Two thirds of hospitals presently have extra Covid sufferers than they did on England’s worst day in April final 12 months when the pandemic first exploded, official figures present as Quantity 10 final evening shifted again to a different nationwide lockdown to ‘defend the NHS’.
There have been a document 26,000 contaminated sufferers in hospital beds throughout England on January 2, the newest day information is obtainable for, and medical doctors warn admissions are nonetheless accelerating because the second wave rages on.
Boris Johnson final evening introduced the hardest lockdown since spring amid fears the resurgence of the virus, pushed by a super-infectious new variant, will trigger hospitals to be overwhelmed by the virus inside weeks.
London yesterday reported 828 new coronavirus sufferers have been admitted to hospital on January 2, within the highest every day toll for 9 months and near the document of 883 again in March.
And evaluation of official statistics reveals some hospitals in hard-hit areas similar to Kent and East Sussex are seeing as much as 3 times as many coronavirus sufferers as they did on April 12, the purpose of the primary wave at which affected person numbers have been highest.
NHS workers from throughout the nation say caring for surging numbers of individuals is turning into increasingly more troublesome, with one London hospital final week declaring it was in ‘catastrophe’ mode. One physician stated medics in some badly hit areas are already having to determine methods to ration ventilators for intensive care sufferers and face ‘horrifying’ selections at work.
Chief of healthcare union NHS Suppliers, Chris Hopson, stated the spike in Covid inpatients since Christmas alone was sufficient to fill 18 hospitals. And the Royal Faculty of Surgeons’s president, Professor Neil Mortensen, warned that affected person numbers are actually so excessive that most cancers operations could should be sidelined once more. There was chaos in spring when non-urgent ops have been cancelled and the NHS is now preventing its method via a backlog of 1000’s.
NHS England statistics present that, in the newest information from December 29, 81 out of 127 main hospital trusts had extra Covid sufferers than on April 12.
Lots of the worst affected are within the South East and London, the place the brand new fast-spreading variant of the virus has taken maintain, with these areas now making up a majority of the every day constructive checks being reported.
Hospitals within the North West, which endured the total pressure of the second wave earlier within the autumn, have now seen affected person numbers drop to extra manageable ranges. The brand new pressure of the virus just isn’t but spreading as extensively within the North of the nation.
Graph reveals the NHS hospital trusts which have the very best variety of Covid-19 sufferers now in comparison with in April, with many hospitals seeing three and even 4 instances as many individuals with the illness than they did on the top of the primary wave
Mr Hopson stated final evening that there was ‘one other steep rise within the variety of Covid circumstances, and the variety of sufferers being admitted to hospital can be rising at an alarming price.
‘There are nearly 9,000 extra Covid sufferers in hospital beds – the equal of practically 18 hospitals – than there was on Christmas Day, simply 10 days in the past.
‘We all know that quantity goes to proceed to rise over the following few weeks. The lockdown announcement will assist, however provided that everybody follows the principles.’
WHICH HOSPITALS HAVE SIGNIFICANTLY MORE PATIENTS THAN IN THE SPRING?
Nearly two thirds of hospitals in England had extra Covid-19 sufferers on the finish of December than they did on April 12, which was the worst day for England as an entire in the course of the first wave.
The worst-affected hospitals now are largely within the South of England, however NHS trusts within the North skilled related spikes in sufferers initially of the second wave within the autumn.
Hospital trusts listed beneath had the largest distinction between complete affected person numbers in April and December, measured in uncooked numbers not adjusted for hospital measurement.
Covid sufferers on April 12, 2020
Covid sufferers on Dec 29, 2020
Frimley Well being
NHS figures present that on the worst day within the first wave, April 12, there have been 18,974 folks with Covid-19 in England’s hospitals.
On December 29 this was 21,787. It has since spiralled to 26,626 however hospital-by-hospital information just isn’t but obtainable for the additional 5,000 sufferers.
December’s information reveals that London has the best variety of Covid sufferers in hospital – partially as a result of it has the largest inhabitants – however there have been far sharper rises within the South East and the East of England.
Within the East of the nation, inpatient numbers are 74 per cent larger than they have been within the spring, with 2,922 sufferers on December 29 in comparison with 1,679 on April 12.
There have been 62 per cent extra within the South East – 3,796 in comparison with 2,342.
In London, the Midlands and the South West, there have been between eight and 9 per cent extra sufferers on the finish of December than on the nation’s peak in April.
