Category Archives: Asthma

Family doctors working ‘beyond safe levels’, says GPs’ leader

As doctors describe dealing with up to 70 patients a day, college warns of risks to public health

Waiting room of GP practice


Patients face longer waits to see a GP, says the Patients Association. Photograph: Alamy


GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.

Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.

The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.

Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”

One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”

Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.

It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.

“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”

Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”

He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.

Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”

Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”

Obesity surgery ‘halves risk of death’ compared to lifestyle changes alone

Latest study of long-term impact of bariatric surgery lends support to experts who say more operations should be carried out in UK

Bariatric surgery reduces the size of the patient’s stomach. It is cost-effective and leads to substantial weight-loss as well as helping to tackle type 2 diabetes.


Bariatric surgery reduces the size of the patient’s stomach. It is cost-effective and leads to substantial weight-loss as well as helping to tackle type 2 diabetes. Photograph: Murdo Macleod for the Guardian

Obese patients undergoing stomach-shrinking surgery have half the risk of death in the years that follow compared with those tackling their weight through diet and behaviour alone, new research suggests.

Experts say obesity surgery is cost-effective, leads to substantial weight loss and can help tackle type 2 diabetes. But surgeons say not enough of the stomach-shrinking surgeries are carried out in the UK, with figures currently lagging behind other European countries, including France and Belgium – despite the latter having a smaller population.

“We don’t think this [new study] alone is sufficient to conclude that obese patients should push for bariatric surgery, but this additional information certainly seems to provide additional support,” said Philip Greenland, co-author of the latest study from Northwestern University.

In the new study, one of several on obesity surgery published in the Journal of the American Medical Association, researchers sought to explore whether stomach-shrinking operations, known as bariatric surgery, had a long-term impact on the risk of death among obese individuals, compared with non-surgical approaches to weight loss.

In total, more than 33,500 participants were involved in the study – 8,385 of whom had one of three types of bariatric surgery between 2005 and 2014. The majority of participants had a BMI greater than 35; obesity is defined as a BMI of 30 or higher.

The researchers followed up the participants over the years that followed their surgery until death, or the end of the follow-up period in December 2015, comparing the number of deaths and other metrics with those for obese patients who had not had surgery but were given dietary and behavioural help. Each surgery patient was compared to three who did not have surgery, but had similar characteristics such as age and sex, and were also followed until they too had surgery, died or the study ended.

The results reveal that the death rate during the study was 1.3% for those who had any form of bariatric surgery, while among those who had not had surgery it was 2.3%, although the length of follow-up period varied considerably from patient to patient.

Once other factors including age, sex and related diseases were taken into account, the team found those who did not have stomach-shrinking surgery had just over twice the risk of death compared to those who had, with all three types of surgery linked to lower mortality.

What’s more, the group which had surgery showed a greater reduction in BMI, lower rates of new diabetes diagnoses, improved blood pressure, and a greater proportion of diabetic individuals going into remission.

But the team add that a small proportion of surgery patients required further surgery, while they note the study was observational so cannot prove bariatric surgery itself reduced the risk of death since patients were not randomised, meaning it is possible that those who did not have surgery were in poorer health.

A second, smaller study in the same journal also highlighted benefits of bariatric surgery, comparing diabetes-related markers in obese adults who had lived with a diagnosis of type 2 diabetes for an average of nine years. Participants either received two years of intensive diet, exercise and medical management or, in addition, had bariatric surgery.

The results from 113 participants reveal that complications were more common among those who had had bariatric surgery, but that one year after the study began they had lost more weight on average, with a greater proportion having reached the combined targets for cholesterol, systolic blood pressure and a marker of glucose.

While this proportion fell for both groups after five years – at which point 98 patients were still providing data – those who had had bariatric surgery maintained the edge, with 23% reaching the combined targets, compared to just 4% of those offered lifestyle and medical interventions alone.

