Hospitals in England’s current Covid-19 hotspot of Liverpool have began the process of scaling back non-urgent treatments because of a spike in infected patients, it was revealed today.
Staff working at Liverpool University Hospitals Foundation Trust have been told that pressures have reached a ‘critical point’, with up to 15 per cent of all beds currently occupied by coronavirus patients.
A leaked memo sent by bosses claims that the trust, which runs four hospitals, has now taken the decision to start reducing its ‘elective’ programme, admitting it will be a ‘distressing’ time for patients whose treatment is postponed.
Local health chiefs are hoping to send patients to ‘alternative locations’ for planned treatment, insisting that both cancer and urgent surgeries will be prioritised ‘where possible’.
It comes as officials today revealed three make-shift Nightingale hospitals, purposely created to ease pressure on the NHS, in Manchester, Sunderland and Harrogate were being put on high alert to re-open.
Sounding a grim warning today about the threat of Covid-19, England’s deputy chief medical officer Professor Jonathan Van-Tam and NHS medical director Professor Stephen Powis revealed the number of Covid-19 patients in hospital is now higher than before the blanket lockdown was imposed in March.
In a televised Downing Street briefing laying bare the data that Boris Johnson will use to plunge millions of people into ever deeper lockdowns, the pair warned that levels could even top the spring’s peak within four weeks.
It comes as another NHS trust in the North has told thousands of patients waiting for routine operations they may need to wait up to two years to be seen. One top expert called the move ‘outrageous’, saying: ‘We need to get back to normal urgently.’
Hull University Teaching Hospitals NHS has written to patients informing them that it is aiming to see them as quickly as possible within the next 24 months, leaving angry patients fearing they may be dead by the time they get an appointment.
Hull University Teaching Hospitals NHS, which runs Castle Hill Hospital and Hull Royal Infirmary, has told thousands of patients they may have to wait up to two years for non-urgent treatment in the wake of the coronavirus pandemic
WHAT DID THE LETTER SAY?
You are receiving this letter from Hull University Teaching Hospitals NHS Trust because you are waiting for a follow up outpatient appointment with us at one of our hospitals.
The coronavirus pandemic has impacted on all of our services. In line with government guidance we cancelled all non-urgent operations and appointments, from Monday, March 23, 2020.
However, we continued to see urgent and emergency patients and we maintained some cancer services and treatments.
We aim to see all patients as quickly as possible within the next 24 months. We are continuously risk assessing every patient on our waiting lists to ensure we see patients priorities on their needs.
The decisions of which patients we see and when are being made by our doctors and nurses in accordance with clinical guidelines to ensure your safety.
WHAT ELSE WAS IN THE LETTER?
The letter also gives advice on what patients should do if their condition deteriorates. It also tells patients the trust is working hard to minimise waiting times by re-introducing non-urgent outpatient clinics and investigations requested by GPs.
It also tells patients the trust is working hard to minimise waiting times by re-introducing non-urgent outpatient clinics and investigations requested by GPs.
Telephone and video consultations have been introduced which enable patients to see their clinician via their phone, tablet or computer, however the trust says there is still a need to carry out some appointments face to face.
Patients must attend their appointment or procedure alone and wear a face covering on entering the hospital.
The Health Service Journal claims to have seen a memo sent to staff at Liverpool University Hospitals Foundation Trust, which says bosses are taking a ‘phased approach to reducing our elective programme’.
The letter, penned by the trust’s chief executive Steve Warburton, read: ‘We will continue to prioritise surgery based on clinical need with a view to maintaining urgent and cancer surgery where possible.
‘We will continue to maintain access to outpatient appointments wherever possible and maintain diagnostic activity.
‘We recognise that this will be distressing for patients whose elective care needs to be rescheduled, however we must always ensure that the care we provide is safe.
‘We understand that this is a very challenging time for staff and we will be sharing more information about the enhanced support we have in place for you in the coming days.’
Data presented by Professor Van-Tam and Professor Powis in the Downing St briefing today showed almost 250 of the hospital’s near-1,300 beds are currently taken up by Covid-19 patients.
NHS England statistics show this rate has more than doubled since the start of the month, when 95 coronavirus-infected patients were receiving care across the trust’s four hospitals.
Hull University Teaching Hospitals NHS, which runs Castle Hill Hospital and Hull Royal Infirmary, is in the North East and Yorkshire, where Covid-19 is currently spreading rampantly.
