Hospitals have become so overwhelmed by the number of patients needing care that nurses have been leaving their A&E unit in order to treat patients stuck in the back of ambulances outside.

Nurses have begun using the highly unusual practice – branded “shocking” by their own union – in a bid to ensure that patients’ health is not suffering in the face of the NHS winter crisis.



One nurse in the south-east of England told how she did that during her shift on New Year’s Day – triaging patients arriving at A&E – because the chaos in the unit meant some patients were being forced to wait up to six hours inside ambulances outside the hospital.



Q&A Why is the NHS winter crisis so bad in 2017-18? Show Hide A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. Read a full Q&A on the NHS winter crisis

“During my shift I treated patients, including taking bloods and prescribing antibiotics while they were in the back of the ambulance as there was no space in the hospital,” said the nurse, who spoke on condition of anonymity.

“One patient arrived early afternoon and was still in the ambulance when I handed over to to the night shift. I did question whether this was safe.”



She acted out of concern that patients’ health could deteriorate because they were spending so long in the vehicles without being assessed and treated by hospital staff, she said.



“It’s shocking news that some nursing staff are having to treat patients in the backs of ambulances,” said Janet Davies, general secretary and chief executive of the Royal College of Nursing (RCN).

“If paramedics have made a decision that a patient needs to be treated in hospital, then that is where they should be, not stuck outside in a vehicle.

Q&A What are your experiences of the NHS this winter? Show Hide We will be monitoring the situation in hospitals over the next few months and want to hear your experiences of the NHS this winter. We are keen to hear from healthcare professionals as well as patients about the situation. Have operations been cancelled? Has pressure led to certain wards being closed? How are staff coping? Help us document what is going on across the UK.



“It also stops the ambulance getting to its next call, thereby creating yet more delays.”

“This is yet another symptom of an NHS operating under severe pressure. There are fault-lines running through the entire system of getting patients into and out of hospital.”



Separately, staff at the Royal Bournemouth hospital in Dorset have told how paramedics have been triaging patients in the hospital’s A&E unit – a task nurses always perform – so that they can offload their patients more quickly and start answering other 999 calls more quickly.

The hospital has been under such pressure this week that it has asked patients to stay away unless they are having a genuine medical emergency.



Richard Renaut, the hospital’s chief operating officer, said on Thursday: “Our emergency department remains incredibly busy and so we encourage you to call NHS 111 and seek advice if you are unsure where to get treatment”.



Nurses in the south-east have given the RCN vivid anonymous personal testimonies about the difficult circumstances their hospitals have found themselves in this week during what senior doctors and NHS bosses say is the worst winter crisis in years. Prof Keith Willett, NHS England’s director of acute care, said that pressures are the greatest since the 1990s.



Q&A: Why is the NHS under so much pressure this winter? Read more

Nurses have described how some patients have had to spend 15 hours in A&E while they wait for a bedand resuscitation units have also run out of space, sparking fears about the safety of patients whose health is already seriously damaged.



“Several patients should have gone into resuscitation and there was no space,” one nurse said.

“If they had had a cardiac arrest or become compromised, we still didn’t have any space. I felt I was playing a game of roulette with people’s lives.”

Meanwhile, patients in Oxfordshire who have kidney disease are facing much longer trips than usual to undergo vital dialysis treatment, because six beds at the Horton hospital in Banbury are now being used to accommodate patients who have arrived as medical emergencies at A&E.



The patients affected now have to travel to Oxford’s Churchill hospital to undergo their treatment, which many dialysis patients have two or three times a week.



Since Tuesday, Oxford University Hospitals NHS foundation trust, which runs both hospitals as well as the John Radcliffe in the city, has been on “black alert” – the NHS’s highest state of alert.

