NHS: BBC goes inside hospital battling winter pressures

The British Broadcasting Corporation (BBC) spent two days observing the emergency room (A&E) at Warwick Hospital while it was under a "critical incident" status. Dr. Rajeev Pa, a senior consultant in the emergency room, was asking a patient in his 90s if he could sit up. The patient had been brought in after collapsing at home, feeling cold and confused. Now that his condition had stabilized, this could free up a bed.

Dr. Pa explained, "If he can sit up, he can be moved to a chair, which will free up his bed." Similar conversations are happening with doctors and nurses in hospitals across the UK as a severe flu season puts immense pressure on the National Health Service (NHS). Over a dozen hospitals, including some considered among the best in the country, have declared a "critical incident." Earlier in the week, the BBC visited Warwick Hospital, which is managed by the South Warwickshire trust, one of the highest-rated in the country, and prides itself on the smooth running of its four hospitals. However, the volume of cases this week has been overwhelming.

Warwick Hospital, with 375 beds, was at one point predicted to need nearly 100 more than that. For the first time ever, the hospital had to declare a "critical incident," the highest level of alert for the NHS. The BBC was on-site as hospital management made this decision. Declaring a "critical incident" is a warning to the local health system that things are deteriorating. Typically, this allows the hospital to redeploy doctors and create new temporary ward space. Over the two days of observation, the BBC saw doctors and nurses doing just that: finding temporary solutions to treat patients in any safe environment they could establish.

Due to the overcrowding in the emergency room, patients were having to be treated in the chairs they were sitting in. Others were having to wait in ambulances parked outside the emergency room for hours before they could be brought inside. One of those was Percy, an 80-year-old with liver failure. He came to the hospital because he had been feeling unwell and losing weight in recent weeks. Dr. Arun Jayakumar, a senior registrar in the wards, was one of the doctors responsible for checking on patients like Percy. He hopped into the ambulance for a brief consultation with Percy. He told Percy they were doing everything they could to get him into the hospital. Percy responded with a weak smile, seemingly resigned to the wait. The paramedic who had brought him to the hospital was also resigned: he had seen many cases like Percy's this season.

Back inside the emergency room, doctors, nurses, and consultants were discussing how to make space for new arrivals. Beds in the hospital were at a premium. With so many patients flooding in, a room near the ambulance entrance was set up for people "fit to sit." Every chair was occupied. "It's not ideal," one doctor said, "but it's safe." Porters had to push beds through this open space, weaving between patients receiving treatment in chairs and nurses kneeling on the floor to remove cannulas. IV poles were moved back and forth to make room. A nurse pushed a patient still attached to an IV drip in a wheelchair to the bathroom. She left the wheelchair in the hallway to help the patient inside. A porter was moving empty wheelchairs back and forth. The nurse rushed out. "That's my wheelchair," she shouted. We pushed the wheelchair back to her, and she began to laugh. "You can't relax for a second, or another patient will be in it," she said, half-jokingly.

Elsewhere, Percy was finally brought into the emergency room from the ambulance after a three-hour wait. "It's getting worse," he said, painfully closing his eyes, but he would still have to wait another 12 hours before being admitted to a ward. When we saw him finally being moved, he was writhing in pain in bed, clutching a vomit bowl tightly. Dr. Pa's first task on his rounds was to check the cubicles to see who he could move from a bed. There was a packed waiting room outside his door, and four more ambulances were waiting outside. In the last cubicle he visited, a woman was crying. Dr. Pa got an update on her condition from a nurse and prescribed some morphine. "You're in the right place," he told the patient. "We will sort your pain out."

Dr. Pa told us, "The patients coming in now are sicker than they used to be. And we are here, trying to get them out faster." Then, he turned to a man who had been admitted two days earlier with a heart attack but was no longer receiving active treatment. Dr. Pa was wondering if he could be safely moved. He told the BBC, "These are the decisions we are being forced to make. I'm looking at moving a heart attack patient to the waiting room so I can free up his cubicle." Another patient Dr. Pa had seen the previous day was still waiting for a bed in the ward, more than 24 hours later. "It's awful. It shouldn't be happening," Dr. Pa said. "People shouldn't be waiting 27, 28 hours in A&E."

During our time at the hospital, we were taken to a set of screens showing statistics. The data showed that patients in the emergency room were waiting nearly 30 hours for a bed, and there were six ambulances waiting outside. One of them had been there for four hours. "This is the worst I've ever seen it," one doctor said. The South Warwickshire trust lifted the "critical incident" status on Thursday, which had lasted for 48 hours. Staff told the BBC that the hospital remained under immense pressure nonetheless.