Leeds A&E under pressure as doctors deal with thousands of extra patients

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There were chaotic scenes when tired patients waited in corridors for care, scores of operations were cancelled and services pushed to breaking point last year, as overcrowded hospitals across the country struggled to cope with the NHS’ worst winter on record.

Now, as the cold begins to bite one year on and health services approach the winter period again, the Yorkshire Evening Post is today launching the first of a series of special reports, examining the pressures faced by the city’s public health services and how the NHS is fighting back in Leeds.

Steve Bush, clinical director of emergency and specialty medicine at Leeds Teaching Hospitals NHS Trust, in the A&E department at St James' Hospital in Leeds. Picture: Bruce Rollinson.

Steve Bush, clinical director of emergency and specialty medicine at Leeds Teaching Hospitals NHS Trust, in the A&E department at St James' Hospital in Leeds. Picture: Bruce Rollinson.

The YEP spent the day at St James’ Hospital’s A&E department to understand its inner-workings, the efficiency work behind the scenes and streamlining of services to prepare ahead of what has been forecast as yet another testing winter period.

Health bosses are also today urging people to ensure they choose the right care and only attend A&Es in an emergency, to help ease the pressure on hospitals.

“Every acute health system in the country fears winter,” said Steve Bush, consultant and clinical director for emergency and specialty medicine at Leeds Teaching Hospitals NHS Trust.

“Because winter brings with it increased illness, potentially flu but particularly patients with long-standing chronic conditions.”

Rising numbers attending St James' A&E Department

Almost 22,000 people walked through the doors of Leeds’ emergency departments seeking care in October this year, latest figures show.

It is a rise of nearly 1,000 compared to the 21,069 people who attended the city’s A&Es in 2017.

Against the national average of 89.1 per cent in October, 82.9 per cent - some 18,000 patients - spent fewer than four hours in A&E from arrival to admission, transfer or discharge.

The remaining 3,730 waited more than the four-hour standard.

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On the increase in attendances, Mr Bush pointed to lung problems such as Chronic Obstructive Pulmonary Disease (COPD), where he said there was typically a significant rise among elderly patients during winter.

Bronchiolitis, which causes young babies to cough or become breathless, is also more common in winter, he said.

“People are more unwell at winter,” Mr Bush

“There are some real reasons why winter is busier than summer.

“It’s about the sort of patients who come and see us.

“In essence there are more patients and they are sicker in the winter than they are in the summer.”

St James’ boasts one of the city’s two A&E departments, dealing with acute medicine and surgery, while Leeds General Infirmary’s A&E specialises in cardiac, trauma and care for children.

'There's a never-ending stream' of patients

Even when the emergency department begins to crowd as ice, cold weather and general winter illnesses take hold, A&E will not turn away patients in need of emergency care.

But, because of it is the region's biggest, Mr Bush said, it leads to a “never-ending” stream of patients.

“There’s no restriction on patients who come to the emergency department - because we can’t,” Mr Bush said.

“Practically, if we said to the ambulance service ‘stop bringing patients to us’, where are those patients going to go?

“We’re the biggest emergency department in the region. We can’t do that. So there’s a never-ending stream of people who need our care.”

When the YEP visited St James’ A&E towards the end of November, there were 38 patients in A&E at St James’. While it was visibly manageable and not crowded, staff were busy dealing with patients.

However, at its busiest last winter, Mr Bush said there were 132 people in A&E at one time.

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'Only attend A&E in an emergency'

But Mr Bush - alongside the NHS nationally - urged people to only come to the city’s A&Es in an emergency, as precious cubicles, beds and assessment time is often being swallowed up by those with less serious illnesses that could be cared for elsewhere.

“What we exist for is to do the accident and emergency bit,” he said.

“We are excellent at spotting somebody who is unwell or severely injured, identifying what they need and delivering that.

“What every emergency department in the world finds is that for every person like that, there’s somebody who has a headache that they’ve had for 10 days but have only just started worrying about it. Or tummy ache: they’ve had it for two years and it’s a bit worse this time. They have fallen and hurt their back three weeks ago but it’s still sore and they want a sick note.”

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He said that because of A&E’s profile, people can often attend in the wrong situation when they could see a GP or call the NHS’ 111 service.

“People who have got medical needs come to A&E because it’s such a powerful brand,” Mr Bush said.

“It’s open 24/7 and they know that they’ll get seen by someone who knows what they’re doing.

“We will always, always have teams available for major trauma patients regardless of the busyness of the department. Even if it’s Armageddon out there.

“The message that we’re giving is clear and simple: if it’s an emergency where you’re worried about a heart attack or a stroke for example, you ring 999 and you get here.

“If you’ve got an urgent need, that you know isn’t an emergency, then ring 111.”

Waiting times: October 2018

Latest figures, published by NHS England, for A&E attendances and emergency admission statistics, in October 2018:

Total of 21,757 people attended A&E in October 2018 in Leeds

Percentage of attendances within four hour-target: 82.9%

National average: 89.1%

18,027 people spent under four hours in A&E (from arrival to admission, transfer or discharge)

3,730 people spent longer than four hours in A&E (from arrival to admission, transfer or discharge)

Waiting times: October 2017

Total attendances: 21,069

Percentage of attendances within four hour-target: 85.8%