On Tuesday Aneurin Bevan University Health Board announced that its NHS services were under "sustained and unprecedented pressure" and could not be stabilised. It meant that a state of "business continuity", commonly known as a "black alert", was declared.
People were urged not to visit the emergency department at The Grange University Hospital in Cwmbran due to record numbers of attendances, with waits to see a doctor taking as long as 14 hours in some cases. "We have very few beds available across our hospitals to accommodate patients requiring admission," a statement read.
"We need to ask for your support and to only attend The Grange University Hospital if it is life-threatening or you have a serious injury". It clarified that these cases would include "severe breathing difficulties, severe pain or bleeding, chest pain or a suspected stroke, or serious trauma injuries, such as from a car crash".
But what is a "black alert", how often does it occur and what happens when one is declared?
What is a black alert?
Each of Wales' health boards has five levels of escalation which determine how pressured its services are. These include:
- Level 1 – Steady state
- Level 2 – Moderate pressure
- Level 3 – Severe pressure
- Level 4 – Extreme pressure
- Level 5 – Business continuity incident
As you can see, a business continuity incident is the highest level of escalation, meaning there is more demand than capacity. It typically results in very large numbers of patients in A&E, lengthy ambulance handovers and numbers of patients waiting for beds increasing significantly. More importantly, it means there is no immediate resolution that will get the system back into a positive position. It is an unacceptable situation for clinical staff, managers and, of course, patients to find themselves in.
The Welsh Government said a black alert is only enacted in "exceptional circumstances" and has quantifiable "trigger points" determined by health boards. It is often reserved for major incidents in the community such as natural disasters or mass terror attacks.
Basically, it's all hands on deck. Not only do health boards try to frantically bring in more staff from other non-acute areas of healthcare, they also enlist the help of more agency staff and, in some cases, the military. It often coincides with an urgent plea to the public to help get their loved ones discharged from hospitals as soon as they're medically fit to do so, rather than waiting for packages of care to be set up.
Why has this happened now?
Aneurin Bevan UHB said there are a number of reasons as to why this has occurred now across the Gwent region. These include:
- Record numbers of very poorly patients needing hospital care;
- The difficulty in discharging patients from hospitals due to staff shortages in health and social care;
- High staff sickness absences due to Covid;
- The widespread knock-on effects of the Covid pandemic, such as the deterioration of people's health.
A spokesperson for the health board said: "It is not just the emergency department that is busy - the system is busy throughout. We are currently seeing large amounts of very poorly people who are needing care, combined with a shortage of staff in health and social care and high levels of staff sickness.
"The shortage of staff in health and social care means patients can't be safely discharged home or into care (despite being medically fit). Like a traffic jam on the motorway, the emergency department gets clogged up with patients if patients can't be discharged from hospital."
Has a black alert been declared before in Wales?
Sadly, yes. Cwm Taf Morgannwg University Health Board declared a "business continuity incident" in February this year which lasted for 48 hours. It ran 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 was forced to bring in the emergency measures which, like Aneurin Bevan UHB, was caused by "exceptional demand throughout the whole system". The health board apologised to anyone who had longer waiting times, and put out a message on its Facebook page asking people to consider possible alternatives before going to its hospital emergency departments.
Similarly, in July 2021 the Welsh Ambulance Service also declared a "business continuity incident". Record call volumes, coupled with lengthy delays outside hospitals across Wales, meant that demand on the service exceeded its capacity to respond. As a result, some patients waited many hours for an ambulance.
On Wednesday, the ambulance service said it was experiencing "very high levels of demand" across south east and north Wales. "Please only call 999 for life-threatening injuries or illness and make alternative arrangements to get to hospital to keep our emergency vehicles free for those who desperately need us," a spokesperson said on Facebook.
Meanwhile on Wednesday Cardiff and Vale University Health Board said both the University Hospital of Wales and University Hospital Llandough were operating at a level four, denoting "extreme pressure". It said: "Our emergency unit at University Hospital of Wales is extremely busy and we would urge you to only attend the department where absolutely necessary."
What can we do to stop this happening again?
The public is not powerless in making a difference. It can help ease pressures on NHS services by only attending hospital or calling an ambulance when absolutely necessary. This month the NHS 111 service was rolled out nationally which gives people free access to urgent out-of-hours medical care and round-the-clock health support.
Advice and information can also be found on the NHS 111 Wales website which includes online symptom checkers for common complaints and conditions. When dialling 111, a call handler assesses a person's condition with the aim of getting them the right help, at the right place, first time. Callers can also receive general health advice over the phone. If further assessment is needed, a clinician will call them back.
In addition, people are urged to use other alternatives to A&E such as minor injury units, GP practices and pharmacies which are now offering a wider range of services. However, there's every chance of a black alert happening again.