The trust has recorded 217 Covid-19 deaths so far of the 30,471 across English hospitals, with only four in October.
Its letters were sent to patients across the vast majority of areas, with the exception of oncology (cancer), obstetrics, community paediatrics and haematology.
One woman, who has not been identified, who received the letter about her appointment in the chest clinic for her breathing problems, said she was stunned to see how long the wait could be.
She said: ’24 months, I’ll be dead by the time I get an appointment.
‘I couldn’t believe it. I was classed as extremely vulnerable and had to shield on the hospital advice.
‘They sent me a letter and I had to register online for priority slots. But I’m not vulnerable when it comes to waiting for an appointment.’
The Trust has told patients it is ‘working incredibly hard’ to try and ensure patients are seen and treated as quickly as possible.
It said: ‘You are receiving this letter from Hull University Teaching Hospitals NHS Trust because you are waiting for a follow up outpatient appointment with us at one of our hospitals.
‘We aim to see all patients as quickly as possible with in the next 24 months. We are continuously risk assessing every patient on our waiting lists to ensure we see patients priorities on their needs.’
The letter also gives advice on what patients should do if their condition deteriorates and that telephone and video consultations have been introduced which enable patients to see their clinician via their phone, tablet or computer,
The letter, from trust chief executive Chris Long also apologises for the delay in treatment. It says: ‘We would like to apologise for any delay in your appointment/procedure.
‘We appreciate this may be a worrying time for you and we are doing everything we can to ensure we see all our patients as soon as possible.
‘We hope you will understand the coronavirus has changed how we work.’
Professor Sikora, chief medical officer for the private cancer care provider Rutherford Health, told MailOnline the letter was ‘pretty outrageous’.
Only two of the Nightingales – which cost £220million to build all seven and £15million a month to run – are understood to have actually treated Covid-19 patients, 54 in London and just over 100 in Manchester
Even at the peak of the crisis in Britain, only a quarter of all hospital beds in England were occupied by virus patients
Furious daughter slams GPs after her mother was repeatedly refused an appointment for her cough because of Covid – which later turned out to be terminal cancer
A daughter claims GPs used coronavirus as an excuse to repeatedly stop her mother booking an appointment – only for her cough to turn out to be terminal cancer.
Marina Sendall’s mum Ellie Krzywy has been told she has just six months to live after her chronic cough was eventually diagnosed as lung cancer in August.
However Ms Sendall, 33, claims Gloucester Health Centre in Gloucester, Gloucestershire, ‘didn’t want to see’ patients during the pandemic.
After rejecting Ms Krzywy’s request for a proper appointment, her GP prescribed antibiotics in two separate telephone consultations in June.
They believed the 62-year-old’s symptoms were a sign of a chest infection.
When she started suffering with severe breathlessness and her lips turned blue, she requested a face-to-face visit.
Marina Sendall (left) claims GPs used coronavirus to repeatedly stop her mother Ellie Krzywy (right) booking an appointment – only for her cough to turn out to be terminal cancer
GPs believed 62-year-old Ms Krzywy’s (pictured) symptoms were a sign of a chest infection and prescribed her antibiotics by telephone consultation
However the grandmother-of-eight was reportedly told she’d need to take a covid test before a paramedic would see her.
After testing negative for coronavirus, she was quizzed about her symptoms and the practitioner discovered the oxygen levels in her blood had plummeted.
They also discovered her right lung was silent and referred her for an x-ray, which had a fortnight waiting list and an additional seven-day wait for results.
Mum-of-three Ms Sendall, a retail administrator from Gloucester, Gloucestershire, rushed her mother to Gloucester Royal A&E on August 1st.
There, doctors told Ms Krzywy she had small cell lung cancer (SCLC) and had just six months to live.
The mother-of-four says she is ‘very disappointed’ that she was refused a face to face appointment while suffering from cancer.
She admits she is still ‘in shock to have so little time left’.
Her daughter claims the doctors who initially refused to see her mother have robbed the family of precious time together by using covid as an ‘excuse’.
Ms Sendall said: ‘I do think Covid was used as an excuse not to see her, it seems that way.
‘Appointments were extremely difficult to get even before lockdown, you were often being dismissed as it is.
‘I don’t know if this [covid] has had a huge impact or whether it’s a ‘get out of jail free’ card [for GPs] thinking ‘now we can blame it on covid’.
She added: ‘If my mum was seen when she first called we probably would have had a different outcome, but at this point it had spread.
