Staff shortages due to COVID infections or isolation are driving the current crisis in the NHS.
And the emergency has been exacerbated by the record rise COVID infections.
It is not only the increasing number of patients who are admitted, but the difficulty of trying to control bed capacity.
A head of the NHS Trust told me that his hospital still had beds available, but that these could not be given to non-COVID patients as all other patients in the same ward had tested positive.
He also said the staff shortage had become so bad over Christmas and into the new year that he sent his staff home for a short break between shifts and asked them to return to a double shift to cover absent colleagues.
Hospital capacity is also affected by COVID outbreaks in nursing homes. Patients who may have been discharged to a local environment should stay longer in the hospital.
The pressure is persistent and unsustainable. At least 12 NHS Trusts have declared a critical incident and 17 hospitals in Greater Manchester are putting non-emergency treatment on pause.
This is a devastating blow to long-suffering and long-awaited patients, and also to healthcare professionals.
No one wants this to happen. The only, very small consolation is that some hospitals are planning fewer non-urgent surgeries and procedures through the winter to help them better cope with seasonal pressures.
Trusts will only declare a critical incident as a last resort. This means that their hospitals are not able to function normally without compromising patient safety. A critical incident can be called at any time and there is no fixed duration.
During the peak of the pandemic, some funds reported critical events in less than 24 hours before escalating.
It sends a message to partners health authorities, primary health networks and ambulance funds, that the hospital at that very moment is struggling to cope. The situation remains fluid and can change at any time.
Another Trust leader told me that the timing of the decision was important. If the critical incident is declared in the late afternoon or evening, it means that it is more serious as it affects emergency admissions, which are busier in the evening and at night.
The Prime Minister is happy with his battle metaphors, and his latest describes the NHS as being on “war footing”. Exhausted frontline staff will agree with the campaign analogy. They have been fighting for over two years.
Are we at record levels for critical incidents?
by Daniel Dunford, senior data journalist
Different trusts have different thresholds for what constitutes a critical event.
Some trusts will only declare a critical incident due to an external incident – Grenfell, for example, caused several London hospitals to declare critical incidents temporarily.
Unfortunately, it is difficult to compare year-on-year how many trusts had declared an incident due to winter demand because there is no central database.
Even Chris Hopson, CEO of a member organization for NHS services and one of the best sources of current information on trusts under pressure, does not know exactly how many are declaring right now.
By doing a Google search for “NHS Trusts Critical Incident” and excluding recent results, you can see that there were at least 15 trusts declaring incidents due to “unprecedented demand” at this time seven years ago, according to research at the time from Guardian.
Currently we know about 12.
In terms of putting these incidents in context, it is interesting that the acute response times that sent hospitals into critical action seven years ago would be among the best in the country now.
They quote that 88.8% of the people who arrive at the emergency department within four hours are at a record low level compared to the target of 95%.
In November 2021, it was 61.9%, more than three times as bad.