Covid UK: Maternity services disrupted in South East England

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Maternity providers are dealing with disruption throughout the South East as a result of ambulance workers are too busy coping with spiralling coronavirus hospitalisations.

The East Sussex NHS Belief and Brighton and Sussex NHS Belief have each suspended providers for home-births and their stand-alone midwife-led models as a result of they can’t assure an ambulance can flip up if there is a matter.

4 different trusts — all in Kent, one of many locations worst-hit by England’s second wave — have additionally paused their home-births service for a similar cause. 

It comes as hospital chiefs warn a whole lot of intensive care sufferers might should be moved between areas to take the stress off essentially the most over-stretched wards.

Some medical doctors are even contemplating transferring essentially the most unwell sufferers from London to as far afield as Yorkshire to take the stress off overflowing models.

And steering up to date in the present day tells medics they could should determine which severely ailing sufferers to deal with primarily based on a ‘lottery’ if the NHS is overwhelmed this winter. 

Maternity services are facing disruption as ambulance staff at South East Coast Ambulance Service say  they are under 'significant pressure' from spiralling Covid-19 hospitalisations

Maternity providers are dealing with disruption as ambulance workers at South East Coast Ambulance Service say  they’re below ‘important stress’ from spiralling Covid-19 hospitalisations

Which maternity providers are being disrupted within the South East? What has been cancelled? 

  • East Sussex Healthcare NHS Belief – suspension of deliberate home-births and births at stand-alone midwife-led models, together with the midwife-led unit at Eastbourne DGH;
  • Brighton and Sussex College Hospitals NHS Belief – suspension of deliberate home-births and births at stand-alone midwife led models;
  • Medway NHS Basis Belief – suspension of home-birth service till at the very least January 21;
  • Dartford and Gravesham NHS Trust – suspension of home-birth service;
  • East Kent Hospitals College NHS Basis Belief – suspension of home-birth service;
  • Maidstone and Tunbridge Wells NHS Belief – suspension of home-birth service and the Crowborough Start Centre.

The choice to axe some maternity providers got here after the South East Coast Ambulance Service warned it was severely overstretched.

‘Because of the present pressures we’re experiencing throughout our pressing and emergency care providers, we’re not ready to ensure an ambulance response to these ladies selecting to plan their delivery at house or inside one of many three stand-alone delivery centres within the area,’ a spokesman mentioned.

‘As an ambulance belief, we all the time prioritise our essentially the most severely ailing and injured sufferers.

‘In gentle of the present operational pressures we face, we have to scale back the quantity of deliberate exercise which will require emergency ambulance switch.

‘Inside maternity providers this pertains to home-births and stand-alone delivery centres.’

Abbie Aplin, the regional head for the south of England on the Royal School of Midwives, mentioned: ‘As we enter one other nationwide lockdown we all know that each belief is making enormous efforts so that ladies can entry the fitting providers safely and with as little disruption as doable.

‘The protection of pregnant ladies and their infants, and maternity workers, should be the primary precedence.

‘It is usually necessary that maternity providers are ring-fenced and that no maternity workers are redeployed to different areas of service. That is essential to make sure the continuation of providers and secure, high-quality care.’

Kent was on the epicentre of the UK’s second wave for weeks, after a brand new variant of coronavirus – that’s 56 per cent extra infectious – was first recognized within the county.

Its hospitals have additionally been below critical stress for longer, as admissions began to surge earlier than in addition they ticked up in surrounding areas. 

Division of Well being information reveals the variety of Covid-19 sufferers within the area’s hospitals surged by 35 per cent over the seven days to January 1, hitting as many as 4,180 on the most recent day for which information is obtainable. 

The President of the Intensive Care Society, Dr Stephen Webb, mentioned round 10 intensive care sufferers are already being moved between hospitals each day.

Most of those are moved from and to hospitals inside the similar areas, he mentioned, however a small quantity could also be moved between areas.