‘Maybe she wouldn’t have had a brilliant prognosis but we definitely would have had a lot more time with her.
‘My mum was completely dismissed when she finally got a face-to-face appointment.’
Cleaner Ms Krzywy began chemotherapy that is due to finish at the end of this month following a biopsy and CT scan.
A spokesperson from NHS Gloucestershire Clinical Commissioning Group said: ‘We are very sorry to hear about this patient’s experiences and that the lady concerned and her daughter are unhappy with the service provided.
‘We have been working very closely with our GP surgeries throughout the COVID-19 pandemic to ensure that appropriate arrangements and safeguards are in place to see patients face to face if their medical need requires it.’
GP SURGERIES TOLD TO RETURN TO FACE-TO-FACE APPOINTMENTS
GP surgeries have been told they must provide face-to-face appointments amid concerns they are too reliant on phone and online consultations.
Dr Andrew Buist, chairman of BMA Scotland’s GP committee said he would be disappointed to hear of any practices refusing to see patients where necessary, and said ‘they are an important part of what we do’.
Mr Buist, who is also a practising GP at Ardblair medical practice in Blairgowrie, Perthshire, said: ‘I would be disappointed if a practice has no face-to-face capacity – it’s important they have this where it’s appropriate and necessary.
‘There’s many things you can fix for a patient by telephone but there are important cases where the doctor wants to see the patient.
‘If someone has a lump in their breast an examination is important.’
Concerns have been raised about GPs refusing to see patients due to the risks posed by coronavirus.
A patient in Hamilton, South Lanarkshire, reported being told it was ‘telephone or nothing’, while campaigners for elderly people have raised concerns that OAPs are bounced between receptionists only to be told a GP is only attending emergencies.
GPs say they are coping with ‘unprecedented’ demand, caused by a ‘perfect storm’ of patients coming forward after delaying seeking help during lockdown, coupled with flu vaccine calls and Covid-19-related enquiries against a backdrop of staff shortages.
Linda Bauld, Professor of Public Health at Edinburgh University, said: ‘The problem with digital medicine is that you do exclude a section of society.
‘My uncle in Peebles doesn’t have a webcam so before we were prevented from visiting other people’s houses I had to go to the Borders and install a camera because he needed to be able to see his GP.
‘He had my support for that but I agree that there will be many who don’t.
‘We are never going to go back to the model we had before and I think the public needs to get the message that this is the new reality.
‘I know people might find that frustrating but surgeries are still open for business and trying very hard to see as many patients.’
He said: ‘It’s likely that many people waiting on the list for surgery or to have investigations or tests may well have serious illnesses. These will cause them to deteriorate significantly during the two year interval.
‘Almost certainly some will have cancer, others will have heart disease or other complex conditions needing far more urgent treatment. It’s impossible to sort things out without prioritising everybody.
‘We need to get a far more positive attitude than this in healthcare.
‘The current rise in admissions is a mere blip compared to April and will be over by early November. We need to get back to normal urgently.’
Deputy chief medical officer Jonathan Van-Tam and NHS medical director Stephen Powis told a briefing in Downing Street today that the number of patients in hospital was now higher than before the blanket lockdown was imposed in March – and could be above the previous peak within four weeks.
‘It is clear that hospital admissions are rising fastest in those areas of the country where infection rates are highest, particularly the North West,’ Professor Powis told the No10 briefing this morning.
Nightingale hospitals in some of the worst affected areas – Manchester, Sunderland and Harrogate – are being put on high alert to reopen.
It will be for local clinicians to decide whether they are used for Covid patients or to provide extra capacity to maintain services for people without coronavirus.
But although Covid-19 hospital admissions have been steeply rising in recent weeks, they still account for a tiny proportion of the total.
Data from the Department of Health shows there are 3,837 Covid-19 patients currently in UK hospitals, including 3,451 in England – 3.4 per cent of all beds.
NHS England officials have not publicly revealed how many beds they have in total but it’s thought to be around the 110,000-mark.
Even at the peak of the crisis in Britain, only a quarter of all beds were occupied by virus patients.
On April 7, 26.5 per cent of the 67,206 people in England’s hospitals were being treated for coronavirus — the highest proportion on record.
But the number of people being admitted for routine treatment in hospitals is still staggeringly low in comparison to before the pandemic.
NHS data revealed last week the number of patients admitted in England was down 43 per cent in August compared with a year ago.
But this is an improvement on the decrease recorded in July (55 per cent) and June (67 per cent).
