Nottingham University Hospitals NHS Trust has declared a critical incident, joining several other trusts across England and Wales, amidst an unprecedented surge in flu, norovirus, and respiratory cases, compounded by high levels of staff sickness. The trust's Queen's Medical Centre A&E department is currently seeing up to 550 patients daily, significantly exceeding its upper capacity of 350 patients over a 24-hour period. This dire situation reflects a broader crisis impacting the NHS, pushing departments to their limits.

A 'critical incident' represents the highest alert level within the NHS, typically declared when disruption is so severe that A&E departments can no longer safely deliver critical services, posing a direct risk of harm to patients. Andrew Hall, chief operating officer at Nottingham University Hospitals NHS Trust, articulated the severity, stating, 'We are experiencing pressures like never before. Despite our teams working tirelessly, the demand on our hospitals far exceeds our capacity.' He emphasized that the decision to declare an incident was not taken lightly but was crucial for patient safety.

This critical juncture follows warnings from leading doctors that the 'worst is far from over' for the NHS. After a brief decline, cases of flu and other winter viruses have begun to rise again. Last week, total bed occupancy across England reached approximately 92 percent, with over 2,940 beds occupied solely by flu patients. The recent cold weather front has further exacerbated the situation, leading to an increase in injuries from slips and falls, and consequently, more frail patients requiring hospital admission, pushing some trusts to full capacity.

The impact on patient care is significant. Trusts, including Nottingham, are prioritizing the 'sickest patients first,' meaning individuals attending emergency departments for non-pressing issues face 'extremely long waits' or may be redirected to alternative services. Non-urgent operations, treatments, and outpatient appointments may also need to be rescheduled to accommodate urgent clinical needs, though cancer and other most urgent operations continue to be prioritized.

Beyond Nottingham, other regions have also raised the alarm. Three trusts in Surrey—Royal Surrey NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, and Surrey and Sussex Healthcare NHS Trust—declared critical incidents, with issues 'exacerbated by increases in flu and norovirus cases and an increase in staff sickness.' East Kent Hospitals University NHS Foundation Trust also announced a critical incident due to 'sustained pressures and rising demand,' particularly at the Queen Elizabeth The Queen Mother Hospital in Margate, driven by high admission rates and winter illnesses.

Further afield, critical incidents have been reported in Birmingham and Staffordshire, and two areas of Wales. Aneurin Bevan University Health Board in south-east Wales cited 'sustained pressure' from a 'significant increase of norovirus cases.' University Hospitals of North Midlands NHS Trust in Staffordshire and University Hospitals Birmingham NHS Foundation Trust also reported exceptionally high demand. In North Wales, Betsi Cadwaladr University Health Board faced similar challenges.

Experts attribute the surge in flu cases to the troublesome mutant h3NS flu strain, dubbed subclade K or the 'super flu.' This strain has mutated multiple times over the summer, enabling it to evade previous immunity and disproportionately affecting the elderly and vulnerable populations. Although flu numbers began to fall before Christmas, festive gatherings are believed to have contributed to a 'bounce back' in the spread of winter viruses. The national health service reported an average of 2,942 people hospitalized with flu daily last week, a 9 percent increase from previous figures, with flu also causing over 1,100 additional hospital staff absences in a single week.

Adding to the crisis, the Health Services Safety Investigation Body (HSSIB) has warned that 'corridor care' is becoming increasingly prevalent in hospitals nationwide. This practice exposes patients to heightened risks, including increased infection rates, difficulty in monitoring their condition, a lack of piped oxygen, and insufficient staff numbers. Dr. Vicky Price, president of the Society for Acute Medicine, voiced profound concern, stating that 'people are dying as a direct consequence of the situation.' While acknowledging the severe risks, an HSSIB spokesperson indicated that, until complex underlying issues related to patient flow are resolved, hospitals 'may have no choice but to use temporary care environments.'