we had so manyjunior doctors go off because they were turning positive and hospital waiting lists are now at record levels. i am worried, i'm worried now because, you know, if — if it er, breaks i mean it's a day out with er, jesus two years into the pandemic for the nhs the fight goes on. the nhs vs covid: the fight goes on university hospital coventry?|�*ve been filming here since before christmas? it's one of the midlands largest hospitals — hello, good morning, everyone. this is the accident and emergency department. erm, very challenging position this morning, er, longest waiting patient... waiting 114 hours. they're a covid—i9 contact so they need a side room. the hospital's started to get omicron cases, though it hasn't really hit coventry yet. but staff here are already trying to work out how to tackle the shortage of beds. anything else needing to escalate? there's four beds, three side rooms and no obs beds, making it really challenging. 0k. thank you. we've got one mental health escalation. - the patient's awaiting a bed in scotland. - thank you, good luck! morning, ed. hi, there. what's it looking like? it's a difficult day today. ed hartley's lead consultant. we've got a backlog of patients waiting to be seen, we've got. a backlog of patients waiting for beds on the wards, - we've got some patients. waiting for beds elsewhere. a&e is the gateway to the hospital. from here, patients need to be able to flow into wards and operating theatres to be treated. what happened to you? i fell over walking the dog. how long have you been here? since about 7 o'clock last night. oh, my goodness, that's nearly... 14 hours. nick will be able to go home after he's seen the physio. but they've looked after me fine, so can't fault this hospital at all. but 50 other people are still waiting to be moved out of the emergency department. anyone with a green arrowl by them is somebody who's ready to move to a ward. or ready to move out of the a&e. - there's a computer system showing the status of patients waiting here for a bed elsewhere in the hospital. so, you can see that - all of these patients here, they've had their a&e treatment concluded, and they're waiting i for a bed somewhere else. that's a lot of green arrows, isn't it? the hospital's a bit _ like a hotel, and if somebody's not checked out of their room, you can't put _ a new guest in there. not enough patients are being discharged from the wards to make way for new arrivals. but we're only, what, just gone nine o'clock in the morning and you know, it's early in the day. yeah, the ambulances. will start to increase over the next three hours, - so we really need to get those discharges from the main wards within the next three hours. - it's not even 9.30 in the morning and already all the ambulance bays are full. one, two, three, four, five, six, seven, eightambulances, and they can't get the patients off because there are no beds in the hospital for them yet. and we just heard that they're accepting patients from another hospital that hasn't got beds, so there's a real log—jam building here. two years into the pandemic, it's adding to the pressures typically caused by a surge in demand during winter. there are a number of different factors at play that _ are impacting, so covid l is definitely one of them. we are seeing patients with covid coming in. i but covid has also meant people haven't been able to access - health care in the normal way for the last couple _ of years, so illnesses - are presenting differently. they're coming in, coming to hospital more poorly. than they were before. we are holding on ambulances and their occupancy is over that ioo%. the pressure on a&e is building so much, all departments are called to an emergency meeting at noon. we've got 102% occupation in ed, which begins to be extremely challenging. but the reality here, folks, is that we're heading towards full capacity protocol, so please prepare yourselves mentally and all your teams for going into that. if a full capacity protocol is called, it could mean having to cancel some operations. so are you pretty close to total capacity? we are over capacity. we require today 125 discharges. erm, if everything comes off, we have probably got about 62, 63. so the hospital expects to be short by more than 60 beds, even if the scheduled discharges happen. everyone must re—double their efforts to free up more beds. two years ago, i filmed here at the peak of the first wave of the pandemic. turn. intensive care and all the wards were full of covid patients. we've had a death on here today already. but this hospital, unlike others, didn't suspend surgery for many procedures. i watched professor kiran patel fix a pacemaker. you have to make sure patients like this have their pacemaker batteries replaced, regardless of what's going on. two years on, covid has had a profound impact. nearly 6 million people in england are now waiting for elective procedures. before the pandemic, university hospital had no one waiting more than a year. that's changed. ideally, i would want no waiting list. but we do have just over 5,000 patients who have waited over a yearfor their care, just over 100 patients who have waited just over two years, and those are numbers we don't want to see. and of course, one of our biggest challenges during the pandemic has been to avoid a huge backlog of care. annette barber is one of those who's had to wait. she's recovering from a cardiac operation for a condition that made walking very difficult. how are you doing? oh, it's knocked me about, that's for sure, it's tested me, the last 12 months, but it's got done. annette�*s waited nearly a year. her surgery was postponed twice because of covid. she's under the care of cardiac consultant nick matharu. so this is the dilemma that you've got, people obviously in pain waiting months for surgery. that just wouldn't have happened before covid. absolutely. and it's also a case of having to constantly re—evaluate whether