Francesco Rubino, professor of metabolic and bariatric surgery at King’s College London, who was not involved in the studies, said misunderstandings and stigma were holding back greater use of such operations in the UK. While Rubino noted that surgery is not for everyone, he added “This is a conversation GPs and doctors should have with patients more often.”

Don’t knock the flu jab – it’s a modern miracle

As the flu season begins to ramp up, so too do the annual complaints about the vaccine

Woman with cold on computer at homeFrome,UK


Varying rates of flu vaccine effectiveness are to be expected, but shouldn’t stop you getting it Photograph: Cultura RM Exclusive/Colin Hawkins/Getty Images/Cultura Exclusive

“The flu jab DOESN’T work, officials admit,” scolded a recent headline from the Daily Mail.

Meanwhile, in the comments under that article, and in shadier regions of the internet, conspiracy theorists are having their usual annual field day: the flu vaccine actually makes people sick; the World Health Organisation is in cahoots with Big Pharma; the vaccine is being deliberately sabotaged by its manufacturers to drum up business for more expensive anti-viral therapies.

Most sensible people understand that our impressive arsenal of vaccines is a modern miracle that prevents vast numbers of premature deaths. Together with improvements in nutrition, sanitation and modern medicine, routine inoculations have lifted us out of the dark ages.

The problem with influenza is that, unlike some other bugs, it’s a tricky shape-shifter. Because of this, the vaccine against it is not nearly as effective as others. For example, a complete course of MMR vaccine is 97% effective at preventing measles; two successive doses of the chicken pox vaccine are about 98% effective; and tetanus toxoid is about 100% effective. What’s more, these impressive figures stay relatively constant year on year.

In contrast, the success of the annual flu vaccine ebbs and flows dramatically, and the healthcare profession is pretty happy when it reaches a modest 40-60% efficacy. Some years it is much worse – as in 2004-05, when its effectiveness was only 10%.

It’s probably no surprise that people think the flu jab is rubbish – especially when the media is delighted to rub failures into the noses of those who work so hard to make it happen. We have become so accustomed to highly effective vaccines that it can be tempting to criticise those that don’t work perfectly. With such high prevention rates, many vaccinated people will feel disappointed when they succumb to the illness. Just as a man who pulled himself out of starvation to become rich might one day frown upon anything but a grand feast, the developed world – from its privileged, 21st century vantage – is happy to talk down a cheap and serviceable preventive measure that improves global morbidity and mortality and reaps significant economic benefit.

And the discontent is rife. In 2014-15, the US Centers for Disease Control issued an early press release warning that some circulating strains had drifted and the vaccine might not be as effective. Traditional media outlets tutted, and antivax interest groups went into meltdown, jeering at the august public health body for this admission, as if anything less than perfection was a humiliation.

In fact, predicting the three or four flu strains that will be included in each year’s vaccination is an astonishing feat of science and surveillance by countless individuals and reference laboratories around the world, on a par with forecasting the precise weather that will occur hour by hour in a month’s time. Every year as the needle slides into my own arm, I give a moment of quiet thanks to these hard-working folk.

Influenza viruses spread from person to person like lightning and also move through various animal reservoirs. In the process, they discard one coat for another, mixing and matching pieces of their genomes with other viruses in an endless game of cat and mouse with the immune systems of the various species they inhabit. Add overpopulated areas and global travel into the picture and what you have is a stochastic, messy and imprecise brew of many thousands of strains, from which only three or four must be plucked.

Once you choose you can’t go back. Because influenza will only grow – painfully slowly – in chicken eggs, it takes half a year to create and stockpile each year’s vaccine. When surveillance picks up crucial shifts after the February deadline, as it did in 2004, it’s far too late to do anything about it.

And let’s unpick the phrase “it didn’t work”. Even the 10% effectiveness rate in 2004-05 wasn’t a complete washout. In the US, as a result of being vaccinated tens of thousands of elderly people did not end up in hospital, and a number of people did not die.