Eastbourne hospital, pictured, has had to suspend its midwife led stand-alone maternity clinic

Eastbourne hospital, pictured, has needed to droop its midwife led stand-alone maternity clinic

Some medical doctors are even contemplating sending sufferers from the South East and London so far as Yorkshire and the South West – with the South West being the almost definitely recipient as a result of it is healthcare providers are below much less pressure.

Usually, it’s uncommon for intensive care sufferers to be moved between hospitals. 

Dr Webb, who additionally works within the East of England, mentioned: ‘The issue with sending sufferers to the North is that these models have been actually badly affected earlier on this wave, they usually could possibly be hit with the brand new variant. It’s a really tough scenario.

‘If the virus continues as it’s, I’m rather more fearful we might get to saturation level for ICUs, however we have now nonetheless acquired a little bit of time. We do have capability in different elements of the nation, however not lots.

‘Presently, within the East of England, South East and London, many intensive care models are already saturated. That is the place we’re seeing every day export of sufferers. however in the mean time that is primarily domestically.

‘So it could be a couple of miles down the highway between London hospitals. We attempt to keep away from transferring sufferers and we all the time attempt to transfer the least sick of our ICU sufferers. They’re transferred utilizing all of the gear wanted to maintain them alive, accompanied by an ICU physician and a nurse.’

Covid rationing plan advises medical doctors at main NHS hospital to choose which severely-ill sufferers to save lots of by ‘lottery’ or primarily based on ‘how a lot they contribute to society’

Medical doctors might should determine which severely ailing sufferers to deal with primarily based on a ‘lottery’ if the NHS is overwhelmed this winter below draft Covid rationing plans.

The steering additionally advises medics have a look at sufferers’ potential to contribute to society or their chance of surviving the therapy as a strategy to prioritise whose lives must be saved.

The protocol says that for sufferers who’re in comparable well being and can’t be separated in different methods, a ‘random allocation, comparable to a lottery, could also be used’. 

The doc, printed within the Journal for Medical Ethics in November, was drawn up by specialists at a significant NHS Belief in Tub in an try to provide you with a system for rationing care within the occasion there aren’t sufficient assets to deal with everybody. 

It being broadly circulated amongst NHS specialists, in line with the Telegraph, as some trusts battle to take care of a tsunami of coronavirus sufferers with the brand new, extremely infectious pressure of the illness. 

Medical, authorized and palliative care specialists on the Royal United Hospital Tub NHS Belief (RUHBT), who drafted the protocol, careworn the well being service has not but reached the tipping level at which care must be rationed.

However two-thirds of trusts in England are actually treating extra Covid sufferers than they have been in April, and on Monday the Chief Medical Officers from the 4 house nations raised the nationwide alert stage to quantity 5, that means there may be ‘a materials danger of the NHS in a number of areas being overwhelmed over the following 21 days’. It compelled Boris Johnson into placing the nation in its third nationwide lockdown on  Monday. 

Dr Kevin Fong, marketing consultant anaesthetist and nationwide scientific adviser to NHS England’s emergency response workforce for Covid, who was not concerned within the protocol, mentioned in the present day he had ‘by no means seen something like’ the degrees of sufferers at present in hospitals. 

Professor Tim Prepare dinner, a marketing consultant in anaesthesia and intensive care drugs at RUHBT who helped provide you with the protocol, informed the Telegraph it was meant for use as a ‘sensible information’ for medical doctors working at velocity in overcrowded Covid wards and ICUS within the occasion they run out of assets. He careworn it was a draft protocol and was to not be taken as coverage.

The authors say they have been compelled to provide you with the protocol as a consequence of an absence of  nationwide steering from the Division of Well being or NHS England.  

There have been disputed claims the NHS was rationing beds and denying older coronavirus sufferers intensive care therapy throughout the peak of the primary wave of the pandemic, although hospitals weren’t pushed to the brink within the spring. 