these people have deteriorated, whether they've now become more urgent in terms of priority and scheduling, and also balancing that across all of the other patients that might need it across the organisation, because there are patients waiting for their cancer surgery, patients waiting for all sorts of other cardiovascular procedures, which are potentially life or limb threatening. so how are you doing? still a slight little bit sore. oh, ok, well, just go easy. so you've got some stairs to manage at home? yeah, but i don't... i mean, i've paid for carers to come in to help me for three months. as well as my daughter and my son. so you've got a good load of support there? yeah. 0k. well, that's just as well, because we really need the bed. um, and also there's a national level four pandemic alert that's gone out. so, we're preparing ourselves for a possible influx. annette�*s on her way home. she has someone there to help her manage. but other patients are stuck here. the hospital can't always discharge those who need care in the community or in a care home as soon as they are medically fit to go. beds in social care are gold dust, and we have to treat them as if they're very precious. we've seen staffing pressures in social care. we've seen some social care providers drop out of the market. so we know that potentially this could become a very scarce commodity. and we're having to use it as such so that we want to make sure that the most appropriate patients are put in those beds. i'm visiting greenways care home, just outside coventry. how many residents have you got here at the moment? we've got 15 in total. and how many could you have? how many have you got the space for? 27. so you are right down on numbers. yeah. that's because there aren't enough staff. it's now compulsory to be vaccinated against covid to work in care homes. that's putting some people off the job. what do you want for pudding? trifle. why don't you have the staff? erm, i suppose there's quite a few... many factors, really, you know. i think due to burn—out, peoplejust don't want to do the job any more. erm, there's also the vaccine status, which hasn't helped at all, within the industry, which kick—started a lot of people leaving the industry. and have people left you because they weren't prepared to be vaccinated? i had one member of staff leave, but other members of staff have left and they've left the care sector and they've gone to otherjobs. you did well last week| with father christmas. you could do the same again today _ no, you do it! no, you are all right! in england, there are currently more than 100,000 vacancies for care home staff. got an empty room here. we've got three occupied rooms upstairs and many empty ones. this one is empty, too? this one is empty, too. how does that feel, as a care home owner, especially with a business to run? firstly and foremost, it's quite heartbreaking cos we know there are people that are in hospital that aren't meant to be in hospital and that need to be in a home. every day, we have four to five phone calls from hospitals. julia thomas has been quarantined in her room since arriving here from hospital. they try to get rid of you, to get you out, to get the next lot in. they didn't say it, but you know they were doing it. they are under pressure, they've got to get beds. julia had to wait another four days before being able to move to this care home. how was it being in hospital all those extra days, when you knew you really should be able to leave, that there was nowhere to go? i packed up, i packed up twice. i packed up all my stuff twice and put it on the bed waiting to go. and, erm, then i packed it up again. how did you feel? i cried. i cried and all the staff came round. julia is now settled in at greenways in time for christmas, with all the other residents. back at the hospital, it's afternoon and the bed situation isn't getting any better. what i'd like to do is hear from the rest of the groups about what the position is now. chief operating officer gaby harris re—convenes the emergency meeting. so gynae are still full at the moment. we've got high demand for side rooms, - especially to free up mdu. is critical care on the call? yes. so we're now red at the moment for critical services. we don't have any emergency capacity. ok, so we don't appear to have sufficient capacity for the night, and we're still holding quite a bit of risk in the emergency department. i'm proposing that we go onto full capacity protocol to decompress ed by creating some additional flow. does anyone think that is not a good idea? no, ok, so on that basis, at quarter past three, we'll call full capacity protocol. so what's happened now and what's the situation that you're in? so we've just called full capacity protocol because we feel that the risk at the front door is sufficient and we don't have enough response around, er, empty beds to move patients into that we're creating an undue risk. it's a precarious situation — staff are being redeployed now. non—urgent operations and out—patient clinics could be cancelled to get more people discharged and free up beds. we were getting close to full, being full with no empty beds available for patients who might need them on an emergency basis as they come in through our front doors. this says something about the pressures you are under. it is worrying and it does reflect increased pressures. but again i think we need to put that in context of winter. pressure is always on, but there are just some times when you get real peak pressure. but there are some operations which must happen, regardless of the pressures of winter and covid. the hospital still has to provide vital cardiovascular treatment to people across the midlands. good morning. so, what are you waiting for? today i'm having aneurism. we're going to be doing a stent in your head for your aneurism. doing a stent, yes. and after that i should be fine. david gee has a weakness in a major