For the price of a cinema ticket, you had a one in ten chance of dodging the disease had you been exposed to. There are lots of gamblers who would be happy to spin the wheel for those odds. I certainly am, having had the flu before and being painfully aware of how long it can wipe you out. Those one in ten who were protected helped to quell infection in others via herd immunity, and the vaccinated people who did get sick likely received some benefit from cross-reacting immunity elicited against the other strains in the vaccine.

There’s been a lot of hype about “Aussie flu” this year, but the offending strain (A H3N2) was around last year and is represented in this year’s vaccine. If the flu season turns out to be as bad in the northern hemisphere as it was in the southern, it won’t be the fault of the vaccine. Instead, we should remember that despite all its imperfections, it’s a remarkable achievement that doesn’t deserve the bad press it perennially suffers. What’s more, one hundred years on from the Spanish flu, which killed 50 million or more people in 1918, it’s comforting to know that we, as a species, have this annual chance to hone our skills of prediction and prevention for when the next pandemic comes.

I survived sepsis eight times. But can care workers spot this deadly illness?

Care staff are increasingly likely to see sepsis, but there is no standard training to make them aware of the symptoms to look out for in clients

Sepsis


There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the ‘sepsis six’. Illustration: Christophe Gowans

I am a survivor of sepsis. Not once, not twice, but eight times.

Sepsis – also known as blood poisoning – kills more people than bowel cancer, breast cancer and prostate cancer combined. It affects more than 260,000 people and claims 44,000 lives every year in the UK. But it is not spoken about in training for social care workers, even though they are increasingly likely to see it.

Sepsis is triggered when the body tries to overcompensate for an underlying infection and too many white blood cells are released into the bloodstream. An example you may see in the social care context is kidney and chest infections. It looks like common flu in the early stages, but it can lead to life-threatening septic shock.

There is a golden hour for the treatment of sepsis, when someone can be saved by basic steps known as the “sepsis six”. Although there is no standard training, there are some symptoms care professionals can look for in a client:

  • Are they sleepy?
  • Is their breathing rapid or shallow?
  • Do they have a raised temperature?
  • Is their complexion mottled?
  • Do they seem confused, distracted or agitated?
  • Have they spoken of feeling the worst they have ever felt?

Taking their temperature at home may be the best indication of whether someone has sepsis until a medical professional is available, but you should try to get the person to a medic as soon as possible after identifying the symptoms.

Most importantly, when you speak to the medic, follow the “just ask” protocol; ask if they think it could be sepsis and give a good, rounded history of the individual. If you are not familiar with the patient, a synopsis of their medical condition should be placed at the front of their care plan.

One of the occasions when I had sepsis offers a pertinent example of why care workers should be aware of the condition’s symptoms. I had been feeling ill for a couple of hours and had told my care workers. They said we should see how it goes – and went back to their mobile phones. This continued until my husband returned from work and, within minutes, he noticed that I was pale and flushed and that my head was nodding. He touched my cheeks and realised I had a temperature – 39.9 degrees at that point. Paul called for an ambulance and asked the paramedics if it could be sepsis; they immediately started to check for the signs using the “sepsis six”.

I spent four weeks in hospital, with a stay in intensive care on high impact antibiotics. I was told that if Paul had not acted so decisively and asked the correct questions, that I may not have received the correct treatment that saved my life. Coincidentally, Paul and I met in hospital when we were both being treated for sepsis.

Please do not underestimate the importance of recognising sepsis and simply asking medics: “Could it be sepsis?” And if you’ve had sepsis before, tell those caring for you about your history – sepsis can and does come back often.

