ever before.
"A combination of record numbers of very poorly patients needing urgent hospital care, staff shortages in health and social care, high staff sickness absences due to Covid, and the knock-on effects of the Covid-19 pandemic have all resulted in the overloading of our services. Our staff are working incredibly hard to provide the best possible care for patients in what are unprecedented circumstances."
According to BBC Wales Today presenter Nick Servini, out of more than a 1,000 general and acute beds in Aneurin Bevan UHB, since Sunday just three have been free. That's an occupancy rate of 99.7%. Evidence shows that hospitals work most safely and effectively at bed occupancy levels no higher than 85%.
Cardiff and Vale University Health Board
Level as of 10am on March 31: Level 4 (red - extreme pressures)
Highest level in last fortnight: Level 4 (red - extreme pressures)
Typical length of wait in A&Es as of 3pm on March 31 : University Hospital of Wales (N/A)
On Wednesday evening, Cardiff and Vale University Health Board issued a statement announcing that the University Hospital of Wales, Cardiff, and University Hospital Llandough sites were operating at escalation level four. It said UHW's emergency unit is "extremely busy" and suggested that people only visit if absolutely necessary or if patients have a life-threatening illness or serious injury.
A spokesperson said: "If you are unwell and think you need to be seen urgently in either our emergency unit or minor injuries unit, please phone first by calling NHS 111. They will assess you and book you an appointment if necessary. If you are unwell and unsure what to do, you can visit the online symptom checker or call NHS 111 for advice. Our Primary Choice webpages also highlight the range of services available through primary care providers such as GP practices and community pharmacists.
"We are also asking those with loved ones who are in hospital and are well enough to be discharged to support their discharge home. This is best for your loved ones and it will also help free up beds for those most in need. Please help us to deliver services safely by only using our services as absolutely necessary, and sharing this information with friends and family."
Cwm Taf Morgannwg UHB
Level as of 10am on March 31: Level 4 (red - extreme pressures)
Highest level in last fortnight: Level 4 (red - extreme pressures)
Typical length of wait in A&Es as of 3pm on March 31: Prince Charles (3 hrs 45 mins), Royal Glamorgan (2 hrs 30 mins), Princess of Wales (3 hrs 15 mins)
Cwm Taf Morgannwg UHB's interim chief operating officer, Gareth Robinson, said all its NHS services are operating under extreme pressure. He added: "Our dedicated teams' agility and focus on delivering the best patient care ensures we are able to continue helping those in need.
"As always, the safety of our patients, our communities, and our workforce remains our number one priority. We thank everyone in our communities for working with us at this time, and continue to ask them to consider which service they use before accessing the NHS.
"If your healthcare need is not urgent or an emergency, please help us help you by considering alternative options such as pharmacies, a minor injury unit or self-care at home."
In February, the health board declared a black alert which lasted for 48 hours from 1pm on Monday, February 21 until lunchtime on Wednesday, February 23. Perhaps surprisingly, it was the first time in the pandemic that the health board had been forced to bring in the emergency measures.
Swansea Bay UHB
Level as of 10am on March 31: Level 4 (red - extreme pressures)
Highest level in last fortnight: Level 4 (red - extreme pressures)
Typical length of wait in A&Es as of 3pm on March 31: Morriston (2 hrs 15 mins)
Swansea Bay UHB said its hospitals, like most others in Wales, remain under extreme pressure due to the continued high demand on health and social care services. A spokesman added: "Our dedicated staff have worked extremely hard throughout the pandemic and continue to do so. The health board is also taking steps to try to ease this pressure.
"We would ask the public to support staff and their local NHS by only attending the emergency department in the event of a life-threatening illness or serious injury. There is a range of alternative services available, including the minor injury unit at Neath Port Talbot Hospital and the online 111 symptom checker. Using these alternatives when appropriate will help take pressure off the system, and for many people will avoid an inevitably long wait in the emergency department."
Betsi Cadwaladr UHB
Level as of 10am on March 31: Has yet to respond
Highest level in last fortnight: Has yet to respond
Typical length of wait in A&Es as of 3pm on March 31: Ysbyty Glan Clwyd (2 hrs 45 mins), Ysbyty Gwynedd (6 hrs 15 mins), Wrexham Maelor (5 hrs 15mins)
Welsh Ambulance Service
Level as of 10am on March 31: Level 4 (red - extreme pressures)
Highest level in last fortnight: Level 4 (red - extreme pressures)
The Welsh Ambulance Service tends to bear the brunt when A&E departments are overstretched. It leads to its ambulances queuing for unacceptably long periods of time outside hospitals waiting to offload their patients. These are known as handover delays. In February alone a total of 23,215 hours were 'lost' due to these handover delays - the most ever recorded in a single month. That equates to nearly 1,000 days.
Due to increased pressures throughout the winter, the Welsh Ambulance Service enlisted the help of 235 Armed Forces personnel from the British Army, Royal Navy and Royal Air Force who joined the service in October. However their voluntary support was withdrawn on March 29.
Chief executive of the Welsh Ambulance Service, Jason Killens, added: "This was the third occasion that we had enlisted military support through the pandemic, in what was always a time-limited agreement to bolster our capacity during the busy winter period.
"We're extremely proud and grateful for military support, but long-term it is not the role of the military to compensate for the complex and long-standing issues in the NHS. We've been making preparations over many months for the withdrawal of the military in order to lessen the impact on patients, which has included the recruitment of 100 emergency medical technicians who will become operational in May. This will bring the total growth in new frontline posts to over 260 in the last 24 months.
"We're also doubling the size of the control room's clinical support desk, which means that we can assess more patients – up to 15% – over the phone, which negates the need to send an ambulance. Despite the growth in our workforce, the reality is that some patients will still wait longer than we would like in the coming weeks while pressures remain across the wider NHS urgent and emergency care system that inhibit our ability to respond."