blood vessel. his consultant's been monitoring him on an outpatient basis. how long have you been waiting to have this done? not too long, not too long. about six month. six months! we were keeping an eye on it. yes, that's right. now it's reached the size where we need to fix it. were you a bit worried as the time went on? i am worried, i'm worried now because, you know, if, if it, er, breaks i mean, it's a day out with er, jesus. i'm sure it won't. or buddy holly. i'm sure it won't. david needs his operation now. the hospital has ringfenced some beds throughout covid for this type of medical procedure, but waiting times are still longer than before the pandemic. we've been able to continue to do key procedures for our vascular patients throughout the pandemic, really. but the gentleman you're going to operate on today has been waiting six months. that sounds quite a lot. so, we generally try to, arm, treat patients with large aneurisms within eight weeks of the diagnosis, but with the pressures from the covid that's been a bit difficult to, to, arm, you know, maintain, or to get there. the cancer unit too at the hospital has kept going throughout the pandemic. i haven't cancelled a clinic over the whole period. so every patient that would have been seen has been seen whether that's face—to—face or over the phone. but dr beth harrison is worried about cancer patients she hasn't seen. we know that there's large numbers of patients who probably have cancer that hasn't been diagnosed. so i suppose what we think of is that there are lost cancer patients that we will find, and we are concerned that those patients will present later in their illness and with more complex or more advanced disease. what sort of numbers might we be talking about? many thousands. there are an estimated 117,000 cases of undiagnosed cancer in the uk. as they're identified and treated, they're likely to create more pressure on the nhs. it's late afternoon and david's come round after his operation. make way forjohn wayne. he's now on his way to a ward. how are you feeling? absolutely wonderful, thank you. a little bit tired, obviously, due to the operation but no, i'm absolutely fine. back in a&e at the end of his shift, dr hartley is still struggling to get more people through and into a bed on a ward. we're coming to the end of a really busy day and it looks like it's going to be really busy into the evening as well. the hospital is still at full capacity. ambulances are still being held outside. the priority for the a&e team this evening will be making sure the keeping patients on the ambulances safe. the worry for us is always the patients who are waiting to be seen, because that's an unknown risk to us. yeah, yeah and more covid cases coming in tonight? yeah, we've had more covid cases today. we'll have more covid cases during the night. it's been an exhausting day, but they haven't had to cancel any operations or clinics this time. it's been a roller—coaster period over the last two years, and the pressure has never really relented. the situation at the moment is incredibly tough. it's tight and it's very pressurised. but we are responding on a day—by—day basis. it takes a lot of commitment and a lot of energy and a lot of responsiveness and understanding from our staff. let's get started. first thing next morning, will there be enough beds for operations to go ahead? it is that flow through that is looking like the biggest challenge. we've got a number of discharges already. omicron is starting to cause problems with staff here going off sick or self—isolating. is there an issue with anaesthesia for the cardiac list at the moment? there is a little bit, but they're working on it, so hopefully we will find someone. we've only got one - anaesthetist at the moment. but we are working on a second one? absolutely, absolutely. despite being one anaesthetist down, the hospital pushes on with the operating list. the urgent patients have gone ahead and we're going to resolve the staffing situation for the second cases to go ahead. i'm heading into the anaesthetic suite where consultant uday dandekar�*s first patient is being prepared for theatre. just oxygen through this mask here. she has been having quite a bit of angina for the last... chest pain for the past few months. it first started in august and it's been getting worse, hasn't it, anne? yes, it has been getting worse. so, you've had a bit of a wait for this, have you? erm, yes, i have. yes, since august. and erm, yes, with each pain it's more worrying. so it's nice that it's now happening today. anne clapham's heart bypass operation is a priority today. so, her operation has been able to go ahead but others are on hold, is that right? others are currently... there's one, err, theatre on hold. err, because of anaesthetics and itu issues, but i think i'm hoping that it will get solved. hello, mrs clapham, how are you? anne's come round after her surgery. everything went well. good. we did what we planned to do. 0k. there was a question mark over four operations that you had to do. how many did you get done in the end? i'm pleased to say that we managed to do three. the fourth one we could have done but the consultant aneasethetist was off sick and that was the reason we started late and why we couldn't do the fourth case. did they have covid? suspected covid. that's what happening, isn't it, across the board. covid has disrupted our normal activity and it has had impact on the waiting list. this is the hospital's intensive care unit. these beds are needed for patients following major surgery as well as those with serious illnesses. how many covid patients are there in here at the moment? so, the numbers have been dropping over the last few weeks, happily. so we're down to five i think today, which is the lowest we've been for months. dr billyard's seen a big difference here in covid numbers since the start of the pandemic. so most of your patients are in critical care for