"It was manic": patients describe meltdown at Worcestershire hospital

The ambulance arrived swiftly, and within an hour of suffering a stroke early on Monday, 66-year-old Pauline Freeman was on a hospital trolley at the Worcestershire Royal hospital.

From then on it went less smoothly. “My wife woke me up at 4.30am and said she couldn’t feel her left side,” said her husband, John. “The ambulance was there in record time and she was on a trolley at the hospital by 5.30am. And there she stayed.”

For 54 hours.

“It was horrendous,” he said. “The nurses did all they could but the place was in meltdown. It was manic. There were at least 20 people on trolleys. It was very difficult to manoeuvre around them. A porter told me they were putting some patients in a decontamination room – basically a big shower room – to cram in more beds. They ran out of pillows and blankets.”

John, from Worcester, said his wife was close to a doorway and was woken every time it opened. At one point she was moved to the plaster room so she could get some peace. He said they struggled to get enough for her to eat. “I went and got her a sandwich and a flask of tea.”

He said he had written to the hospital and his MP to complain. “They should kick the executives out of their offices and put in more beds,” he said. Pauline eventually made it to the stroke ward on Wednesday. Her husband said recovery would be a long process. “What she has gone through will not help.”

The difficult conditions were echoed by others. One woman who was at the hospital on the evening of New Year’s Day said the corridors looked like a war zone.

Another, Sharon Shepherd, said it looked as if the hospital was dealing with a disaster. She had a six-hour wait overnight on Wednesday after her daughter Mollie, 12, injured her foot in a gymnastics session.

“The corridors were lined with patients, with elderly people being treated. The place was rammed and ambulances kept coming,” Shepherd said. “The doctors and nurses were brilliant but they were rushed off their feet. We counted 10 to 12 trolleys on one corridor alone. It was horrendous. It was if there had been a major incident.”

Shepherd said she would have taken Mollie to the minor injuries unit near her home in Tenbury Wells, but it shuts at 9pm. “We had no choice but to go to Worcester.”

Other patients and relatives described their experiences on social media. Sharon Reeves said when she went to A&E with her son they saw elderly patients crying for help on the corridors. Liz Morgan said her mother was in severe pain but could not even get from the ambulance into the building because it was so busy. “I get the nurses are doing what they can but we need another hospital,” she said.

Keith Gormley, 74, has spent many hours waiting in corridors at the Worcestershire Royal. At the end of last year, his wife, Jackie, said he had to wait for 27 hours to be seen. On Thursday it was a more manageable three hours after he had problems with his pacemaker.

Jackie, 72, a retired social worker, said: “We came in at 8am and had a long wait in the corridor to be seen. We were worried it was going to be like the last time we were in hospital on 29 November, when we had to wait 27 hours to be seen. On that occasion we told the staff about his heart problems but he was just left in a corridor.

“Something needs to be done to address the issue because it has been an absolute nightmare.”

Worcestershire Acute Hospitals NHS trust said the trolleys were not hard metal contraptions but A&E beds on wheels, and insisted patients were treated and monitored while on the trolleys, not left to wait.

It said the corridors in question were within the enclosed emergency department, not general corridors. The level of care was not what it would like to provide, it said, but the alternative would be to turn patients away.

A spokesperson said: “Our focus continues to be on providing safe emergency care, however we do recognise that long waits in our A&E departments can cause distress and for this we apologise. We would reiterate that A&E patients continue to be seen and treated in order of clinical priority.”

"It was manic": patients describe meltdown at Worcestershire hospital

"Patients who should live are dying": Greece"s public health meltdown

Rising mortality rates, an increase in life-threatening infections and a shortage of staff and medical equipment are crippling Greece’s health system as the country’s dogged pursuit of austerity hammers the weakest in society.

Data and anecdote, backed up by doctors and trade unions, suggest the EU’s most chaotic state is in the midst of a public health meltdown. “In the name of tough fiscal targets, people who might otherwise survive are dying,” said Michalis Giannakos who heads the Panhellenic Federation of Public Hospital Employees. “Our hospitals have become danger zones.”

Figures released by the European Centre for Disease Prevention and Control recently revealed that about 10% of patients in Greece were at risk of developing potentially fatal hospital infections, with an estimated 3,000 deaths attributed to them.

The occurrence rate was dramatically higher in intensive care units and neonatal wards, the body said. Although the data referred to outbreaks between 2011 and 2012 – the last official figures available – Giannakos said the problem had only got worse.

Like other medics who have worked in the Greek national health system since its establishment in 1983, the union chief blamed lack of personnel, inadequate sanitation and absence of cleaning products for the problems. Cutbacks had been exacerbated by overuse of antibiotics, he said.

“For every 40 patients there is just one nurse,” he said, mentioning the case of an otherwise healthy woman who died last month after a routine leg operation in a public hospital on Zakynthos. “Cuts are such that even in intensive care units we have lost 150 beds.”

“Frequently, patients are placed on beds that have not been disinfected. Staff are so overworked they don’t have time to wash their hands and often there is no antiseptic soap anyway.”

No other sector has been affected to the same extent by Greece’s economic crisis. Bloated, profligate and corrupt, for many healthcare was indicative of all that was wrong with the country and, as such, badly in need of reform.

Acknowledging the shortfalls, the government announced last month that it planned to appoint more than 8,000 doctors and nurses in 2017.

Since 2009, per capita spending on public health has been cut by nearly a third – more than €5bn (£4.3bn) – according to the Organisation for Economic Co-operation and Development. By 2014, public expenditure had fallen to 4.7% of GDP, from a pre-crisis high of 9.9%. More than 25,000 staff have been laid off, with supplies so scarce that hospitals often run out of medicines, gloves, gauze and sheets.

