HEREFORD County Hospital took in 57 emergency admissions on the day it declared a “critical internal incident”.

The declaration was made yesterday when 135 patients attended A&E where daily attendances topped 164 over Christmas-New Year.

Unceasing and unprecedented demand levels over the past fortnight lead to the “internal critical incident” designation, but Wye Valley NHS Trust has so far stopped short of declaring a “major incident” which would mean having to call in help from outside the county.

The trust  has the power to declare an internal incident if it feels pressures in A&E present a serious threat to the disruption of its services.

Internal status has the trust trying to handle circumstances with its own resources.

But the re-allocation of resources has seen a number of routine operations postponed.

As of this morning (Tues), West Midlands Ambulance Service has not yet been asked to divert incoming patients away from Hereford A&E.

The Trust has confirmed a 12 per cent increase in the number of overnight emergency patient admissions compared to the previous month, with the number of emergency admissions over a single 24-hour period topping 57 yesterday (Mon).

Meetings between trust management, WMAS and the Herefordshire Clinical Commissioning Group have been going on over today to assess the extent of response to demand.

Figures taken from the system resilience plan for the county’s health services  show Hereford County Hospital has been taking between 35-55 emergency admissions each day.

Around 23 per cent of these patients are discharged the same day, leaving between 30-45 non-elective overnight admissions.

A further 40-60 day case elective patients can be expected each week day and between 7 -11 elective patients overnight.

This means  that from its total bed base of 208, the hospital has to discharge between 40-50 patients who have been in hospital overnight or longer.

The plan breaks the discharge options down to between 7-11 elective patients and 33-40 non electives.

At weekends, when admissions are less, there is a need to discharge between 25-35 non elective patients who have been admitted for at least one night.

On current assessment non-elective patients stay an average 6 days and elective patients 2 days.

With bed occupancy targeted at 95 per cent this gives an overnight requirement of between 220 to 240 beds dependent on the month of year - well above the actual operating  bedded state of the hospital and contributing to its difficulty in managing to the 95% 4 hour target in A&E.

The interpretation doesn’t currently include additional overnight elective patients transferred to the private sector  because the hospital does not have the physical capacity to deal with them without further  compromising urgent care capacity.

This is around  50 patients a month or, roughly, a further 6-8 elective beds each weekday.

Current bed occupancy at the hospital is 95 per cent and well above the national performance expectation of  around 85 per cent.