Hospital overcrowding caused deaths, say Betsi Cadwaladr doctors

Patients have been dying in ambulances and waiting rooms due to overcrowding, according to doctors.

Letters outlining their concerns over avoidable deaths at north Wales hospitals have been published.

One letter said health board leaders "failed to address patterns of behaviour that cripple efficiency".

Hospital bosses said that "ongoing challenges to discharge many patients" are creating problems throughout the hospital system.

Doctors working at the emergency departments of Ysbyty Gwynedd, Ysbyty Glan Clwyd and Wrexham Maelor have written these letters, asking Betsi Cadwaladr University Health Board bosses to take action.

The letters claim staff are subjected to abuse due to inefficiencies and question the "dangerous" practice of keeping patients on trolleys in corridors and crowded waiting rooms during a pandemic.

Doctors describe an incident this summer in which a patient died in an ambulance after waiting two hours for treatment outside a hospital.

The letters were written in June this year and in December 2020 and have been published by the Local Democracy Reporting Service following a Freedom of Information Act (FoI) request.

Doctors said the overcrowding problem has been made worse by the Covid pandemic, but insist the problem predates this and is linked to the health board being taken out of special measures in November last year.

Royal College of GPs in Wales joint chairman, Dr Peter Saul, told BBC Radio Wales Drive patients were suffering due to long waits in A&E.

"I saw a patient last week with a suspected fractured arm, who had given up when they were told it was going to be 16 hours before they were going to be seen," he said.

"It's a crisis."

Dr Saul said emergency departments across north Wales had been under pressure for years.

He said: "I have never known it as bad, and I've been in practice for 30 years.

"As a GP we are finding it very difficult to get ambulances to take patients to hospital, but they are subject to very long waits in the emergency department."

Gareth Owen's 77-year-old mother waited 12 hours in an ambulance outside Wrexham Maelor Hospital after falling.

"They need to get people off ambulances, indoors," he said.

"Whether it be just a sort of reception area, a waiting room where there's chairs, maybe a couple of beds. And get those ambulances back out on the road.

"Because there are people dying who desperately need an ambulance, and we're being told, 'Sorry they're sitting in the car park'."

In one of the letters, doctors said that "even the most fundamental aspects of emergency medicine" were compromised.

"This is causing identifiable patient harm and mortality with deaths occurring in our waiting rooms, ambulances, and out in the community that are attributable in significant part to delays caused by crowding.

"These catastrophic incidents are currently reviewed in isolation by each site, and we have no evidence or assurance that lessons are being learned over the wider health economy," the letter stated.

The letter from December 2020 said the health board has been issued with at least a dozen regulation 28 notices, which are interventions by the coroner to improve public safety.

The notices highlight overcrowding and "the lack of meaningful progress on this by the health board".

Aberconwy Conservative Senedd member, Janet Finch-Saunders, has called for an inquiry.

"I actually believe that senior management are to blame," she said.

"I believe it is top-heavy on management and not enough resources are going into front-line staff."

Betsi Cadwaladr medical director, Nick Lyons, said the health board was trying to make patient flow through the hospital more effective - so people can be discharged and space created for those waiting.

There were "challenges" around discharging some patients to suitable accommodation or care services, which slowed patient flow, he said.

"This is about recruiting staff to be here on the front line, and that's about a whole system change," Dr Lyons said.

"The pressures we're talking about today in the emergency department are only the tip of the iceberg, it's the obviously easily-seen problem."

He warned there was no overnight solution.

"We do face a particular recruitment challenge in north Wales, which makes it very difficult to embed some of the changes," Dr Lyons said.

The Welsh government said it had provided £300m extra to tackle NHS waiting times, and improve emergency care and social services.

A spokesman said: "This money will help deal with short-term pressures over the winter and to transform the way services are delivered in the future.

"Everyone can play their part this winter by considering other options for care, like the 111 online service and pharmacies."