However the North East, North West and Yorkshire all now have fewer inpatients than they did 9 months in the past.
Many hospitals within the North, nonetheless, skilled the identical spiralling pressures now being seen within the South initially of the primary wave in September, October and November, when circumstances have been nonetheless low in different elements of the nation.
Mid and South Essex NHS belief, which runs hospitals in Southend, Basildon and Chelmsford, is among the ones to have seen the largest spike in sufferers in the course of the second wave. On December 29 it had 785 folks on wards with Covid-19, which was 411 greater than double the 374 on April 12, England’s peak.
East Kent Hospitals has seen admissions nearly 3 times as excessive, with 415 sufferers in comparison with 143, whereas the Maidstone and Tunbridge Wells belief had 3.5 instances as many sufferers in December: 299 in comparison with 85.
The UK’s chief medical officers warned final evening that there’s a threat the well being service may very well be overwhelmed inside weeks as they upgraded the coronavirus threat stage to the utmost stage 5.
In a letter written by the UK’s 4 CMOs – who embrace Professor Chris Whitty – and NHS England’s nationwide medical director, Professor Stephen Powis stated: ‘Following recommendation from the Joint Biosecurity Centre and within the mild of the newest information, the 4 UK chief medical officers and NHS England medical director advocate that the UK alert stage ought to transfer from Degree 4 to Degree 5.
‘Many elements of the well being techniques within the 4 nations are already underneath immense strain. There are presently very excessive charges of neighborhood transmission, with substantial numbers of Covid sufferers in hospitals and in intensive care.
‘Circumstances are rising nearly all over the place, in a lot of the nation pushed by the brand new extra transmissible variant. We’re not assured that the NHS can deal with an additional sustained rise in circumstances and with out additional motion there’s a materials threat of the NHS in a number of areas being overwhelmed over the following 21 days.
‘Though the NHS is underneath immense strain, vital adjustments have been made so folks can nonetheless obtain lifesaving therapy.
‘It’s completely crucial that individuals nonetheless come ahead for emergency care. If you happen to require non-urgent medical consideration, please contact your GP or name NHS 111.’
Surgeons have warned that the rising numbers of sufferers being seen throughout the nation may imply that most cancers operations fall by the wayside once more.
Document variety of sick sufferers are ready 12 hours on a stretcher
NHS figures yesterday revealed a document variety of very sick sufferers waited on trolleys in A&E throughout December.
The info, seen by the Health Service Journal, reveals that greater than 2,930 folks spent no less than 12 hours in A&E departments.
Practically half of those have been in London.
The earlier highest variety of 12-hour trolley waits – the time between arriving at A&E and receiving a mattress – was 2,847 in January 2020.
The provisional figures – which is able to most likely improve -are set to be printed formally by NHS England subsequent week.
Vice chairman of the Royal Faculty of Emergency Drugs Adrian Boyle informed The Times: ‘Nobody must spend 12 hours in an emergency division.
‘Not solely is it undignified for sufferers, however research have discovered that the longer a affected person waits for admission to a hospital mattress, the larger the chance of demise.’
He added: ‘These waits normally end result from an absence of inpatient beds and workers, and — in addition to placing the affected person in danger — result in additional harmful crowding and hall care inside the emergency division.
He stated the extra sufferers there are on stretchers, the tougher it’s to manage care in an already-strained A&E.
Docs have been already making an attempt to make their method via a backlog of tens of millions of non-Covid sufferers earlier than the second wave struck, and this progress is now threatened once more regardless of officers saying cancelling routine operations once more could be unthinkable.
The primary operations to be postponed are non-urgent ones for situations that are not life-threatening, similar to joint replacements and cataracts. Extra severe procedures similar to organ surgical procedures or most cancers operations are stored going for longer till well being bosses don’t have any alternative however to cancel them as a result of an absence of workers or restoration beds.
Professor Neil Mortensen, president of the Royal Faculty of Surgeons, warned the scenario in hospitals is getting ‘a lot worse’, and escalating quicker than the ‘slow-motion automobile crash’ he beforehand predicted.
King’s Faculty Hospital in south London has already known as off all ‘precedence 2’ most cancers operations, procedures which specialists have judged to be pressing and should be achieved inside 28 days of a choice to undertake them.
It’s feared different hospitals within the nation could face the identical troublesome resolution within the coming days if admissions do not begin to fall.