Damian Bridgeman is a social entrepreneur, disability rights activist, and board member of Social Care Wales. He is speaking at an event on this topic in London on 18 January. For more information on sepsis, visit the Sepsis Trust

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com

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Death and the cruel process that follows | Letters

Annalisa Barbieri was lucky to have been able to keep her father at home for 11 hours after he died (Family, 6 January). I found my mother (aged 90) who had died in her sleep at home. Not knowing what to do, I rang her GP. This started a legal process that whisked her body away before I had time to say goodbye. Because she did not die in hospital or hospice and hadn’t seen her GP in the last two weeks, the GP was required to contact the police, who had to come and keep guard on the body until the undertakers came to take it away, I assume in case she’d been murdered. They couldn’t even wait for my sister to arrive to see my mother dead in her bed.

If I’d been warned that this would happen, I would have spent an hour or two quietly with my mother’s body before I rang the GP.

It would be good to publicise this system so that others don’t have the same experience. Everyone was kind, but the process is cruel.
Christine Holloway
Winchester

Join the debate – email guardian.letters@theguardian.com

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NHS cancer hospital may have to delay or reduce treatment

An NHS cancer hospital may have to make patients wait to undergo chemotherapy, or reduce the amount of treatment that dying patients receive, because it has so few nurses, a leaked memo has revealed.

Macmillan Cancer Support said the prospect of the Churchill hospital in Oxford in effect rationing life-extending and potentially life-saving chemotherapy was “deeply worrying”, especially for people dying of the disease.

The warning is thought to be unprecedented in cancer care. It is set out in an email from Dr Andrew Weaver, the chemotherapy lead, to fellow cancer specialists at the hospital.

Sent on 3 January, Weaver refers to the difficulties on the day treatment unit (DTU) caused by a shortage of specialist cancer nurses who administer chemotherapy.

He makes clear that limiting access to the treatment could affect both newly referred cancer patients and those in their final weeks or months of life.

Weaver writes: “Currently we are down approximately 40% on the establishment of nurses on DTU and as a consequence we are having to delay chemotherapy patients’ starting times to four weeks.”

Two types of cancer patients will continue to receive their chemotherapy as normal: dying patients undergoing their first course of chemotherapy and those who are receiving it in addition to other cancer treatment, such as surgery or radiotherapy.

In future, however, dying patients could receive less chemotherapy as a result of the lack of nurses.

Weaver said: “We propose that for second, third and fourth line palliative treatments the cycle length is increased by one or two weeks and/or the total number of cycles administered is reduced – for example, where normally six cycles are given then teams should consider reducing to four cycles in total.

“I know that many of us will find it difficult to accept these changes but the bottom line is that the current situation with limited numbers of staff is unsustainable in the short, medium and long term. Sadly we cannot see the staffing levels on DTU improving for at least 18-24 months.”

Q&A

Does the UK have enough doctors and nurses?

The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors they have relative to their populations. Greece, Austria and Norway have the most; the three countries with proportionately the fewest medics are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals.

NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say that understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem.

Read a full Q&A on the NHS winter crisis

Dr Karen Roberts, Macmillan’s chief nursing officer, said patients’ lives could be shortened if the hospital implemented Weaver’s proposals.

“Such a situation is deeply worrying and delays cause untold distress to patients. A group who may be particularly affected by such a decision would be those who have treatable but not curable cancer.

“Chemotherapy can help relieve their symptoms, extend survival and enable people to spend precious time with their family. If access to treatment is reduced, all these factors may be affected.”

Oxford Universty hospitals NHS trust, which runs the Churchill, said it had not decided to implement any of the suggested measures, but did not rule out doing so.

“We have not made any decisions to delay the start of chemotherapy treatment or to reduce the number of cycles of chemotherapy treatment which patients with cancer receive,” it said in a statement.

“We would like to reassure our patients that no changes to chemotherapy treatment have been made or will be made before thorough consideration has been given to all possible options.”

David Bailey, a nurse with the trust who is being treated for cancer at the Churchill, said the high vacancy rate for cancer nurses, and any consequent reduction in chemotherapy, would affect the outcomes for patients..

“I am lucky, I’m part of a clinical trial, which will not be affected; but how frightening is this for other, newly diagnosed cancer patients?”