Doctors may have to decide which severely ill patients to treat based on a 'lottery' if the NHS is overwhelmed this winter under draft Covid rationing plans drawn up by experts at a major NHS Trust in Bath

Medical doctors might should determine which severely ailing sufferers to deal with primarily based on a ‘lottery’ if the NHS is overwhelmed this winter below draft Covid rationing plans drawn up by specialists at a significant NHS Belief in Tub

The guidance also advises medics look at patients' potential to contribute to society or their likelihood of surviving the treatment as a way to prioritise whose lives should be saved (file)

The steering additionally advises medics have a look at sufferers’ potential to contribute to society or their chance of surviving the therapy as a strategy to prioritise whose lives must be saved (file) 

Dr Kevin Fong, consultant anaesthetist and national clinical adviser to NHS England's emergency response team for Covid, who was not involved in the protocol, said today he had 'never seen anything like' the levels of patients currently in hospitals

Dr Kevin Fong, marketing consultant anaesthetist and nationwide scientific adviser to NHS England’s emergency response workforce for Covid, who was not concerned within the protocol, mentioned in the present day he had ‘by no means seen something like’ the degrees of sufferers at present in hospitals

‘This doc is explicitly and just for use in instances of insufficient useful resource, throughout which we have to change strategy, and wish a powerful moral framework in an effort to make honest choices’, says the protocol.

‘When assets are adequate, choices are primarily based solely on what’s greatest for every particular person affected person.

‘When assets are inadequate, choices want to incorporate a broader view on what’s ethically honest for the broader neighborhood (society).

‘This implies components comparable to equity to others are included in decision-making’.

It provides: ‘The protocol goals to allow structured, express, clear decision-making in a scenario all of us hope won’t ever come up.

‘This doc has been produced domestically as there isn’t a express nationwide steering’, says the doc.’ 

A spokesperson for Royal United Hospital Tub NHS Basis Belief described the draft protocol as a ‘analysis doc for the needs of dialogue’.

It was not ‘belief coverage and as such there isn’t a associated protocol on the RUH’, they informed the Telegraph.  

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 a complete throughout the first wave.

The worst-affected hospitals now are principally within the South of England, however NHS trusts within the North skilled comparable spikes in sufferers at the beginning of the second wave within the autumn.

Hospital trusts listed under had the largest distinction between whole affected person numbers in April and December, measured in uncooked numbers not adjusted for hospital dimension.

Covid sufferers on April 12, 2020 

Covid sufferers on Dec 29, 2020

Mid/South Essex

East Kent 

Maidstone

Portsmouth 

East Sussex

Barking, Havering

Frimley Well being 

North Midlands

Dartford

Hull College

374

143  

85

130

68

171

276

134

79

44

785

415

299

342

257

356

453

304

241

191

The protocol says a ‘four-stage course of’ must be adopted to determine who ought to get therapy within the occasion the NHS is overwhelmed.

Medical doctors are suggested to hold out a well being evaluation which takes into consideration the affected person’s survival probabilities and whether or not they have underlying well being situations, together with if they’re an alcoholic.

They’re then informed the communicate with the affected person and their household to get consent about their therapy path.

The doc says medics should then think about ‘moral components’ with the purpose being to ‘save extra lives and extra years of life’. It provides that for sufferers who’re in comparable well being, a ‘random allocation, comparable to a lottery, could also be used.’

‘Different moral concerns are extra complicated and opinions differ significantly. Some decide that a person’s potential to contribute to upkeep of the crucial infrastructure all through the epidemic could also be thought-about in figuring out precedence for allocation of ICU care.

‘Others have proposed that individuals who take part in analysis to enhance therapies or vaccines throughout an epidemic must be given some precedence for therapy’.

A remaining examine is then to be carried out by a senior clinician circuitously concerned within the affected person’s therapy. 

There have been disputed claims the NHS was rationing beds and denying older coronavirus sufferers intensive care therapy throughout the peak of the Covid-19 pandemic, although hospitals weren’t pushed to the brink within the spring. 

These aged over 80, and a few over 60s, weren’t given doubtlessly life-saving therapy as a result of well being officers have been involved the NHS could be overwhelmed, in line with reviews.