Professor Mortensen informed Instances Radio: ‘My colleagues in London doing ward rounds, for instance, report that there are issues with workers numbers on the wards, workers numbers in theatres.
‘After which after all if you’ll want to go to the intensive care unit, if the intensive care unit is stuffed with Covid sufferers there is no room for you.
‘So it is a actually severe scenario and, clearly, the less-priority operations have already stopped in lots of locations – hips, knees, ENT (ear nostril and throat) procedures.
‘We’re now involved about operations like most cancers surgical procedures being cancelled or postponed as a result of there simply is not the capability to have the ability to handle them.’
He added: ‘I believe if in case you have a delayed operation for most cancers which will have an impact.
‘If you happen to are available from a highway site visitors accident and also you’re critically sick, and you’ll want to go to an intensive care unit afterwards and there’s no intensive care unit, that is going to have severe penalties.
‘And that is why everyone is so involved proper now that we’re correctly locked down, that we’re so far as we presumably can decreasing the transmission of the virus, and making it doable for what amenities we do have to hold on working successfully to maintain folks alive.’
‘Important incident’ declared at Lincoln County Hospital as Covid affected person numbers rise
Well being bosses have declared a ‘crucial incident’ at Lincoln County Hospital over rising numbers of Covid-19 sufferers.
There round 200 sufferers with Covid-19 within the hospital in Greetwell Street and at Pilgrim Hospital in Boston at a time of workers shortages due to an infection and self-isolation.
The suspension of affected person visiting in all however distinctive circumstances continues. The crucial incident – the very best alert stage – means most nose to nose workers coaching stays cancelled, however important core studying, research depart and annual depart can proceed.
The Grantham & District Hospital ‘inexperienced web site’ stays totally operational, finishing up pressing and most cancers surgical procedure for folks from throughout Lincolnshire.
United Lincolnshire Hospitals NHS Belief deputy chief government Mark Brassington stated: ‘We declared a crucial incident final evening, Monday, January 4 at Lincoln County Hospital as a result of massive variety of sufferers requiring admission.
‘We’re sorry for the waits that our sufferers have confronted yesterday and in a single day. The incident is being managed internally with help from our companions and sufferers ought to proceed to attend appointments until contacted immediately.’
He added: ‘The variety of inpatients who’ve been confirmed as having COVID-19 throughout our websites stays larger than in wave one and we stay extraordinarily busy throughout our wards and intensive care items.
‘Our place is compounded by challenges with staffing as a result of an absence of availability of colleagues as a result of a lot of elements.
‘We want to thank all of our colleagues for all they’re doing to help one another and for persevering with to take care of sufferers throughout these troublesome instances.
‘The general public will help by making certain they observe authorities tips to cut back the unfold of Covid-19 and by making certain they use probably the most applicable NHS service for his or her situation.’
The best stage of alert was beforehand declared at Lincoln County Hospital and Pilgrim Hospital, Boston in November when the variety of sufferers with Covid-19 at each hospitals rose from 56 to 175 in per week at a time of workers shortages.
Coaching, research depart, non-clinical time, and, the place doable, annual depart, have been cancelled.