My cancer operation was cancelled and I can’t sleep at night. Jeremy Hunt, how can you? | Carly O’Neill

Dear Jeremy Hunt,

I didn’t sleep well last night. I was nervous, anxious about what was going to happen the next day. I’m not great with needles, never mind scalpels. But I also knew that I was in the hands of professionals, who would do absolutely everything they could to make me better.

I was diagnosed with skin cancer in early October. It’s been a stressful few months, because a cancer diagnosis, even with an excellent prognosis like mine, is terrifying. It was hard to be at the mercy of the NHS waiting lists for different appointments in different hospitals with different specialists.

But at last, today was the day. I would have surgery, and after that I would be able to focus on recovering and putting all of this behind me. I would be able to get back to my PhD again – I’m due to submit that very soon. I’m getting married later this year, and I look forward to planning the wedding and trying on wedding dresses. Life feels a little like it’s on hold until this cancer is dealt with.

It’s quite a big operation, and it’ll take a few weeks to recover. Last week, four months since my GP first referred me and three months after being diagnosed, I heard that I would be having surgery soon. I was worried, but mostly really relieved that it would all be over soon. I only heard a few days in advance, so it was quite a dash to get everything sorted. My colleagues have been amazing in organising cover for me at such short notice. My fiance had to take time off work, too. So his colleagues have had to be equally wonderful.

This morning I got up very early and made my way to the hospital. I saw nurses, and the surgeon, and the anaesthetist. There were boxes to tick and forms to sign. They drew the markings for surgery on me, and I was put in a gown and given wristbands with my name and allergies on them. The most suitable vein for the IV was found. They went through all the possible risks in detail, which is of course a good thing, but it didn’t help me relax.

Hospitals can be intimidating places and it’s stressful to be at the mercy of others, even when they are the amazing people in the NHS. I can’t emphasise enough how much respect they deserve for working in the circumstances they’re put in, and they remain not only impressively professional, but understanding, calm and kind.

But at last, all the waiting was over, I was all prepared, the only thing left to do was to actually have the surgery. And after all that, Mr Hunt, after all that: I was sent home, because there wasn’t a bed available.

The winter pressures on the health system – including flu, which can exacerbate underlying conditions to the point where urgent care is needed – had brought the hospital to a near standstill. Only life-threatening conditions were being treated in the theatres. Even cancer operations, like mine, had to be shelved.

I’ve been pencilled in for February, but have been warned the same thing could happen again. And I’ve seen the headlines – people with more urgent problems than me are being sent home, sometimes repeatedly. I read yesterday about a young child who had faced five cancellations.

Mr Hunt, I know you didn’t cancel my operation yourself. And I know that hospitals sometimes have to prioritise. But my local hospital didn’t get into this state simply because of the season.

You keep telling us how funding for the NHS has increased. What you don’t mention is that, since 2010, the rate of increase has been far below the long-term average increase in health spending, at a time of massively rising demand. Our health system is like an old building: it’s creaking and shaking in the bad weather because the owners haven’t bothered to keep it in good repair. That is something you are responsible for.

Long term I’ll be OK, because I’m sure that eventually there will be a bed available. I’ll have a few more sleepless nights, though.

Congratulations on keeping your job, Mr Hunt. I’m sure you’ll continue to do it ruthlessly. I hope you sleep well.

Yours,

Carly

Carly O’Neill is working on a PhD

NHS beds crisis: sick patients can sit in A&E, says health minister

The NHS minister, Philip Dunne, has been accused of “belittling” the beds crisis by telling MPs that patients who need to be admitted can sit on seats in A&E units while they wait for a bed.

Philip Dunne was responding to the disclosure that patients have been forced to sleep on the floor in at least one hospital because the NHS’s beds shortage was so acute.

Doctors’ associations and Labour seized on Dunne’s remark, which he made in answer to an urgent question in the House of Commons about how the NHS was managing the winter crisis.

