A&E live: Join us for a day in the life of one of London's busiest accident and emergency departments

It's a wrap!

We’re signing off after an action-packed of day of shadowing staff and speaking to patients at Northwick Park Hospital.

A day in A&E showed us the incredible work of staff in one of the capital’s busiest hospitals, who currently have to juggle providing emergency care with the added pressure of freeing up beds for incoming patients.

8,000 steps in just FOUR hours

Our reporter Katy took 8,000 steps in just FOUR hours while shadowing staff in Northwick Park hospital A&E department today.

If Katy’s movement’s are anything to go by then A&E staff on 12-hour shifts would walk at least 24,000 steps per DAY.

John Ross, advanced clinical practitioner in training - "A lot of our population is very unwell.”

John Ross is a trainee advanced clinical practitioner who spent the day working in resus. He said:

“It’s usually full capacity throughout the day.

“There are a lot of patients in A&E that need to be moved elsewhere, they end up in here for quite a while, so they end up in the corridor unfortunately when we’ve not got space for them anywhere else - which nobody thinks is ideal.”

When asked what the NHS or the hospital can do to help ease the pressure of the current winter crisis he added:

“Unfortunately most of the patients that come to A&E have to come to A&E.

“The hospital isn’t big enough but I don’t think it can be big enough for the patients that we have.

“ Things can always be more efficient at times but a lot of our population is very unwell.

“I love my job here, I wouldn’t be here otherwise and as trainees a lots still fresh for us, we still smile a lot.”

“We simply don’t have enough beds and that can be so stressful" - Emergency department physician associate, Hennel Agrawl

Hennel Agrawal, physician associate (PA) in the emergency department, rotates between A&E and the Clinical Decisions Unit (CDU) and spent today in CDU.

“It’s really busy here in the Clinical Decisions Unit today, all our beds are full. There’s a lot of complex injuries here and every winter it just gets busier and busier.

“The staff here are all happy though, but we do have a lot of pressure on us, and that is increasing. In the past three years the pressure has built on NHS staff.

“We simply don’t have enough beds and that can be so stressful. Sometimes I feel like I can’t do my 100% best because of the lack of beds. We’re dealing with more and more people with not enough resources.

There’s more schools and housing in the area, which leads to more patients coming into hospital.

“My feeling is that the NHS is the best thing our country has and it would be a really sad for it not to function as well as it could be. I love my job, and I hope that we can keep going.

“At the moment, there simply isn’t enough movement in the hospital, I don’t know why the patients aren’t movement through fast enough.”

Hennel has been a PA for three years and says there aren’t enough of them. The curriculum is medical-based and the course is six years.

There are now 300 qualified PAs in England and there are now 30 courses.

Today's Resus team

We’re nearing the end of our time in Northwick Park’s A&E today so we thought we’d share a picture of some of the hospital’s hardest workers.

This is the Resus team today, looking after the patients with life threatening illness and injury.

Name this dummy

Our reporter has come face to face with this gurning guy.

He’s a hi-tech training dummy used to run medical scenarios for training.

Remarkably he has no name, so we’ve decided to change that. Please comment below or email qasim.peracha@trinitymirror.com if you have a suggestion.

While he’s a brilliant piece of kit, he didn’t half give Katy a scare when she stumbled across him.

I nearly required medical attention after being so scared walking into their in the dark and spotting him!

Northwick Park's A&E at 2pm

Here is how the A&E is looking this afternoon.

• 74 patients are currently in the department
• 56 of these patients have been treated
• The wait to see a doctor is currently two hours and two minutes
• The wait for a hospital bed is eight hours and 15 minutes.
• 88% of patients were seen withing four hours. The government target is 95%.

The Resus Ward

Northwick Park’s resus ward was moved into in 2014.

The NHS website says:

The resuscitation area is used for the treatment of trauma victims, those requiring life threatening illness or injury and those who require direct monitoring and immediate life/limb saving interventions.

The Starrs of A&E

Katy has been hearing unanimous praise for the Starrs of Northwick Park’s A&E.

Short Term Assessment Rehabilitation and Reablement Services are responsible for getting patients who have been assessed home as quickly and safely as possible.

Lead Physiotherapist Jignesh Patel spoke to Katy:

We’re keeping patients safe and we’re keeping them out of hospital, which is the ultimate goal.

I believe we save about 900 beds a year which saves the trust a lot of money.

A&E Health Check

So what is the situation right now?

• Resus is still full
• The last three admissions had bad chest infections
• A patient at the hospital who suffered a cardiac arrest has been brought to Resus but is alive and speaking.

Paramedics say they are "feeling the pressure"

This is Bridey Sabin and Georgina Fern, paramedics for the London Ambulance Service.