It’s claimed paperwork known as a ‘triage software’, drawn up on the request of England’s chief medical officer Professor Chris Whitty, have been utilized in stopping aged Covid-19 sufferers from receiving air flow in intensive care.

As a part of an investigation, the Sunday Times says the software was used to create a ‘rating’ for sufferers primarily based on their age, frailty, and sickness. 

Underneath the unique system, over-80s have been robotically excluded from ICU therapy as a consequence of their age. Even over-60s thought-about frail and with pre-existing well being situations, comparable to coronary heart illness, might have been over the intensive care threshold.

The software was by no means formally printed, nor was it official NHS coverage. However the newspaper, which carries claims by medical doctors who say the software was used of their hospitals, mentioned the paperwork have been broadly circulated amongst well being care professionals.

Earlier this yr NHS chiefs hit again on the accusations and mentioned they have been false, whereas ‘deeply offensive to NHS medical doctors, nurses and paramedics’. 

Officers say that whereas early work on an intensive care nationwide ‘triage software’ did happen, it was ‘not accomplished’ and by no means issued. 

Graph shows the NHS hospital trusts that have the highest number of Covid-19 patients now compared to in April, with many hospitals seeing three or even four times as many people with the disease than they did at the height of the first wave

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 peak of the primary wave

In the meantime, Dr Fong informed BBC Radio 4’s Immediately programme the third nationwide lockdown gave the NHS a preventing likelihood of not being overwhelmed this winter. 

Most cancers disaster hits hospitals: Fears for sufferers and coronary heart victims as medical doctors are compelled to axe pressing surgical procedure amid Covid-19 surge 

Pressing most cancers surgical procedure is being cancelled as hospitals wouldn’t have house for non-Covid sufferers.

Hovering admissions imply bosses in London and Kent say that they had no alternative however to take the drastic step to allow them to take care of emergency virus circumstances.

In London, the place hospitals are near being overwhelmed, surgical theatres and restoration wards normally be used for operations have been became Covid wards.

Medical doctors concern coronary heart assault and stroke sufferers might additionally turn out to be collateral victims of the brand new lockdown, with an enormous fall within the variety of non-virus sufferers attending A&E. The primary lockdown was blamed for tens of hundreds of extra non-Covid deaths.

The NHS had pledged to maintain most cancers therapy going all through the winter however sufferers have had operations cancelled on the final minute.

Surgical procedure would require an intensive care mattress for the affected person to get well in – however in lots of hospitals all ICU beds are taken up treating Covid. Operations classed as Precedence Two – deemed so pressing they should be executed inside 28 days – have been known as off at hospitals together with King’s School London. It mentioned: ‘A small variety of most cancers sufferers as a consequence of be operated on this week have had their surgical procedure postponed, with sufferers being saved below shut evaluation by senior medical doctors.

‘Because of the massive enhance in sufferers being admitted with Covid-19, together with these requiring intensive care, we have now taken the troublesome resolution to postpone all elective procedures, except circumstances the place a delay would trigger fast hurt.’

Any delay to most cancers surgical procedure dangers the tumour rising and the illness spreading, lowering survival probabilities.

The Well being Service Journal reported that cancellations have been ‘rife’ throughout London, with nearly all non-emergency surgical procedure scrapped.

1000’s of elective operations, comparable to knee and hip replacements, had already been known as off. Professor Neil Mortensen, president of the Royal School of Surgeons, informed Instances Radio: ‘Over the weekend we talked a couple of slow-motion automobile crash, however I believe it’s getting a lot worse than that now.

‘My colleagues in London report that there are issues with workers numbers on the wards, workers numbers in theatres.’

Sara Bainbridge, head of coverage at Macmillan Most cancers Help, mentioned: “We nonetheless should guarantee that most cancers doesn’t turn out to be “the forgotten C”. It’s crucial that individuals anticipating assessments and therapy face minimal disruption.’