other reasons? yes, absolutely. and what sort of numbers are we talking? so we have about 30 non—covid patients in critical care at the moment. the vaccine and new treatments have helped reduce the number of covid patients needing these beds. but there are some and they appear to be getting younger. what sort of people are ending up in, err, the covid critical care area? the key headline is unvaccinated. the vast majority have have the patients that needed critical care have not had the vaccine. we've had patients, in their 30s and 40s, which is what i would definitely consider young. does it make the staff angry to deal with those people? erm, i think angry would be the wrong word. we are...we�*re sad, i think that's probably the best word for it. everyone is tired, you know, we know this is isn't going to end any time soon and and i think there is a determination to to get through it, but we all wish we didn't have to. over the christmas period the number of people being admitted with covid doubled, here and across the uk. i'm back at university hospital a week into the new year. in this area actually, you are better off having our other masks. on ward 30, a respiratory ward, dr asad ali is dealing with a sharp increase in covid patients. the week before xmas we were having 115/46 patients at a time in hospital. right now this morning we have 175 in hospital. so, they have trebled or quadrupled, should i say, very quickly. they are less unwell as compared to how unwell they were last year. we had 160—170 patients at that stage but we had so many more in intensive care. in intensive care, the number of seriously ill covid patients is also rising but more slowly. well, when i was last here just before christmas there were only five covid patients in intensive care. now that number has doubled, there are ten. but that is still far fewer people than were here in intensive care in previous peaks of covid. maria fletcher is recovering here after being taken ill just after christmas. i got a cough which got worse and worse. and then the next morning my husband tried to get me up early to go to the bathroom. and he said i was totally unresponsive. do you think it was omicron that caused this, the new variant? my feeling is yes. cos i've been fullyjabbed, we all have in, at home. i think what would i have been like if i hadn't have done that? the burden now is on the respiratory wards, which are full of patients. and the impact of omicron on staff is really being felt. our staffing levels have been very badly affected. that is medical staff, nursing staff, our other support staff. the infection is rife. 30% of our pharmacy staff is off. yesterday we had so manyjunior doctors go off because they were turning positive. the nhs is already under—staffed. there are 93,000 vacancies in england. 10,000 people work at coventry hospital. the numbers off sick because of covid are rising. we've got approaching 600 staff who are currently absent from work because of covid, and we assume that that is a majority of omicron cases. and what's the worry with that? well, the concern is if it, if it continues to grow, erm, and it has grown over the last few days, so we're keeping a very close eye on that. because of course that would then start to impact in a greater way on the services we can provide. they're under immense pressure again today, with this area being over—full. we've got patients waiting to be seen. chief operating officer gaby harris is in a&e to assess the situation. more people turning up have omicron although many don't realise it. we're finding patients coming in with other conditions and then when we're testing them, we find that they have incidentally got omicron as well. and then us having to make sure that we're protecting other members of staff and patients by isolating them. once again, gabby has called a "full capacity protocol" because of the shortage of beds and staff. you're back in the same situation we saw you in in december and do you think there's going to be more of that going ahead? absolutely, january is always really, really tough in the nhs and err, we do see situations like this most januarys. however, it feels slightly different this time, predominantly because of the impact that covid and covid—related absences are having on our staff. so, it does feel different. nhs funding had been squeezed. now spending is going up to help deal with covid. £8 billion will be dedicated to cutting waiting times over the next three years. how long is it going to take us to get back to where we were is, of course, in many ways, a 64 million dollar question. i'm optimistic. i don't think it'll be three, four, five years, i think we could do this in a year ortwo. of course, i have to say that depends on what happens to covid in the next few months and how that shapes up. but i also think we're gonna have to be possibly more honest and open with the population as we say around how long people are gonna have to wait. what the nhs can do. how quickly we can do it. after two years of covid, the fight goes on. but it will be a challenge for the nhs to provide the level of care many of us have come to expect. this is bbc news — i'm tim willcox. our top stories. britain's prince andrew loses his royal and military titles — and will no longer be officially known as his royal highness. this comes a day after a judge in new york ruled that the prince must defend an accusation of sexually assaulting virginia guiffre in a civil court case. britain's prime minister's political future in the balance as new downing street party allegations come to light. sedition charges are brought for the first time against people accused of taking part in the storming of the us capitol last year. britain's security services issue a rare alert — warning of a chinese agent operating at the heart of westminster trying to influence mps. still a favourite to win, but will he play? 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