|NHS Belief identify||Covid-19 sufferers on
April 12, 2020
|Covid-19 sufferers on
December 29, 2020
|Distinction (+/-)||% distinction|
|MID AND SOUTH ESSEX NHS FOUNDATION TRUST||374||785||411||110%|
|EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST||143||415||272||190%|
|MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST||85||299||214||252%|
|PORTSMOUTH HOSPITALS NHS TRUST||130||342||212||163%|
|EAST SUSSEX HEALTHCARE NHS TRUST||68||257||189||278%|
|BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST||171||356||185||108%|
|FRIMLEY HEALTH NHS FOUNDATION TRUST||276||453||177||64%|
|UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST||134||304||170||127%|
|DARTFORD AND GRAVESHAM NHS TRUST||79||241||162||205%|
|HULL UNIVERSITY TEACHING HOSPITALS NHS TRUST||44||191||147||334%|
|MEDWAY NHS FOUNDATION TRUST||106||253||147||139%|
|EAST SUFFOLK AND NORTH ESSEX NHS FOUNDATION TRUST||123||264||141||115%|
|WEST HERTFORDSHIRE HOSPITALS NHS TRUST||129||270||141||109%|
|UNITED LINCOLNSHIRE HOSPITALS NHS TRUST||72||201||129||179%|
|UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST||195||304||109||56%|
|THE QUEEN ELIZABETH HOSPITAL, KING’S LYNN, NHS FOUNDATION TRUST||51||159||108||212%|
|MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST||66||171||105||159%|
|NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST||73||166||93||127%|
|NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST||77||168||91||118%|
|WEST SUFFOLK NHS FOUNDATION TRUST||36||126||90||250%|
|BARTS HEALTH NHS TRUST||559||638||79||14%|
|NORTHAMPTON GENERAL HOSPITAL NHS TRUST||104||181||77||74%|
|UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST||225||302||77||34%|
|NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST||210||283||73||35%|
|NORTH WEST ANGLIA NHS FOUNDATION TRUST||78||150||72||92%|
|UNIVERSITY HOSPITALS BRISTOL AND WESTON NHS FOUNDATION TRUST||81||150||69||85%|
|LEWISHAM AND GREENWICH NHS TRUST||286||346||60||21%|
|BEDFORDSHIRE HOSPITALS NHS FOUNDATION TRUST||180||239||59||33%|
|HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST||90||149||59||66%|
|GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST||148||207||59||40%|
|SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST||53||111||58||109%|
|NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST||226||283||57||25%|
|EAST LANCASHIRE HOSPITALS NHS TRUST||122||179||57||47%|
|DONCASTER AND BASSETLAW TEACHING HOSPITALS NHS FOUNDATION TRUST||67||121||54||81%|
|YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST||14||66||52||371%|
|COUNTESS OF CHESTER HOSPITAL NHS FOUNDATION TRUST||120||170||50||42%|
|EAST AND NORTH HERTFORDSHIRE NHS TRUST||65||112||47||72%|
|NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION TRUST||70||114||44||63%|
|BARNSLEY HOSPITAL NHS FOUNDATION TRUST||63||106||43||68%|
|OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST||125||167||42||34%|
|KINGSTON HOSPITAL NHS FOUNDATION TRUST||101||142||41||41%|
|THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST||109||147||38||35%|
|CROYDON HEALTH SERVICES NHS TRUST||153||191||38||25%|
|WHITTINGTON HEALTH NHS TRUST||83||121||38||46%|
|EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST||148||185||37||25%|
|BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST||107||141||34||32%|
|SOUTH TYNESIDE AND SUNDERLAND NHS FOUNDATION TRUST||200||231||31||16%|
|ST GEORGE’S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST||219||249||30||14%|
|THE ROTHERHAM NHS FOUNDATION TRUST||70||100||30||43%|
|EAST CHESHIRE NHS TRUST||57||87||30||53%|
|LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST||132||162||30||23%|
|ROYAL BERKSHIRE NHS FOUNDATION TRUST||142||169||27||19%|
|ROYAL DEVON AND EXETER NHS FOUNDATION TRUST||54||81||27||50%|
|THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST||102||128||26||25%|
|COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST||129||155||26||20%|
|SURREY AND SUSSEX HEALTHCARE NHS TRUST||128||152||24||19%|
|UNIVERSITY HOSPITALS DORSET NHS FOUNDATION TRUST||76||99||23||30%|
|SOMERSET NHS FOUNDATION TRUST||32||55||23||72%|
|ASHFORD AND ST PETER’S HOSPITALS NHS FOUNDATION TRUST||114||136||22||19%|
|WYE VALLEY NHS TRUST||31||51||20||65%|
|WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST||77||96||19||25%|
|WARRINGTON AND HALTON TEACHING HOSPITALS NHS FOUNDATION TRUST||98||112||14||14%|