They’ve brought patients in and are now waiting to hand them over before they can get back out.

It’s definitely been busy since December and we’ve been feeling the pressure, but it always gets busy this time of year.

Person waiting in corridor

Our reporter Katy Clifton has spotted one person having to wait in the corridor at Northwick Park’s A&E.

"The NHS is a godsend and anyone who says otherwise needs to be schooled" says first time A&E user

This is Ronald Matthias, of South Harrow.

“I had a dizzy spell at 12 o’clock last night. My son brought me here at around 7am, I didn’t sleep at all.

“Since I’ve been here, I have been treated really well. This is my first time in A&E since I moved here in 1964.

“Honestly, the NHS is a godsend and anyone who says otherwise needs to be schooled.

“The staff are a credit to this hospital and have made me feel comfortable throughout.

“It’s something we should all be proud of, my experience here has been fantastic from start to finish.”

"Everyone from the doctors to the cleaners were wonderful" - Patient Anita Benson describes A&E experience

This is Anita Benson, 85, from Stanmore, with doctor Paul Humphrey, trainee advanced clinical practitioner.

She’s here for stress-related injuries.

“My experience today has been absolutely wonderful, it really had been fantastic.

“My doctor was so attentive - the whole experience in A&E was over in four hours from start to finish.

“Everyone from the doctors to the cleaners were wonderful.”

Ms Benson came in at 9am and is being taken home now. She says today has been the best in a while, she’s been in a few times and sometimes the wait can be longer but today was very good.

More beds need to be found

Meetings with staff from all of the hospitals divisions are called “bed meetings” and are held three times a day at 8.45am, 12pm and 3pm.

At the moment the hospital needs to free up 22 beds but on Monday that number rose to 50/60, so more beds need to be found.

Maeue O’Callaghaan-Harrington, divisional general manager for emergency and ambulatory care, organises the “bed meetings”.

“We hold these meeting to bring all the people together to know what’s going on across the hospital.

“I have worked here for 15 years and I love it, but it’s the staff here who make the job, for me.

“They do an absolutely remarkable job day in day out, they’re all fantastic.

“Overall we’re improving - the number of black breaches are down. A black breach is when ambulances are made to wait for more than an hour.

“This Monday we had 8 black breaches but last month there was a day with 24. We have our busy days, we were minus 50/60 beds on Monday.

“This meeting is the hub, everything that’s going on comes through here. This is where all the information is and means we know what’s going on across the board.”

Maeue added that today 95 admissions are predicted in A&E.

The reps in the meeting now have to go to their departments and chase up nursing and residential homes and packages of care to make sure the people are discharged in the near future, they chase it and nursing homes/res homes come in to check they’re okay to be discharged.

Laura Fraser emergency medicine consultant at Northwick Park A&E - "There's no normal day"

Laura Fraser, emergency medicine consultant at Northwick Park, says: “There’s no normal day.”

Patients who come into A&E should be seen within fours hours.

Hospital staff meeting - Need to free up 20 beds

Staff from all of the hospital’s five divisions have met to discuss plans for the day.

The hospital is at -20 beds - Meaning it needs to make 20 beds free by discharging 20 patients.

The nine-hour wait for a bed is for people who have been seen and told they need to be admitted and have a bed.

That’s the longest time someone has had to wait, nine hours and five mins.

They are two A&E staff down for this evening which is and are contacting agencies now to get more staff.

After the initial warning that operations will be cancelled, they only had to postpone 6 and they’ve all been booked in

Hospital in 'red escalation'

10 ambulances have come into the hospital in the last hour which has led to a ‘red escalation’ and means it’s particularly busy.

There are currently 55 patients in A&E and 41 patients have been treated today so far.

See resus unit staff manning the blue light phone

Resus unit staff swap over every day. They man the blue light phone and take down details of patients being brought in by London Ambulance Service.

"It's either sink or swim here" - Resus unit doctor

John Ross, advanced clinical practitioner in training, has been working at the hospital for 5 years.

“It’s either sink or swim here, but I love it because it’s fast paced and constantly on the go.

“We’re all here by choice and that’s because we like it.

“There’s definitely been an increase of patients coming through A&E since last Christmas.

“We are one of the busiest in London and the LNWUH Trust covers around a million people.”

The blue light phone - resus unit backlog

London Ambulance Service calls get passed onto a control centre in Waterloo and then onto blue light phone at resus units in hospitals across the capital.

When a call comes in to the blue light phone at the resus unit - details and vitals of the patient are taken down.

Northwick Park has seven rooms and try to keep one free so they can bring the patients in straight away.

Right now it’s full and two people are on the way - three people arrived in resus in the past five minutes

The phone can get up to 40 calls each day, on a bad day.