“The seats comment sounds flippant and belittling of the problem that exists,” said Dr Nick Scriven, the president of the Society for Acute Medicine, which represents hospital doctors specialising in acute and general medicine.

“If that is what he truly thinks, it shows a worrying lack of appreciation of reality in our emergency departments and acute medical units.”

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Dunne was responding to Labour MP Tracy Brabin, who described how one of her constituents had taken photographs of people “sleeping on the floor” in a hospital as winter pressures led to severe overcrowding.

“These were poorly people in chairs waiting for hours, not being given a bed or a trolley,” she said. “What I didn’t hear in his response was an apology. Is now the time for the minister to apologise to those affected?”

Dunne replied: “[Brabin] will have heard last week the apology from the secretary of state [Jeremy Hunt] to those patients who are having operations postponed, and I absolutely am prepared to apologise today to those patients who are not able to be treated as quickly as we would like them to.”

He added: “There are seats available in most hospitals where beds are not available and I can’t comment individually what happened in her case but I agree with her it’s not acceptable.”

Brabin said Dunne’s remark was “appalling and ignorant” and showed ministers were out of touch with how bad the situation was facing hospitals.

“This is an appalling and ignorant remark from a minister entirely out of touch with the reality of the NHS winter crisis,” said Justin Madders, the shadow health minister.

“Placing sick patients in chairs because of acute bed shortages is clearly not acceptable in the 21st century. And yet with numerous trusts this winter at times reporting 100% bed occupancy, hospitals simply cannot cope and are being forced into these intolerable situations.”

Hospitals are supposed to have no more than 85% of their general and acute beds filled at any one time, in order to ensure patient safety, for example by minimising the spread of potentially fatal infections such as MRSA. However, this winter has seen some hospitals hit 100% bed occupancy and many others become 98% or 99% full as they struggle to cope with a sudden influx of patients, many with breathing problems.

The NHS-wide lack of beds and A&E crisis has forced NHS England to tell hospitals to postpone tens of thousands of planned operations, and even outpatient appointments, until the end of February.

Essex woman dies after waiting nearly four hours for ambulance

An 81-year-old woman was found dead in her house after waiting almost four hours for an ambulance.

The pensioner, who lived in Clacton, Essex, called 999 on Tuesday complaining of chest pains, according to the GMB union. East of England (EEAST) ambulance service said a crew arrived three hours and 45 minutes after the initial call.

Dave Powell, GMB regional officer, said the crew had to force their way into the property on arrival because the control room could not contact the woman by phone, and found her dead.

“They’re devastated because they’re not in the job to find people dead, they’re in the job to help people and keep them alive,” said Powell.

“It puts enormous strain and stress on people who are working really hard as it is.

“Three hours and 45 minutes is totally unacceptable for an elderly woman on her own with chest pains.

“Something has got to be done and the government has got to wake up to this crisis.”

He said such cases were likely to be more widespread than the public was aware of.

Sandy Brown, the deputy chief executive at EEAST, said: “Our sincere condolences and apologies go out to the patient’s family and friends and we are truly sorry for the ambulance wait that occurred at this incident.

“We have very publicly expressed how stretched the ambulance service is and the pressures our staff and the NHS as a whole have been under the past few days. As a trust, we have experienced our busiest days ever and we know our partners in the hospitals are in the same situation.

“A clinician in one of our control rooms made a welfare call and spoke to the patient at 9.47pm and an ambulance crew arrived at the address at 11.46pm. The patient was found unconscious and not breathing and sadly died at the scene.

“This incident is being investigated by the trust and we will report back our findings in due course.”

Ambulance services, like hospitals, have struggled to cope in the midst of the NHS’s winter crisis. Last week, EEAST raised its operational level to the highest possible, an indication that its ability to respond to potentially life-threatening incidents had been affected. In some cases, it used taxis to transport patients to hospital.

The service says it received 4,200 calls on Tuesday, compared with a daily average of about 3,000. It says it has also been affected by a shortage of capacity at hospitals, with nearly 500 hospital handovers lasting an hour or more between 29 December and 1 January inclusive.

