CASUAL+Y CODE RED
...that’s the persistent state of emergency at the hospital starring in a major new TV series, where lack of – yes, you guessed it – beds is driving staff to breaking point
IT IS a TV shocker that dramatically captures the crisis that is gripping Britain’s Health Service. A leading London hospital is on red alert – so short of beds that it might have to put sick patients in the gym.
‘If we have a significant flu epidemic we are going to be completely stuffed,’ warns Tim Orchard, medical director at St Mary’s Hospital in West London.
‘We’ve never started winter with so little spare capacity,’ he bluntly tells fellow executives. ‘We need to think about… what we do when we actually run out of beds.’
It may sound like a scene from Casualty but this is real life – dramatic footage from a worrying fly-on-the-wall documentary about the crisis in NHS hospitals.
It shows, in disturbing detail, stressed senior staff struggling on the brink of Code Red, the dreaded moment for a hospital when there is barely a bed to be found, no matter how great the emergency. Shot in late autumn, the six-part series called Hospital details the difficult decisions doctors, nurses and managers across the country are now having to make on a daily basis to squeeze as many patients as they can into the finite number of beds they have available.
In the BBC2 series, which starts on Wednesday, doctors are seen arguing among themselves to try to secure a slot for their patient, in a process one surgeon compares to a ‘moving jigsaw’.
In the first episode, a patient called Simon is seen waiting for an operation to remove a cancerous tumour from his oesophagus. His surgery has been cancelled before and he is getting close to the end of the eight-week ‘window’ after chemo and radiotherapy when the complex operation is best undertaken.
But then doctors receive a call telling them that an elderly woman is being brought in from Norfolk – her aorta, the body’s largest artery, has started to rupture. Retired primary school teacher Janice Medcalfe will need the intensive care bed if she survives the journey and the operation.
‘There’s a patient coming in who might require the intensive care bed,’ Simon tells the camera, trying to remain calm and matter-of-fact.
‘If they die, then the bed is available for me,’ he thinks aloud, obviously conflicted.
Asked how that makes him feel, he replies: ‘Guilty, actually.’
His surgeon, Professor George Hannah, argues with intensive care director Simon Ashworth that he should be allowed to operate, with Simon taking the last space in the 16bed unit – a bed usually kept free in case of sudden emergencies.
‘Cancelling a cancer patient three times is a serious incident,’ he says.
‘There’s a surgeon, there’s a theatre, there’s three or four nurses [available],’ he argues. ‘It is a waste!’ But Dr Ashworth insists ‘there is not enough slack in our capacity’ to let Prof Hannah go ahead, adding: ‘That’s the practical reality.’
Later, Dr Ashworth tells the film-makers: ‘We do need more capacity because we are always under pressure.
‘And it does feel to me like the elastic is a bit nearer to breaking now than it ever was.’
Simon did get his eight-hour operation the following day, but only after a patient was moved to another hospital altogether to make room for him. He was later told it had cleared his cancer, but he tragically died five weeks later.
In another case, a patient with a huge aneurysm – which means he might die at any moment – is placed in a similar position.
Doctors have worked for two months to arrange his complex operation, which requires five surgeons, three anaesthetists and other specialists to co-ordinate their diaries. Software
engineer Peter Lai is preparing to be put under by an anaesthetist when he is abruptly told by his surgeon: ‘I’m really sorry. There’s no bed.’
A shocked Mr Lai responds: ‘It’s unreal isn’t it? At the last minute – “Yes” and then “No”.’
Mr Lai, described by staff as an ‘exceptional human being’ for his calmness and politeness, had his surgery delayed by a month.
When it did take place, it went well, but he died of complications related to surgery six weeks later.
The hospital makes no claims that delays to these patients contributed in any way to their deaths, as there is nothing from their medical cases to suggest that was the case.
But the documentary makes it plain to see how the struggle of dealing with exceptional demand exerts a human price on the psyche of patients, loved ones and staff.
Consultant surgeon George Reese, who manages to get his bowel cancer patient into surgery, says afterwards: ‘Why should I feel victorious because I was actually allowed to do what I started doing at eight o’clock this morning? ‘It’s because the beds are so bad at the moment that it seems rare to be allowed to actually go ahead and do an operation.’
From nurse to surgeon to medical director, all at the hospital lament the lack of available beds.
Site manager Lesley Powls, who has the power to stop preplanned operations if there are no beds available, admits: ‘A lot of the time at St Mary’s we are running at 98, 99 per cent capacity, which is extraordinary.
‘What that means is that we are always running with one or two empty beds, which isn’t nearly enough.
‘It wouldn’t be a problem if we never admitted more than one patient a day. But we do.’
‘It’s all about beds, beds and more beds,’ says nurse Alice Mackay, who has to find patients to discharge. ‘The walls are not elastic.’
A meeting is called to sort out the problem, with hospital bosses knowing the situation will not let up until March or April – and could get worse.
There, gastroenterologist Professor Orchard makes his bald assessment of the situation, admitting that Imperial College Healthcare NHS Trust, which runs five hospitals including St Mary’s, could run out of beds altogether for the first time in its history.
Lesley Powls admits: ‘If we get noro[virus], and we lose a ward, organisationally we are not going to be able to manage at the moment. We’ve got nowhere to go.’
Prof Orchard discusses using hospital gyms, the endoscopy unit and cardiac wards to put in extra beds. ‘It’s about using every square inch of space, even if it doesn’t normally have a bed in it,’ he says.