|NORTHERN DEVON HEALTHCARE NHS TRUST||15||28||13||87%|
|BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST||117||129||12||10%|
|SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST||261||272||11||4%|
|WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST||93||104||11||12%|
|BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST||88||97||9||10%|
|SALISBURY NHS FOUNDATION TRUST||38||47||9||24%|
|SALFORD ROYAL NHS FOUNDATION TRUST||136||144||8||6%|
|THE DUDLEY GROUP NHS FOUNDATION TRUST||122||129||7||6%|
|SOUTH WARWICKSHIRE NHS FOUNDATION TRUST||75||81||6||8%|
|UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST||142||148||6||4%|
|GEORGE ELIOT HOSPITAL NHS TRUST||69||75||6||9%|
|BIRMINGHAM WOMEN’S AND CHILDREN’S NHS FOUNDATION TRUST||5||11||6||120%|
|UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST||130||136||6||5%|
|ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST||43||48||5||12%|
|GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST||64||69||5||8%|
|KETTERING GENERAL HOSPITAL NHS FOUNDATION TRUST||69||73||4||6%|
|ISLE OF WIGHT NHS TRUST||19||23||4||21%|
|CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST||243||244||1||0%|
|BUCKINGHAMSHIRE HEALTHCARE NHS TRUST||86||87||1||1%|
|SHEFFIELD CHILDREN’S NHS FOUNDATION TRUST||1||0||-1||-100%|
|DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST||17||16||-1||-6%|
|WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST||128||125||-3||-2%|
|MID YORKSHIRE HOSPITALS NHS TRUST||165||161||-4||-2%|
|ROYAL CORNWALL HOSPITALS NHS TRUST||32||27||-5||-16%|
|ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST||63||55||-8||-13%|
|SHREWSBURY AND TELFORD HOSPITAL NHS TRUST||77||68||-9||-12%|
|ROYAL FREE LONDON NHS FOUNDATION TRUST||410||400||-10||-2%|
|TORBAY AND SOUTH DEVON NHS FOUNDATION TRUST||23||13||-10||-43%|
|ALDER HEY CHILDREN’S NHS FOUNDATION TRUST||11||0||-11||-100%|
|CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST||65||52||-13||-20%|
|YORK TEACHING HOSPITAL NHS FOUNDATION TRUST||108||94||-14||-13%|
|TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST||74||58||-16||-22%|
|HARROGATE AND DISTRICT NHS FOUNDATION TRUST||34||12||-22||-65%|
|CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST||93||71||-22||-24%|
|JAMES PAGET UNIVERSITY HOSPITALS NHS FOUNDATION TRUST||74||50||-24||-32%|
|UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST||160||133||-27||-17%|
|STOCKPORT NHS FOUNDATION TRUST||117||90||-27||-23%|
|SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST||214||186||-28||-13%|
|NORTH BRISTOL NHS TRUST||107||77||-30||-28%|
|AIREDALE NHS FOUNDATION TRUST||58||26||-32||-55%|
|CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST||122||87||-35||-29%|
|KING’S COLLEGE HOSPITAL NHS FOUNDATION TRUST||509||474||-35||-7%|
|GUY’S AND ST THOMAS’ NHS FOUNDATION TRUST||303||267||-36||-12%|
|HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST||139||103||-36||-26%|
|SOUTH TEES HOSPITALS NHS FOUNDATION TRUST||145||102||-43||-30%|
|SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST||104||59||-45||-43%|
|BOLTON NHS FOUNDATION TRUST||141||95||-46||-33%|
|LONDON NORTH WEST UNIVERSITY HEALTHCARE NHS TRUST||357||310||-47||-13%|
|NORTH CUMBRIA INTEGRATED CARE NHS FOUNDATION TRUST||152||103||-49||-32%|
|NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST||134||84||-50||-37%|
|WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST||128||78||-50||-39%|
|UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST||166||110||-56||-34%|
|UNIVERSITY HOSPITALS PLYMOUTH NHS TRUST||89||28||-61||-69%|
|PENNINE ACUTE HOSPITALS NHS TRUST||259||193||-66||-25%|
|THE ROYAL WOLVERHAMPTON NHS TRUST||228||154||-74||-32%|
|GATESHEAD HEALTH NHS FOUNDATION TRUST||114||39||-75||-66%|
|IMPERIAL COLLEGE HEALTHCARE NHS TRUST||334||256||-78||-23%|
|LEEDS TEACHING HOSPITALS NHS TRUST||230||148||-82||-36%|
|MID CHESHIRE HOSPITALS NHS FOUNDATION TRUST||85||-85||-100%|
|WALSALL HEALTHCARE NHS TRUST||180||94||-86||-48%|
|THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST||141||53||-88||-62%|
|ST HELENS AND KNOWSLEY TEACHING HOSPITALS NHS TRUST||153||51||-102||-67%|
|MANCHESTER UNIVERSITY NHS FOUNDATION TRUST||414||270||-144||-35%|
|LIVERPOOL UNIVERSITY HOSPITALS NHS FOUNDATION TRUST||346||179||-167||-48%|
|UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST||694||509||-185||-27%|