Tim Gardner, a senior policy fellow at the Health Foundation, said the delays will largely be due to coronavirus infection control in hospitals.
He told MailOnline: ‘Absolutely there is nothing really more important than making sure hospitals can ensure social distancing is maintained, that people aren’t stuck together for hours in a crowded waiting room, and finding more time to disinfect equipment and clean rooms.
‘This is absolutely the wrong time to have crowded waiting rooms, to be cutting corners on infection control and not cleaning down rooms and equipment.’
Asked about the transmission of the disease in hospitality settings, Professor Van-Tam said at the Downing Street briefing today: ‘We do know the virus thrives on the thing we like most which is human contact.’
Mr Gardner said the NHS, along with health services across Europe, have been left with little choice but to postpone health care and this will continue as ‘long as the virus remains a threat’.
He said: ‘Quite a lot of progress has been made since the peak in mid-April since re-opening services. But it’s just incredibly difficult to do that.
‘It is very worrying at the moment. The progress that has been made so far is clearly at risk if the [coronavirus] situation deteriorates a lot more.’
He added: ‘The normal approach would be to do more activity than usual.
‘But because of the need to make sure that treatment is Covid secure for patients and staff alike, hospital capacity is going to be severely strained for as long as the virus remains a threat. That backlog unfortunately is just going to grow.
‘There really is an urgent need for action to contain the virus. Because the worse it gets, the more hospitals will be forced to postpone treatment for other conditions. And that’s the last thing they want to do.
‘As we saw in March and April, if hospitals are getting increasingly busy, realistically there won’t be any other choice.
‘The real worry right at this moment is that we’ve got winter coming as well. Winter is always a really tough time for the health service.’
NHS services were transformed in March and April to free up beds and manage the spread of the infection; patients were discharged from hospitals, planned treatment postponed or cancelled and consultation services shifted online.
Hospitals turfed out tens of thousands of patients to free up space for infected patients, while non-urgent surgeries and cancer treatments were cancelled.
In a drive to ‘protect the NHS’ in the spring, private hospitals were commandeered at the cost of millions of pounds per day.
But they complained of being left empty at the height of the outbreak, with up to 40,000 beds across the NHS going unused during the darkest weeks of the pandemic.
NHS data published last week was a stark reminder of the impact Covid-19 has had on treatment for other diseases.
Some 1.96million people had waited more than 18 weeks for treatment in August – triple the figure in the same month last year.
Even before the pandemic hit, the standard that at least 92 per cent of patients should wait no longer than 18 weeks to start elective treatment had not been achieved for four years, despite it being a legal right under the NHS constitution.
A further 111,026 patients have waited more than a year for non-urgent care – the highest level since 2008 and 90 times higher than August 2019 (1,236).
The majority of people waiting for non-urgent care will not actually go on to have an operation, but may see a specialist about their condition, get a diagnosis or be referred to outpatient services for ongoing care.
Cancer charities have warned of a ‘ticking time-bomb’ of undiagnosed diseases as a result of fewer referrals from GPs and screenings.
Mr Gardner, who has worked as a senior policy advisor in the NHS Strategy and Delivery Unit and spent ten years at the Department of Health, said: ‘Non-urgent does not mean not important. Those facing longer waits are going to be doing so possibly in pain and discomfort or in anxiety waiting for a diagnosis.’
NHS England has said the service is still encouraging people to visit hospital for all medical needs if and when they need to, amid fears Britons are still too scared to visit in case they catch the virus.
NHS England’s medical director Professor Stephen Powis said today did not want to have to delay operations by diverting staff to battle coronavirus second time round.
‘Where we can, we don’t want this to happen again this time, but that depends on all of us doing what needs to be done to contain this virus in the community,’ he said.
And he urged: ‘Please use NHS services if you need them for your health needs.’
A spokesperson for the Trust said: ‘If you’re waiting for an appointment or an operation at our hospitals, you may well have received a letter from us, or you’ll likely be receiving one in the next few days.
‘It’s no secret that the Covid-19 pandemic has had a huge impact on our ability to carry out routine appointments and planned surgery.
‘Our waiting lists have grown longer in recent months because of all the cancellations we had to make in the first part of the year.
‘We wanted to write to you to apologise for this and to reassure you that our staff are working incredibly hard to try and ensure you’re seen and treated as quickly as possible, while also maintaining urgent and emergency care for those who need it.’
MailOnline has contacted the Department of Health and NHS England for further comment.