HEREFORD County Hospital is headed for “critical incident” status again - little more than a week after coming out.

Wye Valley NHS Trust stopped short of making the “critical” call this morning (Wed).

But both the trust and the Clinical Commissioning Group (CCG) are re-iterating pleas for patients to take up alternatives to A&E.

Patient numbers put urgent care at the hospital under unprecedented pressure over Christmas-New Year to the extent that a “critical incident” was declared.

By January 14, numbers had tapered off  enough to allow a stand down of “critical” status.

But, over recent days, an A&E  designed to handle around 125 patients over 24 hours has been seeing around 160 a day.

Now, the trust and CCG hope the spirit that saw critical incident status lifted will see patients seeking alternatives to A&E again.

“The public responded well during Christmas and the New Year when we asked them to consider the alternatives to our Emergency Department,” said Lisa Hunt, Wye Valley NHS Trust’s chief operating officer.

“These alternatives are still available and we would urge people to try these instead of turning up with relatively minor illnesses or injuries. We currently have a lot of very sick people who need attending to which inevitably means longer waits for those with minor injuries.”

The alternatives include:

Ringing NHS 111
Visiting a local GP
Using the GP walk in centre
Visiting a local pharmacy for advice

David Farnsworth, CCG Executive Nurse for quality and safety said: "We are working to ensure we are doing everything within our power to address the pressures the trust is currently facing and alleviate them where possible.

“The first priority in every decision we make is that patients receive the safe and high quality care that they need.

“We hope that members of the public will also help by only using A&E for emergencies and use alternatives such as a local pharmacy or walk-in centre, or GP for all other illnesses and injuries". 

The hospital is still adjusting to the unprecedented demand over Christmas-New Year.

High service demand dropped off, but never went away.

Even the mortuary risked running out of room and needed a temporary back-up unit for a time.

The trust also has a big backlog of cancelled operations to catch up on as a result of the “critical incident” call.

As an illustration of the problem, over one Saturday-Sunday period earlier this month 222 patients attended A&E – 112 on the Saturday and 110 on the Sunday.

Sixty-two patients were admitted on the Saturday, 33 from A&E, and 38 on Sunday, 26 from A&E.

With bed availability at a maximum of 220, a single day earlier this month saw 57 emergency admissions all described as “extremely sick” and in need of urgent care.

At one point, the pressure was so acute that the hospital had nearly 50 patients in A&E, five waiting on trolleys to be seen, a full Clinical Assessment Unit, a full discharge area, and a single resuscitation bay free.

Many routine operations have had to be cancelled with knock on effects to the trust’s tightened finances.

Figures show that over the last three months of 2014, 85 per cent of people attending A&E were seen within four hours against the national target of  95 per cent.

During the Christmas and New Year period, this figure fell to 74 per cent due to the increase in patients.

When the critical incident call was made on Monday, January 5, 135 patients attended A&E and 57 emergency admissions accepted.

By then, demand levels described as “unceasing and unprecedented” had taken the hospital to a “level 4” alert – the point at which demand exceeds capacity by 30 to 40 per cent.

Daily attendances at A&E topped 164 over Christmas- New Year.

Extra ambulance space was also found with turnaround a major issue as emergency vehicles waited with patients while blue light calls came in.

At one point last month, seven ambulances - almost the entire fleet available to the county at the time - were waiting outside A&E to admit patients.

As yet, West Midlands Ambulance Service has not been asked to divert incoming patients away from Hereford A&E.