When the rooms are full then people end up in the corridor after being assessed.

People in a better conditions get moved to different units.

See inside Northwick Park hospital ambulance bay

Northwick Park hospital receives more ambulances than any other in London - up to 130 daily.

Cathy Grimes, Senior Sister, working at the Northwick Park “pit stop”

Nurse working at A&E "pit stop" - "It’s not unusual for patients to be waiting in the corridor here"

Cathy Grimes, the Senior Sister working at the “pit stop” today, has worked at the hospital for seven years.

“Every day we’re moved to a different area. It’s not unusual for patients to be waiting in the corridor here, it’s the same across all A&Es at the moment.

“We just don’t have the number of beds to deal with the amount of patients coming in, we’ve definitely been affected by the winter pressures.

“We see a high turn over of nurses working in A&E just because of the pressure the role brings.

“Paramedics often have to help with the patients coming in. Since we moved into this new unit (in 2014) we have seen an increase of patients and more serious illnesses.

“We have much more ambulances coming in from before.”

Pictures from A&E "pit stop"

“They call this “pit stop” - all the ambulances come in here after calling ahead first. Patients will go into bay and be assessed

Statement from London North West University Healthcare Trust (LNWUH) on coping with winter crisis

Ms Arshiya Khan, Chief Operating Officer at London North West University Healthcare NHS Trust, said:

“Like other hospitals in London and across the country, we have experienced sustained pressure since Christmas.

“This is due to the high number of people seeking emergency medical care, combined with a much higher number of frail older patients who require social support to be discharged from hospital.

“Our staff are a credit to the Trust and the entire NHS, and they are working tirelessly to see everyone in a safe and timely manner.

“As always, we will triage and treat our sickest patients first. This means that some people may experience longer waits while we treat those most in need.

“We are asking our local communities to help us during this very busy time and attend our emergency departments for serious and life-threatening injuries and conditions only.

“If you are unsure whether you need emergency care please call NHS 111 for advice.”

On non-urgent operations in January, Ms Arshiya Khan, Chief Operating Officer at London North West University Healthcare NHS Trust, said:

“As part of our plans for winter, we significantly reduce the number of routine operations planned.

“This allows us to free up capacity for our sickest patients.

“Of the 3,336 elective procedures carried out to date since the start of January, six day case operations have been cancelled.

“All six patients have been given new dates for their procedure and we apologise to those patients affected. We have not cancelled any cancer or urgent operations.”

10 flu symptoms to be aware of

People suffering these flu symptoms this winter have been urged to stay away from hospitals:

• fever (38 degrees centigrade)
  
• shortness of breath or cough
  
• headache
  
• runny nose
  
• sore throat
  
• tiredness
  
• aching limbs
  
• lack of appetite
  
• vomiting and diarrhoea
  
• stomach cramps
  

Patients urged to call 111 before going to A&E

At 10.30am there were already 46 patients waiting in A&E and Northwick Park urges patients to call 111 before attending hospital.

Patients with flu told to keep away

London North West University Healthcare Trust which runs Northwick Park hospital has urged the public to help protect patients from flu this winter by avoiding hospital if they are experiencing flu-like symptoms.

The UK has seen a surge in infections from the influenza virus this year. Across the country, over 3,750 people have been admitted to hospital with the virus so far – but over 4.5 million people are thought to have flu-like symptoms.

In most cases, these symptoms don’t require hospital treatment, but can pass influenza on to people who may be vulnerable to infection.

Since December, the Trust has seen 173 people who have tested positive for flu – with 94 patients at Northwick Park Hospital, and 79 at Ealing Hospital.

Infectious diseases consultant Dr Bill Lynn said:

“Influenza can be dangerous for patients who already require medical treatment.

“None of us would want our loved ones to be put at risk by the virus, and that’s why we’re asking for the public’s support in stopping flu from spreading wherever possible.

“Please help us protect our patients by staying away from hospital if you have two or more flu symptoms.”

The trust is asking patients who have a booked appointment to reschedule it if they experience two or more of ten symptoms commonly associated with flu.

Those planning to visit the hospital to see friends or relatives are also asked to wait until they are symptom-free before coming in, except in an emergency.

Both measures help to reduce the likelihood of spreading the virus, which can have serious consequences for patients who are already unwell enough to need hospital care.

A day in the life of one of London's busiest A&E departments

We are LIVE today (January 24) bringing you a snapshot from a day in the life of one of London’s busiest accident and emergency departments at Northwick Park hospital.

The Harrow hospital’s accident and emergency department receives 120 to 130 ambulances a day - more than any other in London.

Its A&E and UCC take on average more than 700 patients each day and along with hospitals across the country it is currently coping with the pressures of the NHS winter “crisis”.