The NHS is reeling under what doctors’ leaders and hospital chiefs say is the most intense strain it has faced in decades as a result of flu, bad weather and more patients suffering breathing problems.

Hospitals’ inability to keep up with the demand for care on Tuesday night prompted NHS England to tell them to take unprecedented measures to try and stabilise the service.

They included cancelling outpatient appointments and day case surgery, extending an existing ban on non-urgent surgery until the end of the month and deploying consultants in A&E units to assess if patients really are a medical emergency.

Amid growing evidence of chaos as the NHS’s winter crisis bites, hospitals are being forced to create makeshift wards for patients, growing numbers are declaring a black alert – an official admission that they cannot cope – and patients are waiting as long as 12 hours for A&E care.

“We are seeing conditions that people have not experienced in their working lives,” said Dr Taj Hassan, an A&E consultant in Leeds and president of the Royal College of Emergency Medicine (RCEM), which represents A&E doctors.

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.



“The position is as bad as I’ve ever known,” said Dr Nick Scriven, president of the Society for Acute Medicine, whose members look after emergency admitted patients not needing surgery. “I’m 34 years in and I’ve never seen anything like this,” said Tracy Bullock, the chief executive of Mid Cheshire hospitals NHS foundation trust.

Dr Richard Fawcett, a senior doctor in emergency medicine at the Royal Stoke hospital in Staffordshire, tweeted on Tuesday: “As an A&E consultant at University of North Midlands NHS Trust I personally apologise to the people of Stoke for the third world conditions of the department due to overcrowding.”

Scriven told the Guardian how he worked from 8am to 7pm on Monday but was then called back in to his hospital in Halifax, Yorkshire, at midnight because the hospital was full and he worked on treating patients until 4am.

His hospital was experiencing major difficulties despite having opened extra beds in preparation for the expected surge in demand at this time of year, he said.

Scriven said that during his long shift the hospital had run out of beds that could be safely staffed and that patients were being “bedded down” in the A&E.

Patient safety could be at risk across the NHS because there were too few nurses to staff all the beds that needed to be opened, warned Scriven. “Big issues are currently nurse staffing levels, with extra beds being opened around hospitals to cope with winter surge and not enough nurses to go round.” That, allied to similar shortages of doctors and therapists and diagnostic facilities being “swamped”, were creating “a vicious circle of increased need causing longer delays in [the] whole system”, he added.

Officials estimated that extending the ban on non-essential operations could lead to 55,000 procedures being deferred.

The NHS’s new “recommendations” to hospitals, from the national emergency pressures panel chaired by overall NHS medical director Prof Sir Bruce Keogh, sparked suggestions that NHS chiefs are acutely worried.

They were accompanied by an admission by NHS England that its intensive planning for this winter, designed to avoid a repeat of shambolic scenes in hospitals last January that led the British Red Cross to call the situation a “humanitarian crisis”, appears to have had only a limited impact.

Keogh thanked NHS staff who worked hard over a difficult Christmas. “We expect these pressures to continue and there are early signs of increased flu prevalence. The NHS needs to take further action to increase capacity and minimise disruptive last minute cancellations. That is why we are making these further recommendations,” he added.

Southend hospital in Essex declared an “internal critical incident” on Tuesday because it could not cope with what Dr Neil Rothnie, its medical director, said was “the high number of acutely unwell patients arriving at our emergency department requiring admission to hospital”.

In an email to staff Rothnie said that by Monday night they had “no medical or surgical beds” available and that “ambulances [were] queuing for considerable periods of time throughout the night”. In addition, many patients had to wait “for considerable time” in the hospital’s A&E unit before they could be admitted to a bed on a specialist medical ward.

On Monday it treated just 63.5% of its 277 A&E patients within four hours, far fewer than the 95% stipulated by ministers and guaranteed in the NHS constitution. Other hospitals are treating and admitting, transferring or discharging as few as 40% of those arriving at A&E, as a result of “exit block” – the rest of the hospital being too full – Hassan said.

