The NHS in Norfolk and Waveney has declared a “critical incident”. What does it mean and how will it affect you?

We’ve known for some time that the NHS is under huge pressure. The Norfolk and Norwich University Hospital (NNUH) moved to its highest alert level on Tuesday, while the East of England Ambulance Service Trust (EEAST) has been on its top alert level since the summer.

However, this week things escalated, with the entire health and social care system in Norfolk and Waveney declaring a “critical incident”. This also includes mental health services and community hospitals.

What does it mean?

A critical incident means that the local NHS is under so much pressure that it cannot deliver services fully and patients are at increased risk of harm.

According to documents on the NHS website, “decisive action” must be taken to increase capacity and improve safety.

Simply put, it means that hospitals are full, ambulance services cannot get to patients anywhere near target times and GPs cannot see even urgent cases.

For care homes and social care, it means they cannot get care packages in place for patients leaving hospitals.

This creates more problems as beds are taken up in hospitals by patients ready to leave but with nowhere to go. At the NNUH, for example, there are 170 patients currently stuck in the hospital waiting for care in the community to be put in place for them.

How will it affect me?

A critical incident covers every aspect of Norfolk and Waveney’s health and care system, from mental health to GPs.

If you need help from the NHS at the moment it is likely to have a big impact on you.

Before declaring the highest alert level, NHS England tells local hospitals to cancel operations and discharge patients who would not normally be discharged. So, if you have an operation scheduled it could be postponed.

However, a spokesman for the NNUH said at the moment they were maintaining already planned procedures. Cancer, those waiting the longest, and the most urgent cases are being prioritised.

Father-of-three Gareth Stevens, from Attleborough, has a rare brain tumour and is currently waiting for a CT scan at the NNUH.

Because of the pandemic, it took the 41-year old 15 months to get a diagnosis as he had to have GP appointments on the phone rather than in person, meaning he said, his tumour was missed.

Eastern Daily Press: Gareth Stevens with his three sons, Joseph, 13 and Christopher, 10. Mr Stevens, from Attleborough, has been diagnosed with a rare brain tumour.Gareth Stevens with his three sons, Joseph, 13 and Christopher, 10. Mr Stevens, from Attleborough, has been diagnosed with a rare brain tumour. (Image: Gareth Stevens)

“My mum is a nurse and was disgusted with the lack of treatment I received,” the ex-soldier said. “It has left me feeling completely useless.”

For those waiting for ambulances, one paramedic warned they could be a very long time.

They advised getting friends or family to take you to A&E rather than wait for an ambulance.

Meanwhile, social care services will look to find placements out of the area and use more expensive agencies, meaning if you are waiting for a care home you could be placed further away.

Mental health services are told to speed up discharges of patients, increase capacity and prevent admissions into their hospitals. So again, if you need to access their services expect delays.

For ambulances, all long-distance transfers are reviewed, and, as has happened in recent weeks, patients may not be taken to their nearest hospital.

However, the biggest impact is likely to be long waits both for an ambulance, and once you get to hospital, to wait to be unloaded from the ambulance as there is no space in A&E.

Cath Byford, chief nurse at NHS Norfolk and Waveney Clinical Commissioning Group (CCG) said: "Patient safety must take priority and we need to take action to make sure that those who are more clinically urgent get the help they need as quickly as possible.

Eastern Daily Press: Cath Byford, chief nurse at the Norfolk and Waveney Clinical Commissioning Group.Cath Byford, chief nurse at the Norfolk and Waveney Clinical Commissioning Group. (Image: Norfolk and Waveney Clinical Commissioning Group)

"This means that many patients in less urgent need of care may have to wait longer than we would like. We apologise to those patients and ask for their understanding during this time of exceptional pressures."

What has caused it?

Winter is always the NHS’ busiest time of the year, but right now services are so stretched they can no longer cope. That is down to a combination of staff self-isolating because of Covid, a rise in Covid patients in hospitals and a huge backlog of patients needing help, which built up during the pandemic.

There are also seasonal illnesses like flu, adding to sickness levels. After Christmas there was a surge in Covid patients in hospitals and staff self-isolating; that appears to have tipped services over the edge.

Mrs Byford said: "We are seeing large numbers of very unwell people requiring 999 ambulance services and urgent hospital care.”

What is being done?

Eastern Daily Press: Aerial photo of the NNUHAerial photo of the NNUH (Image: Norfolk and Norfolk University Hospital)

Each hospital will be taking its own steps to cope. At the NNUH, for example, a seventh bed is being squeezed into bays only designed for six.

Hospitals themselves have also shifted departments around to increase capacity. The rheumatology department at the NNUH has been moved to what was its Covid isolation unit. That has freed up room in rheumatology for patients arriving by ambulance who are waiting to go into A&E. The process called “co-horting” means ambulance staff look after patients when they arrive at the hospital because there is not enough room or staff in A&E.

The ambulance service called on volunteers, called Community First Responders, to help them staff the cohorting areas over new year.

At the James Paget University Hospital in Gorleston a roving team of medics has been set up to go to the wards needing the most help because of staff absences or a sudden spike in demand.

Staff are also being offered more money to work shifts. At the ambulance service, staff were told they would be paid £150 bonus on top of their pay for working certain shifts over Christmas.

Mrs Byford said: "Key actions include creating additional bed capacity in our hospitals and in the community, continuing to support the safe and timely discharge of people who no longer need to stay in hospital, providing additional support to care homes to avoid unnecessary hospital admissions and redeploying staff where help is needed most."