In early December Giannakos, a nurse by training, led a protest march, which started at the grimy building housing the health ministry and ended outside the neoclassical office of the prime minister, Alexis Tsipras. At the ministry, hospital technicians erected a breeze-block wall and from it hung a placard with the words: “The ministry has moved to Brussels.”

Few advanced western economies have enacted fiscal adjustment on the scale of Greece. In the six years since it received the first of three bailouts to keep bankruptcy at bay, the country has enforced draconian belt-tightening in return for more than €300bn in emergency loans. The loss of more than 25% of national output – and a recession that has seen ever more people resorting to primary health care – has compounded the corrosive effects of cuts that in the case of public hospitals have often been as indiscriminate as they are deep.

Pressure to meet creditor-mandated budget targets means that in 2016 alone, expenditure on the sector has declined by €350m under the stewardship of Syriza, the leftist party that had once railed against austerity, said Giannakos, citing government figures.

More than 2.5 million Greeks have been left without any healthcare coverage. Shortages of spare parts are such that scanning machines and other sophisticated diagnostic equipment have become increasingly faulty. Basic blood tests are no longer conducted at most hospitals because laboratory expenditure has been pared back. Wage cuts have worsened the low morale.

“The biggest problem is shortage of staff because people are retired and never replaced,” said Dr Yiannis Papadatos, who runs the intensive care unit of one of the three paediatric hospitals in Athens. “Then there’s the problem of equipment and, periodically, lack of supplies like gloves, catheters, and cleaning tissues.”

Small acts of heroism have done much to keep the broken system afloat: doctors and nurses work overtime, with donors and philanthropists also helping.

Papadatos said: “I was brought up partly in Kenya by parents who emphasised the virtues of helping others. These days I spend a lot of time going round asking friends, or the private sector, for help when our hospital runs out of supplies. The monitors we use to track heart rhythms, blood pressure, that sort of thing, were all donated. People like to give. It makes them feel good.”

Unionists argue that healthcare is an easy target because successive governments have refused to properly tackle tax evasion, the biggest drain on public coffers. In a rare public admission, the International Monetary Fund recently conceded that cuts had been so brutal “basic public services such as transport and healthcare are being compromised”.

But at a time when the Greek debt crisis has flared again, after Tsipras’s controversial announcement of a series of welfare benefits, there are many who fear worse is to come.

One of them is British-trained Dr Michalis Samarakos, who believes that while the health system is in need of further reform it also runs the risk of running out of specialists and clinical trainees. Already there has been a massive exodus of doctors abroad, mostly to Germany and the UK, as a result of lack of opportunity.

“The best are leaving because their potential cannot be developed here,” he said. “I can see it teaching sixth-year students at Athens University, everyone wants a reference, everyone wants to go.

“It’s become a growing problem. We don’t have nephrologists, for example, because there are no prospects for specialists, either in or out of the system [in private practice].

“Trainee doctors are the backbone of any hospital – without them hospitals can’t function. Unless there is a big change, I worry greatly that things can only become worse.”

"Patients who should live are dying": Greece"s public health meltdown

NHS facing "pockets of meltdown" this winter

The NHS will experience “pockets of meltdown” this winter as the service comes under increasing pressure, a leading doctor has warned.

Dr Mark Holland, president of the Society for Acute Medicine, said the resilience of medical units was being “put to the test like never before”.

It comes a day after the chief executive of NHS Providers, Chris Hopson, said the government would fail to achieve its aim of a seven-day NHS without more cash.

Writing in the Observer, he warned that hospitals are cutting services and the NHS risked “slowly deteriorating” as it did in the 1990s.

Holland echoed the warnings about a service under pressure, saying those parts of the NHS where performance was already weak would find the winter months particularly difficult.

He also pointed to the “national emergency” of medically fit patients not being discharged home from hospital. This is partly due to inadequate social care in the community.

He said the current concern was “that hospitals where performance is already weak will find it very difficult to cope during the winter and that will lead to pockets of meltdown”.

He added: “At the core of the issues facing the NHS is the rapidly increasing number of delayed discharges. The figures are spiralling and are fast becoming disastrous.

“If hospitals cannot discharge patients then the system comes to a halt. We need an overhaul of the discharge and social care process nationally so we can release pressure on front-of-house services in our hospitals – it is a national emergency.”

Delayed discharges – often called bed-blocking – refer to the number of people stuck in hospital who are medically fit to leave.

Figures for July show the equivalent of 184,188 days were lost due to delayed discharges, the highest on record, with estimates suggesting the figure across a year could be as high as 2.7 million bed days lost.

Holland was speaking before the Society for Acute Medicine’s conference in Edinburgh. Acute medical units deal with the immediate treatment of adults with a variety of conditions who present to hospital as emergencies.

The society published a new report on the performance of acute medical units based on speed of assessment, access to clinical decision-makers within four hours and a consultant review within 14 hours.

The audit, which covered 94 units and 4,140 patients, showed 81% of patients were seen by a consultant within the target, 69% by a competent decision-maker within four hours and 69% had an early warning score recorded on arrival. However, only 41% of patients received all three.

Holland said: “The findings are that, while we are still doing well on average and some units are doing very well, there is a spread and variance in what we achieve and, overall, performance has dipped over the last three years.

“This tells us that, despite the brilliant work of acute medicine practitioners to maintain quality and safety – and there are some fantastic examples of staff going above and beyond – our resilience is being put to the test like never before and that is not sustainable in the long term.”

He said it was vital that NHS trusts that were struggling to cope were not “hidden” by better performers who average out the statistics.

MPs on the Commons health committee will hear about winter preparations later on Monday.

Professor Keith Willett, director for acute care at NHS England, and Pauline Philip, urgent and emergency care director, will be among those appearing before MPs in Westminster.

NHS facing "pockets of meltdown" this winter