Nottingham University hospitals NHS trust is also among those which have declared a black alert – the highest form of alert in the NHS. It did so on Tuesday because, director of operations Miriam Duffy told staff in an email, “the last few weeks have been difficult. We … have opened a winter respiratory ward due to significant pressures within respiratory and emergency flow, [but also] run out of bed capacity in medicine”, she said.

In other hospitals:

• A children’s day surgery ward at St Helier hospital in Sutton, Surrey, has been closed to under-18s. Instead adults – fewer than 10, the hospital says – are now being treated there because the trust has run out of beds to put them in.

• The Royal Albert Edward Infirmary in Wigan in Lancashire has warned that patients turning up at its A&E “can expect long waits up to 12 hours while the most serious cases are prioritised”.

• Prof Chris Moulton, the RCEM’s vice-president, warned that “massive queues in corridors” were now common and that flu – especially the influenza A strain that has caused havoc in the southern hemisphere recently – was starting to circulate in a potentially ominous way.

• Milton Keynes hospital said it was under “extreme and sustained pressure”. “We are doing our best in extraordinarily difficult circumstances,” said Prof Joe Harrison, its chief executive.

Meanwhile, new findings from RCEM monitoring of winter pressures on hospitals shows that A&E performance was worse in the run-up to Christmas than in the same period last year, with hospitals treating just 80.6% of patients within four hours, compared with 83% in 2017.

In addition more operations were being cancelled – an average of 3,351 a week, compared with 1,948 last year – in further evidence of the huge strain that the service is under. The figures are based on information from 43 hospital trusts and boards across the UK received by the RCEM as part of its “winter flow” research project. More positively, though, the proportion of beds occupied by “delayed transfers of care” patients, who are fit to leave but cannot safely be discharged, is slightly better than a year ago.

The Department of Health responded to the gathering NHS winter crisis with a short statement. It said only that: “We know the NHS is extremely busy – as it always is at this time of year – but hardworking staff are taking the necessary steps to make sure patients continue to get seen as quickly as possible.

“Our NHS was recently ranked as the best and safest healthcare system in the world, and the government is supporting it this winter with an additional £447m as well as £1bn extra social care funding this year.”

Hospital roundup

Maidstone and Tunbridge Wells trust, Kent

On Tuesday, the trust was forced to call a black alert – known as an opel 4 incident. According to NHS guidelines, this happens when “decisive action must be taken … to recover capacity and ensure patient safety” in the face of “rising system pressure”. It comes after Maidstone hospital A&E department endured the busiest Christmas Day on record. In total, more than 330 people attended the emergency departments at Maidstone and Tunbridge Wells hospitals, the trust said.

Darent Valley hospital, Kent

The hospital, which is also operating on opel 4, informed patients on Tuesday morning that its emergency department was “extremely busy” and that patients should seek an alternative option where possible.

Epsom and St Helier hospitals, Surrey

Another trust on black alert, local people have been urged not to attend A&E unless its a genuine emergency. Chief operating officer, Dan Bradbury, said: “We are seeing and admitting high numbers of sick people and our hospitals are very busy indeed.” The trust confirmed that as a result they have had to call for extra staff and some care admissions had been rescheduled.

Claire Jackson-Prior, 44 from south London, said her daughter, 13, was sent home, after turning up at St Helier hospital for an appointment at the paediatric day surgery unit. The space was instead being used for adult inpatients. “We know it’s not the staff’s fault but it worries me that they are so stretched,” she said.

Southend University hospital, Essex

The hospital has declared an internal critical incident due to the high number of acutely unwell patients arriving at A&E. On 2 January, it said in an email to staff that the previous day there had been no medical or surgical beds and ambulances were queuing for “considerable periods of time throughout the night.” Yvonne Blücher, managing director at Southend University NHS foundation trust, said: “In common with hospitals across the country we are experiencing very high demand on our services.”

Medway NHS trust, Kent

On Tuesday, staff tweeted to tell patients that the emergency department was experiencing high numbers of attendances and that there were longer waits than usual. It said: “Please consider whether the emergency department is the most appropriate place for your care.” The director of finance, Tracey Cotterill, said: “That’s certainly the busiest new year’s day I have ever had! Thank you to all staff working today.”