EEAST is not the only ambulance service that is struggling. On Tuesday, North East ambulance service also raised its operational level to the highest possible, citing “extreme pressure”.

Norman Lamb, a former health minister whose North Norfolk constituency is served by EEAST, said that while it was possible the woman could not have been saved even if the ambulance had arrived quicker – for example, if she had suffered a cardiac arrest – tragic consequences were unavoidable where there was underinvestment in the NHS.

“I’ve been making clear that the state that the system is in, it’s inevitable that people will lose their lives and failures of care will mean people will be left with long-term disabilities,” he said.

“One of the major strains is the ambulance service and its link with A&E, problems with handovers and ambulances stacking up, which leads to delays. Paramedics are having to work long shifts because of insufficient workforce. These are the human consequences of the financial state the NHS is in. This is why it’s vital the government acts, the prime minister can’t stand by and allow the NHS to deteriorate.”

Essex woman dies after waiting nearly four hours for ambulance

An 81-year-old woman was found dead in her house after waiting almost four hours for an ambulance.

The pensioner, who lived in Clacton, Essex, called 999 on Tuesday complaining of chest pains, according to the GMB union. East of England (EEAST) ambulance service said a crew arrived three hours and 45 minutes after the initial call.

Dave Powell, GMB regional officer, said the crew had to force their way into the property on arrival because the control room could not contact the woman by phone, and found her dead.

“They’re devastated because they’re not in the job to find people dead, they’re in the job to help people and keep them alive,” said Powell.

“It puts enormous strain and stress on people who are working really hard as it is.

“Three hours and 45 minutes is totally unacceptable for an elderly woman on her own with chest pains.

“Something has got to be done and the government has got to wake up to this crisis.”

He said such cases were likely to be more widespread than the public was aware of.

Sandy Brown, the deputy chief executive at EEAST, said: “Our sincere condolences and apologies go out to the patient’s family and friends and we are truly sorry for the ambulance wait that occurred at this incident.

“We have very publicly expressed how stretched the ambulance service is and the pressures our staff and the NHS as a whole have been under the past few days. As a trust, we have experienced our busiest days ever and we know our partners in the hospitals are in the same situation.

“A clinician in one of our control rooms made a welfare call and spoke to the patient at 9.47pm and an ambulance crew arrived at the address at 11.46pm. The patient was found unconscious and not breathing and sadly died at the scene.

“This incident is being investigated by the trust and we will report back our findings in due course.”

Ambulance services, like hospitals, have struggled to cope in the midst of the NHS’s winter crisis. Last week, EEAST raised its operational level to the highest possible, an indication that its ability to respond to potentially life-threatening incidents had been affected. In some cases, it used taxis to transport patients to hospital.

The service says it received 4,200 calls on Tuesday, compared with a daily average of about 3,000. It says it has also been affected by a shortage of capacity at hospitals, with nearly 500 hospital handovers lasting an hour or more between 29 December and 1 January inclusive.

EEAST is not the only ambulance service that is struggling. On Tuesday, North East ambulance service also raised its operational level to the highest possible, citing “extreme pressure”.

Norman Lamb, a former health minister whose North Norfolk constituency is served by EEAST, said that while it was possible the woman could not have been saved even if the ambulance had arrived quicker – for example, if she had suffered a cardiac arrest – tragic consequences were unavoidable where there was underinvestment in the NHS.

“I’ve been making clear that the state that the system is in, it’s inevitable that people will lose their lives and failures of care will mean people will be left with long-term disabilities,” he said.

“One of the major strains is the ambulance service and its link with A&E, problems with handovers and ambulances stacking up, which leads to delays. Paramedics are having to work long shifts because of insufficient workforce. These are the human consequences of the financial state the NHS is in. This is why it’s vital the government acts, the prime minister can’t stand by and allow the NHS to deteriorate.”