Kruti Shrotri, Most cancers Analysis UK’s head of coverage, mentioned: ‘It’s extraordinarily regarding to listen to that most cancers surgical procedure is being delayed in some elements of the nation, and this reveals simply how a lot the NHS is struggling to manage. We all know NHS workers are doing every part they will. We’re doing all we will to help the NHS to guard most cancers providers.

‘Anybody who thinks they may have indicators or signs of most cancers, please go and see your GP – the NHS remains to be open to see you.’ In the meantime, Royal School of Emergency Drugs vice chairman Dr Adrian Boyle mentioned attendances at A&E by non-virus sufferers has fallen by as much as 30 per cent.

‘We fear in regards to the lacking sufferers,’ he mentioned. ‘Individuals with coronary heart assaults and strokes will be too scared to return to hospital. Individuals are coming extra severely ailing as a result of they’ve waited too lengthy to get assist. We wish to get the message out that when you do go to hospital we are going to do every part we will to take care of you.’ He warned that the surge in Covid sufferers is having a knock-on affect, with trolley waits in A&E at their worst stage for a decade.

Professor Ravi Mahajan, the president of the Royal School of Anaesthetists, mentioned: ‘If we don’t take decisive motion to deal with this virus now, we are going to see rising ready lists which can take years to get below management.’

A spokesman for NHS England mentioned: ‘Trusts proceed to deal with as many elective sufferers as doable, and are prioritising those that have been ready the longest, while sustaining most cancers and pressing therapies. Howev

He mentioned: ‘I believe what we have got arising now are essentially the most harmful 4 to 6 weeks of the entire pandemic and we’d like this final push to get us by, and we’d like everyone’s assist… to assist choke off the availability of those circumstances coming by.

‘We want the general public to assist us, we’re on the market that will help you. We want you to assist us.’

He mentioned ‘the entire nation is busy in the mean time – do not let anybody inform you in any other case, we’re operating tremendous sizzling.’

‘I believe my colleagues in intensive care are out at full stretch, they’ve been for a while now, and that is as laborious as I’ve ever seen the groups work.

‘We’re grateful that the lockdown has come. It offers us a preventing likelihood, however I’ve by no means seen something prefer it.

‘We’ve got been working flat out throughout Christmas doing every part we will to handle the surge in circumstances of Covid-19.’

He mentioned ‘staffing is an issue due to isolation – individuals having to enter isolation due to contacts – individuals being sick themselves, and simply the workers being exhausted actually’.

He added: ‘So sure, all of those pressures are build up within the system.

It comes as MailOnline’s evaluation of NHS figures confirmed two thirds of hospitals in England at present have extra Covid sufferers than they did on the nation’s worst day in April final yr when the pandemic first exploded. 

There have been a file 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.   

On Monday London 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 file of 883 again in March.

And evaluation of official statistics reveals some hospitals in hard-hit areas comparable to Kent and East Sussex are seeing as much as thrice 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 changing into increasingly more troublesome, with one London hospital final week declaring it was in ‘catastrophe’ mode. 

One physician mentioned medics in some badly hit areas are already having to determine how you can ration ventilators for intensive care sufferers and face ‘horrifying’ selections at work.

Chief of healthcare union NHS Suppliers, Chris Hopson, mentioned the spike in Covid inpatients since Christmas alone was sufficient to fill 18 hospitals. 

And the Royal School of Surgeons’s president, Professor Neil Mortensen, warned that affected person numbers are actually so excessive that most cancers operations might should be sidelined once more. 

There was chaos in spring when non-urgent ops have been cancelled and the NHS is now preventing its approach by a backlog of hundreds.

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 assessments being reported.

Hospitals within the North West, which endured the complete power 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 isn’t but spreading as broadly within the North of the nation. 

NHS figures present that on the worst day within the first wave, April 12, there have been 18,974 individuals 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 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 at the beginning 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 without doubt one of the ones to have seen the largest spike in sufferers throughout the second wave. On December 29 it had 785 individuals 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 thrice 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. 



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